cns examination hadeel khadawardi, teaching assistant at internal medicine department, faculty of...
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![Page 1: CNS Examination Hadeel Khadawardi, teaching assistant at Internal Medicine Department, Faculty of Medicine, Umm Al-Qura University](https://reader035.vdocuments.site/reader035/viewer/2022062321/56649e625503460f94b5d671/html5/thumbnails/1.jpg)
CNS Examinatio
n Hadeel Khadawardi, teaching assistant at Internal
Medicine Department, Faculty of Medicine, Umm Al-Qura University
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CNS examination consists of:
A. High Cortical Function B. Cranial Nerves C. Motor D. Coordination E. Sensory
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High Cortical Functions
1. Handedness2. Consciousness3. Orientation4. Memory5. Speech
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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.
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2. Consciousness
Levels of consciousness • Alertness• Lethargy • Obtundation• Stupor• Coma
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3. Orientation
• Time
• Place
• Person
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4. Memory
• Remote (long) memory: Birthdays,…
• Recent (short) memory: event of the day, …
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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
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Cranial Nerves
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I. Olfactory Nerve
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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.
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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
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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;
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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?
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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
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XI. Accessory Nerve
Trapezius muscleSternomastoid muscle
XII. Hypoglossal Nerve
Inspect the tongueAsk the patient to protrude his/her tongue
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Motor
Motor
Exposure & InspectionTonePowerReflex
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Inspection
• Skin (rash, scar, ulcer,…)• Muscle (wasting, fasciculation)• Deformity• Abnormal movement
Drift (For Upper Limb Only)
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Tone
• For upper & lower limbs• Examine each joint• Start from distal to proximal • Always compare both sides
What are the types
of hypertonia
?
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Power
• For upper & lower limbs• Examine each joint • Always compare both
sides
What are the
grading of
power?
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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?
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Coordination
1)Finger nose test
2)Rapidly alternative movement
3)Heel to shin test
4)Rebound
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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?
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Thank You