A Basic Neurological Examination
Top Mnemonic = Is That Physician Really So Cool?
LMNL – wasting, fasiculations, ¯tone, ¯reflexes, plantars flexor à THINK DOWN
MRC – 0-5
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.
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.
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