cns examination hadeel khadawardi, teaching assistant at internal medicine department, faculty of...
TRANSCRIPT
CNS Examinatio
n Hadeel Khadawardi, teaching assistant at Internal
Medicine Department, Faculty of Medicine, Umm Al-Qura University
CNS examination consists of:
A. High Cortical Function B. Cranial Nerves C. Motor D. Coordination E. Sensory
High Cortical Functions
1. Handedness2. Consciousness3. Orientation4. Memory5. Speech
1.Handedness
• Shake patient hand and ask if he or she Rt. or Lt. handed to assess for the likely dominant hemisphere.
• 94% of people are Rt. handed.
2. Consciousness
Levels of consciousness • Alertness• Lethargy • Obtundation• Stupor• Coma
3. Orientation
• Time
• Place
• Person
4. Memory
• Remote (long) memory: Birthdays,…
• Recent (short) memory: event of the day, …
5. Speech
• Dysphasia: dominant higher center disorder in the use of symbols for communication.
• Dysarthria: difficulty with articulation.• Dysphonia: altered quality of the voice.
Types od dysphasia;
1. Expressive2. Receptive
Cranial Nerves
I. Olfactory Nerve
II. Optic Nerve
a)Visual acuity: Is checked by using Snellen Chart.
b) Visual field:
c) Visual color:Is checked by using Ishihara Charts.
d) Fundoscopy:
e) Light reflex:The afferent of light reflex is by optic nerve and the efferent is by oculomotor nerve.
III, IV, VI. Oculomotor, trochlear & abducent Nerves
a) Inspect the eyes for ptosis, shape and size of pupils.
b)Eye movement; ask the patient to follow your finger in H shape comment on: Failure of eye movement Diplopia Nystagmus
c) Light reflex
d) Accommodation
V. Trigeminal Nerve
a)Motor; (Muscle of mastication)TemporalisMasseter Pterygoids
b) Sensory; Access for fine touch and pin break in the 3 divisions ( ophthalmic, maxillary, mandibular).
c) Corneal reflex;The afferent of corneal reflex is by trigeminal nerve and the efferent is by facial nerve.
d) Jaw reflex;
VII. Facial Nerve
• Inspection Forehead wrinklesAngle of the eyeCorner of the mouthLoss of nasolabial fold Dropping of saliva
• MotorFrontalis muscleOrbicularis oculiBuccinator muscleOrbicularis oris
• SensoryAnterior 2/3 of the tongue.
• Corneal reflex
How would differentiate b/w UMNL & LMNL of
VII nerve?
VIII. Vestibulocochlear Nerve
• Whispering• Rinnes test• Webers test
IX, X. Glossopharyngeal & Vagus Nerves
• Inspection of uvula.• Difficulty of swallowing• Ask the patient to say ‘Ah’• Gag reflex
XI. Accessory Nerve
Trapezius muscleSternomastoid muscle
XII. Hypoglossal Nerve
Inspect the tongueAsk the patient to protrude his/her tongue
Motor
Motor
Exposure & InspectionTonePowerReflex
Inspection
• Skin (rash, scar, ulcer,…)• Muscle (wasting, fasciculation)• Deformity• Abnormal movement
Drift (For Upper Limb Only)
Tone
• For upper & lower limbs• Examine each joint• Start from distal to proximal • Always compare both sides
What are the types
of hypertonia
?
Power
• For upper & lower limbs• Examine each joint • Always compare both
sides
What are the
grading of
power?
Reflex
• Patient should be comfortable and relaxed
• Expose the tested muscle• Strike the tendon, not the muscle
belly• Observe the muscle contraction • Reflex of upper limb: Brachioradialis reflex (C5,C6) Biceps reflex (C5,C6) Triceps reflex (C7,C8)• Reflex of lower limb: Ankle reflex (S1,S2) Knee reflex (L3,L4) Planter reflex (S1,S2)• Clonus: Ankle clonus Knee clonus
What are the
grading of
reflex?
What is reinforcem
ent?
Coordination
1)Finger nose test
2)Rapidly alternative movement
3)Heel to shin test
4)Rebound
Gait • Expose both legs
• Ask the patient to: walk heel to toe walk on toes walk on heels squat to stand
• Romberg test
How to differentiate b/w UMNL
&LMNL ?
What are the types of
abnormal gait?
Thank You