Provides an orderly explanation of the actual steps in a neurologic examination
Simplifies learning with illustrative diagrams and flow charts
Helps identify neurological signs and symptoms in clinical practice
Bedside Neurological examination is an important tool in diagnosing neurological disorders . Despite significant advances in the investigations available for diagnosing neurological disorders bedside neurological examination remains the cornerstone in diagnosing neurological disorders and should not only be conducted prior to the investigations but should be actually be utilized to plan the appropriate investigations .The book provides a focused account of various aspects of the neurological examination leading to clinical localisation and hence obtaining the neurological diagnosis. It includes topics like' how to obtain a appropriate neurological history' , 'higher mental system examination', examination of speech and various cranial nerves and examination of other systems including motor system, sensory system, reflexes , cerebellar and autonomic nervous system.The book also includes certain interesting topics like 'neurological examination of the unconscious patient 'and 'tricks and tips of neurological localisation. The book is easy to read and memorize due to multiple self explanatory illustrations and important aspects being highlighted in bulleted format. The book will be of extreme help for MD and DNB students of Internal Medicine as well as DM and DNB students of Neurology and DNB and MCH Neurosurgery students , hence covering a fairly large readership base . It will also be read by practising Internal medicine physicians , neurologists and neurosurgeons who may want to revise the basics and tricks of neurological examination and localization
Author(s): Vinit Suri
Edition: 1
Publisher: Springer
Year: 2021
Language: English
Tags: Clinical Medicine; Internal Medicine; Neurology; Neurological Examination and Localization; Neurosurgery; Neurological Diagnosis
Acknowledgments
Contents
About the Author
1: Introduction
1.1 Basic Neuroanatomy
2: The Neurological History
2.1 Components
2.1.1 Demographics
2.1.2 History of Present Illness
2.1.2.1 Specific Questions to be Enquired in Certain Common Neurological Symptoms
Motor Weakness
Headache
Seizure
Dizziness
Numbness
Diplopia
Memory Loss
2.2 Specific Questions
2.3 Negative History
2.4 Past Medical History
2.5 Family History
2.6 Social History
2.7 Neurological Examination
2.7.1 Format
2.8 The Neurological Kit
3: Higher Mental Function
3.1 Higher Mental Function
3.2 Screening Tests of Higher Mental Function
3.2.1 Attention Span and Vigilance
3.2.2 Orientation
3.2.3 Memory
3.2.4 Calculation
3.2.5 Abstract Thinking and Judgment
3.2.5.1 Abstract Thinking
3.2.5.2 Judgment
3.2.6 Visuospatial Tests
3.2.7 Apraxia
3.2.8 Agnosia
3.2.9 Appearance, Behavior, Mood, Delusions, and Hallucinations
3.3 Specific Lobar Function
3.4 Frontal Lobe
3.4.1 Functions and Tests According to Functional Regions of Frontal Lobe
3.4.1.1 Primary Motor Cortex (Area 4)
3.4.2 Premotor Area
3.4.3 Supplementary Motor Area (Area 6)
3.4.3.1 Released Reflexes
Grasp
Sucking (Pout, Spout, Rooting)
Palmo-Mentalis
Glabellar Tap
3.4.4 Frontal Eye Field Area (Area 8)
3.4.5 Broca’s Area (Area 44)
3.4.6 Prefrontal Lobe
3.4.6.1 Dorsolateral Prefrontal Cortex
3.4.6.2 Medial Prefrontal Cortex
3.4.6.3 Orbito-Frontal Region
3.5 Parietal Lobe
3.5.1 Functions of Parietal Lobe and Tests According to Functional Regions of the Parietal Lobe
3.5.1.1 Post-Cental Gyrus (Area 3, 1, 2)
3.5.1.2 Visual Pathway (Optic Radiation)
3.5.1.3 Cuneous (Medial Aspect)
3.5.1.4 Superior Parietal and Inferior Parietal Lobe
Dominant Lobe Lesions
Nondominant Lobe Lesions
Constructional Apraxia
Dressing Apraxia
Topographic Memory Loss
Anosognosia
Hemineglect (Contralateral)
Hemiasomatognosia
3.6 Temporal Lobe
3.6.1 Functions and Tests According to Functional Regions of the Temporal Lobe
3.7 Occipital Lobe
3.7.1 Functions and Tests According to Functional Regions of Occipital Lobe
4: Cranial Nerve Examination
4.1 Olfactory Nerve: 1st Cranial Nerve (Figs. 4.1)
4.1.1 Neuroanatomy (Figs. 4.2 and 4.3)
4.1.2 Clinical Testing
4.1.3 Clinical Interpretation
4.2 Optic Nerve: 2nd Cranial Nerve
4.2.1 Neuroanatomy (Fig. 4.4)
4.2.2 Functions
4.2.3 Clinical Testing
4.2.3.1 Visual Acuity
4.2.3.2 Color Vision
4.2.3.3 Visual Field testing
4.2.3.4 Pupil
4.2.3.5 Fundus Examination (Fig. 4.7)
4.2.4 Fluorescein Angiography
4.2.5 Optical Coherence Tomography (OCT)
4.3 Oculomotor (3rd), Trochlear (4th), and Abducens (6th) Cranial Nerves
4.3.1 Neuroanatomy
4.3.2 Supranuclear Ocular Movements
4.3.3 Saccades
4.3.4 Pursuit
4.3.5 Convergence
4.3.6 Vestibular Eye Movements
4.3.7 Nystagmus
4.3.7.1 Pendular Nystagmus
4.3.7.2 Jerk Nystagmus
4.3.8 Non-nystagmus Ocular Oscillatory Movements
4.4 Ooculomotor or 3rd Cranial Nerve
4.5 Trochlear Nerve 4th Cranial Nerve
4.6 Abducens or 6th Cranial Nerve
4.6.1 Clinical Evaluation
4.6.1.1 Ocular Movements
4.6.1.2 Diplopia Testing
4.6.1.3 Saccadic Eye Movement
4.6.1.4 Evaluate Convergence
4.6.1.5 Vestibulo-Ocular Reflex (Dolls Eye Movement)
4.6.1.6 Evaluation of Nystagmus
4.6.2 Clinical Interpretation
4.7 Trigeminal or 5th Cranial Nerve
4.7.1 Neuroanatomy
4.7.2 Sensory Component
4.7.3 Motor Component
4.7.4 Clinical Evaluation
4.7.5 Localization of 5th Nerve According to Signs
4.8 Facial Nerve or 7th Cranial Nerve
4.8.1 Neuroanatomy (Figs. 4.26 and 4.27)
4.8.2 Intracranial Course
4.8.3 Extracranial Course
4.8.4 Clinical Testing
4.8.5 Upper Motor Facial Palsy (UMN)
4.8.6 Lower Motor Facial Palsy
4.8.7 Sites of LMN 7th Palsy
4.9 Vestibulocochlear or 8th Cranial Nerve
4.9.1 Neuroanatomy
4.9.2 Clinical Testing
4.9.2.1 Tests of Cochlear Function
4.9.2.2 Tests of Vestibular Function
4.9.3 Electronystagmography (ENG)
4.10 The Glossopharyngeal (IXth) and Vagus (X) Nerves
4.10.1 Neuroanatomy
4.10.2 Function
4.10.2.1 Glossopharyngeal (IX) (Fig. 4.30)
4.10.2.2 Vagus (X) (Figs. 4.31 and 4.32)
4.10.3 Clinical Testing
4.11 Spinal Accessory Nerve: 11th Cranial Nerve
4.11.1 Neuroanatomy
4.11.2 Clinical Testing
4.12 The Hypoglossal Nerve or XIIth Cranial Nerve
4.12.1 Neuroanatomy
4.12.2 Clinical Testing
5: Examination of Speech
5.1 Language Disorders or Aphasia
5.1.1 Spontaneous Speech
5.1.2 Comprehension of Speech
5.1.3 Repetition
5.1.4 Paraphasic Errors
5.1.5 Naming: Word Finding Difficulty (Anomia)
5.1.6 Reading (Alexia)
5.1.7 Writing (Agraphia)
5.2 Dysarthria
5.2.1 Clinical Evaluation
5.3 Dysphonia
6: Motor System Examination
6.1 Muscles of Head, Neck, and Face
6.2 Muscles of Upper Limb
6.3 Muscles of Trunk
6.4 Muscles of Lower Limb
7: Reflexes
7.1 Superficial Reflexes
7.1.1 Abdominal Reflex (T1–T12)
7.1.2 Cremasteric Reflex (L1)
7.1.3 Anal Reflex (S4/5)
7.1.4 Bulbocavernosus (S3/4)
7.1.5 Plantar Response or Babinski Response (S1)
7.2 Deep Tendon Reflexes
7.2.1 Reinforcement of Reflex
7.2.2 Grading of Deep Tendon Reflex
7.2.3 Components of a Brisk Reflex
7.2.4 Inverted Reflex
7.2.5 Hung Up Reflex
7.2.6 Pendular Jerk
8: Sensory System Examination
8.1 Exteroceptive Sensations
8.2 Proprioceptive Sensations
8.2.1 Pain and Temperature Pathway
8.2.1.1 Segmental Sensory Dermatomes
8.2.2 Sensory Areas According to Peripheral Nerves
8.2.3 Sensory Loss Patterns
8.3 Clinical Testing
9: Cerebellar Examination and Examination of Posture, Stance, and Gait
9.1 Cerebellar Signs
9.1.1 Vermian
9.1.2 Hemispherical cerebellar signs
9.2 Clinical Tests
9.2.1 Dysmetria
9.2.1.1 Finger–Nose Test
9.2.1.2 Knee-Skin-Heel Test
9.2.2 Dysdiadokokinesia
9.2.3 Titubation
9.2.4 Intention tremor
9.2.5 Truncal Ataxia
9.2.6 Pendular Knee Jerk
9.2.7 Holmes Rebound phenomenon
9.2.8 Hypotonia
9.3 Posture, Stance, and Gait
9.3.1 Posture and Stance
9.3.2 Gait
9.4 Common Gait Disorders
9.4.1 Asymmetrical Gait
9.4.1.1 Hemiplegic Gait
9.4.1.2 Foot Drop
9.4.2 Symmetrical Gait
9.4.2.1 Apraxic Gait
9.4.2.2 Sensory Ataxia
9.4.2.3 Cerebellar Gait
9.4.2.4 Paraplegic or Quadriplegic Gait
9.4.2.5 Waddling Gait
9.4.2.6 Antalgic Gait
10: Involuntary Movements
10.1 Types of Movement Disorders
10.1.1 Hypokinetic Disorders
10.1.2 Hyperkinetic Disorders
10.1.2.1 Tremor
Postural Tremor
Action Tremor
Intention Tremor
Rest Tremor
Certain Other Tremors
10.1.2.2 Chorea
10.1.2.3 Athetosis
10.1.2.4 Tics
10.1.2.5 Hemi-Ballismus
10.1.2.6 Dystonia
10.1.2.7 Asterixis
10.1.2.8 Myoclonus
10.1.2.9 Tardive Dyskinesias
11: Examination of Skull, Spine, Nerves, and Neurocutaneous Markers
11.1 Skull
11.2 Spine
11.3 Thickened Nerves
11.4 Neurocutaneous Markers
11.4.1 Neurofibroma
11.4.2 Sturge Weber Syndrome
11.4.3 Tuberous Sclerosis
11.4.4 Ataxia telangiectasia
11.4.5 Hypomelanosis of Ito
11.4.6 Von-Hippel-Lindau Disease
12: Autonomic Nervous System Examination
12.1 History
12.2 Tests for Autonomic Nervous System
12.2.1 Inspection of skin
12.2.2 Cardiovascular Reflexes
12.2.3 Sweating Tests or Sudomotor Tests
12.2.4 Rectum
12.2.5 Bladder
12.2.6 Pupillary Signs
12.2.7 Laboratory Tests
13: Examination of the Unconscious Patient
13.1 Q 1. What Is the Level of Consciousness?
13.2 Q 2. Is the Neurological Examination Focal or Generalized?
13.3 Q3 What Is the Possible Site and Etiology of the Lesion?
13.3.1 Pattern of Respiration (Fig. 13.3)
13.3.2 Motor Status
13.3.3 Pupils
13.3.4 Ocular Movements
13.3.5 Reflexes
13.3.6 Sensory Evaluation
13.3.7 Other Aspects of Neurological Evaluation
14: Summary of Localization
14.1 LMN Lesions
14.2 UMN Lesion and Sites
