A Basic Neurological Examination

Neurology

Top Mnemonic = Is That Physician Really So Cool?

• Inspection – wasting (LMN), shakes, fasciculation, ataxia, beside, sticcato speech (cerebellar)
• Tone – don’t shake everywhere. Cogwheeling = Parkinson’s
• Power – Chicken arms + driving wheel + pincer grip + abducted fingers.
• Reflexes – C5-6. C5-6. C6-7. L3-4, L5-S1 
• Sensation – Cotton wool (dorsal columns –crude touch)
     + Neurotip (spinothalamic is pain/temp/non-discrim/pressure)
• Coordination – Heel Shin, Finger Nose, Disdiadochkinesis.
  
  
•  Proprioception (dorsal columns) & Gait (cerebellar is co-ord)

UMNL –­tone, reflexs, plantars, ankle clonus, Hoffman’s +ve à THINK UP
LMNL – wasting, fasiculations, ¯tone, ¯reflexes, plantars flexor à THINK DOWN
MRC – 0-5 

Gait
Spastic – circumduction of legs +/- foot scuffling,
Extra-pyrimidal (Park) – flexed posture, shuffling, slow to start, postural instable Apraxic – glued to floor/wide-based unsteady gait à FALLS! (Multi-infarct and NPH)
Ataxic – wide-based, falls, cannot walk heel-toe à cerebellar lesions like MS, tumours, alcohol and phenytoin or sensory loss.
Myopathic – waddle, hip girdle weakness, can’t climb stairs.
Psychogenic – bizarre, not conforming to gait disturbance.
 
CN’s
I – Smell & taste, each nostril. Not alcohol hand-gel.
II – Snellen, Fundoscopy, Reading, Fields.
III, IV, VI - PERLA, eye mvts, nystagmus - LR6SO4
V – facial sens. & clench teeth whilst feeling; open jaw à say about corneal reflex.
VII – expressions – eyebrows, close eyes, smile, blow-out cheeks.
VIII – Rinne’s and Webbers (forehead)
IX, X – A,E,I,O,U and “aaaaaah”.
XI – Shrug and move head.
XII – Tongue out and side to side.
 
CN 3 Palsy - down and out eye.