Neurological Exam
Introduction
The neurological exam – ahh!! I remember as a student trying to wrap my head around it. There were so many things to learn! So many things to remember! Cranial nerve exams, sensory motor examination, nerve roots, cord levels, disease patterns and their recognition … there was just so much! So where do you start?
The Hands-on Guide to Clinical Reasoning in Medicine helps simplify the neurology exam – and all your organ system examinations into a friendly, easy-to understand, easy to use, practical, hands-on style for students, junior doctors and nurse practitioners.
History taking, neurological exam, investigations, common presentations… we have it all covered.
For instance, have you ever considered the motor pathway as a motorway/ highway and the motorway junctions as the levels at which the lesions are found? All the cars travel in their own lanes, some driving north, some driving south. Some crossing lanes to merge, enter or exit and continuing to their destinations. The sensory signs are like signposts pointing you to the exits. Wouldn’t this be an amazing way to learn about cortico-spinal anatomy and its interpretation?
Topics covered include:
This section simplifies history taking through concept maps by drawing your attention to some basic principles like:
- The pathological processes that lead to neurological problems – did you know there are only five?
- How to tease out relevant and important, neurological signs or symptoms from less relevant herrings – hint: negative symptoms are most important.
Topics discussed include:
- Motor-sensory deficits.
- Speech disorders and how they occur – there are only 6 components within the assessment.
- Transient loss of consciousness.
- A simple way to figure out dizziness!
- That most vexing of neurological presentations, headaches – with only three aspects to consider. For instance, look at figure 1 to see how to differentiate thunderclap headache from the rest.
….the list goes on.
Figure 1
Credit source: Irfan M, Hands-on Guide to clinical Reasoning in Medicine, Wiley-Blackwell; 1 edition (1 Feb. 2019)
What do all your neurological examination findings mean and why do they occur? The motorway is blocked by a southbound traffic jam at junction 8… ah… that’s why there is a sensory level!
Limb examination
Interpretation of the limb examination starts the moment you lay your eyes on the patient and then with assessment of the tone.
Did you know how important it is to differentiate between spasticity and rigidity? Spasticity takes you down the corticospinal pathway (upper motor neuron – UMN) and rigidity the extrapyramidal system.
You differentiate them by noticing if it is velocity dependent or not. If you move the wrist slowly from pronation to supination you feel no resistance but when you do it ‘quickly’ and it catches mid-way it is called the supinator-catch implying spasticity. On the other hand if there is resistance throughout the range of movement whether you do it slowly or quickly, it is called rigidity.
Clonus occurs only in UMN lesions and can also help discriminate between the two.
Sensory examination
What patterns are we looking for in our sensory examination? We have that covered too – cortical sensory signs, sensory level, differential sensory loss, symmetrical/ asymmetrical, unilateral – dermatomal.. We said it can be easy…. See that’s not too much to remember 🙂
Cranial nerves? That’s covered too.
Ocular movements – yep and that.
Cerebellar signs – just remember DANISH – people or pastries – it’s up to you. By the way it stands for dysdiadochokinesia, ataxia, nystagmus, intention tremor, staccato speech and hypotonia – mouth, eyes and pointing fingers! I said it’s easy peasy!
CSF fluid interpretation using a concept map and CT head interpretation with a mnemonic – Blood can be very bad, you know! We have all this and more..
- Blood – blood
- Can – cisterns
- Be – brain
- Very – ventricles
- Bad – bone
- Headache
- Diplopia
- Unilateral weakness
- Leg weakness
Engaging dialogues in an apprenticeship model teach you how to arrive at the relevant diagnoses in a workbook format in no time. Plenty of concept maps and figures carry you through the process with ease. In short you will have a teacher albeit in spirit, by your side, guiding you every step of the way.
Ready for a helping hand? You can find out all about the neurology exam right now and buy the Hands-on Guide to Clinical Reasoning in Medicine here.
Not quite sure yet?
See all the other topics here..
- Cardiology
- Pulmonolgy
- Gastroenterology
- Endocrinology and Diabetes Mellitus
- Geriatric Medicine
- Nephrology
- Rheumatology
- Common Clinical Conditions
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