Introduction
-
Greet the patient.
-
Introduction / Consent
-
Wash then begin
-
General examination
-
Vital signs
-
Growth charts
-
Dysmorphic Features (Cutanous stigmata, expose front & back, spina bifida, scoliosis)
Inspection
- Equal shape / portion?
- Deformity
- Bulk (wasted/hypertrophied)
- Abnormal movement (spontaneous or induced)
- Neurocutanous stigamata’s
- subcutanous nodules
- scars
Tone / Power
done by joint movement in all of the limbs - assessed as - and compare
Forearm
- Internal & external rotation
- Abduction & Adduction
- Flexion & extension
Elbow
- Flexing & Extension
Wrist
etc…
HIP
- Internal & External rotation
- Abduction & Adduction
- Flexion & extension (Hip concentrated)
Knee
- Full Flexion & extension
Foot
- Full flexion & extension
Tone
- always compare
- Grade them as spasticity (pyrimidal tract) / rigidity (Extraparymidial tract i.e. ganglia)
- Do it quick to differentiate between the two
Power
- graded to 5
- start from passive to active
- Gowers sign may be done
Reflex
Start by normal side fully, then compare Move your wrist
Upper
- Brachioradials
- triceps
- biceps
Lower
- Knee (rest it above your arm)
- Ankle (dorsiflex foot before testing)
- babinski sign
- Clonus
Equil
Upper
- finger to nose test
- Dyskinesia, Alternating movement
- …
Lower
- Heel knee chin test (starts with passive explaination then active)
- Gait + gowers sign
Sensation
- …
Quick History:
- name age nationality residence
- Chief of complaint
- SOCRATES
Differential
- Infection ( encephalitis, meningitis)
- HIA (CP)
- Neoplasm
- Metabolic
- Bleeding disorder
Investigations
- EEG
- CT
- MRI
- Metabolic screening
- Gene study
- Bleeding profile
- CBC, CRP, ESR
UMN vs LMN Differences
| UMN | LMN | |
|---|---|---|
| Fasiculation | Rare/Absent | Often present (fibrillations, visible fasciculations) |
| Tone | Increased (spasticity; velocity-dependent, clasp-knife) | Decreased (flaccid) |
| Muscle bulk | Mild/disuse atrophy | Marked wasting/denervation atrophy |
| Reflexes | Hyperreflexia; increased deep tendon reflexes; possible clonus | Hyporeflexia or absent reflexes |
| Plantar response | Upgoing (extensor/Babinski positive) | Downgoing (flexor/Babinski negative) |
CNS Examination
Higher function
CNV Exam
Olfactory Nerve
- Ask the patient if they have noticed any change in their sense of smell lately.
2nd Cranial Nerve (Optic Nerve)
- Visual Acuity:
- Use the Snellen eye chart.
- Visual Fields:
- Confrontation test.
- Appropriate Distance:
- Examination of the patient’s right and left eyes.
- Pupillary Light Reflex:
- Both direct and consensual for left and right eyes.
pappilary
3rd, 4th, and 6th Cranial Nerves
- Inspection:
- Check for ptosis of both eyes.
- Extraocular Movements:
- Through the six cardinal fields of gaze.
- Cover-Uncover Test.
- Alternate Cover Test.
V (Trigeminal Nerve)
- Sensory:
- Test for touch/pain for ophthalmic, maxillary, and mandibular branches.
- Motor:
- Test the power of the muscles of mastication (temporalis, masseter, and pterygoid).
- Reflexes:
- Jaw jerk and corneal reflex.
VII (Facial Nerve)
Contralateral affection
-
Sensory:
- Test the anterior two-thirds of the tongue for sensation (taste).
-
Motor:
- Test the power of the facial muscles. - frontalis, orbicularis oculi, buccinator, retractor angularis, orbicularis oris
-
Reflex: - corneal reflex
VIII
IX
X
XI
Trab..
XII
Hypoglossal - wasting & fasiculation lower motor neuron.
deviation towards affected side
Motor system
UMN
LMN