Neurological Examination

Mental Status and Speech

Mental status examination Mental Status Examination Psychiatric Assessment is an assessment of a subject’s current mental capacity based on the following factors:

• Appearance:
  • Age and concordance of appearance to age
  • Gender Gender Gender Dysphoria (be aware of the increasing disparity in gender Gender Gender Dysphoria identification Identification Defense Mechanisms)
  • Race:
    • Be sensitive about the assumption of race based on skin Skin The skin, also referred to as the integumentary system, is the largest organ of the body. The skin is primarily composed of the epidermis (outer layer) and dermis (deep layer). The epidermis is primarily composed of keratinocytes that undergo rapid turnover, while the dermis contains dense layers of connective tissue. Skin: Structure and Functions color.
    • Be aware of cultural differences.
  • Body build
  • Posture
  • Eye contact
  • Dress/grooming
  • Alertness/attentiveness to the examiner
  • Distinguishing features
  • Physical features/abnormalities
  • Emotional facial expression
• Orientation Orientation Awareness of oneself in relation to time, place and person. Psychiatric Assessment (awareness) to:
  • Person
  • Place
  • Time
• Attention Attention Focusing on certain aspects of current experience to the exclusion of others. It is the act of heeding or taking notice or concentrating. Psychiatric Assessment and concentration:
  • Ability to spell a word backward and forward
  • Ability to count by serial 7’s
• Spatial orientation Spatial orientation Change in position or alignment in response to an external stimulus. Psychiatric Assessment: ability to draw a house or a clock face within a specific time
• General motor Motor Neurons which send impulses peripherally to activate muscles or secretory cells. Nervous System: Histology status:
  • Retardation
  • Agitation Agitation A feeling of restlessness associated with increased motor activity. This may occur as a manifestation of nervous system drug toxicity or other conditions. St. Louis Encephalitis Virus
  • Abnormal movements
  • Gait
  • Catatonia Catatonia A neuropsychiatric disorder characterized by one or more of the following essential features: immobility, mutism, negativism (active or passive refusal to follow commands), mannerisms, stereotypies, posturing, grimacing, excitement, echolalia, echopraxia, muscular rigidity, and stupor; sometimes punctuated by sudden violent outbursts, panic, or hallucinations. This condition may be associated with psychiatric illnesses (e.g., schizophrenia; mood disorders) or organic disorders (neuroleptic malignant syndrome; encephalitis, etc.). Major Depressive Disorder
• Speech:
  • Rate
  • Rhythm
  • Volume
  • Articulation
  • Spontaneity
• Affect:
  • Stability
  • Range
  • Appropriateness
  • Intensity
  • Mood
• Thought process Thought process Psychiatric Assessment:
  • Associations
  • Coherence
  • Logic stream
  • Perseveration
  • Neologism
  • Blocking
• Thought content Thought content Psychiatric Assessment:
  • Suicidal ideation Suicidal ideation A risk factor for suicide attempts and completions, it is the most common of all suicidal behavior, but only a minority of ideators engage in overt self-harm. Suicide
  • Homicidal ideation
  • Depressive cognitions
  • Obsessions Obsessions Recurrent thoughts, images, or urges that are intrusive and recognized as unwanted, causing significant anxiety and distress . Obsessive-compulsive Disorder (OCD)
  • Ruminations
  • Phobias
  • Ideas of reference
  • Paranoid ideation
  • Magical ideation
  • Delusions
  • Overvalued ideas
• Memory Memory Complex mental function having four distinct phases: (1) memorizing or learning, (2) retention, (3) recall, and (4) recognition. Clinically, it is usually subdivided into immediate, recent, and remote memory. Psychiatric Assessment:
  • Ability to recall 3 simple objects after 2 and 5 minutes
  • Able to provide a reliable history
• Abstract reasoning Reasoning Decision-making Capacity and Legal Competence: ability to identify a unifying theme connecting 3–4 objects
• Perception Perception The process by which the nature and meaning of sensory stimuli are recognized and interpreted. Psychiatric Assessment:
  • Hallucinations Hallucinations Subjectively experienced sensations in the absence of an appropriate stimulus, but which are regarded by the individual as real. They may be of organic origin or associated with mental disorders. Schizophrenia
  • Illusions Illusions The misinterpretation of a real external, sensory experience. Schizophrenia
  • Depersonalization Depersonalization State in which an individual perceives or experiences a sensation of unreality concerning the self or the environment; it is seen in disorders such as schizophrenia, affection disorders, organic mental disorders, and personality disorders. Depersonalization/Derealization Disorder
  • Derealization Derealization Derealization is a persistent subjective sense of detachment or unreality of the surrounding world often described by the patient as unreal, dreamlike, foggy, lifeless, or visually distorted reality. Depersonalization/Derealization Disorder
  • Déjà vu
  • Jamais vu
• Intellect Intellect Psychiatric Assessment:
  • Average versus above average/below average
  • Educational and professional achievements
• Insight Insight Psychiatric Assessment: awareness of the illness and its implications
• Judgment Judgment The process of discovering or asserting an objective or intrinsic relation between two objects or concepts; a faculty or power that enables a person to make judgments; the process of bringing to light and asserting the implicit meaning of a concept; a critical evaluation of a person or situation. Psychiatric Assessment: ability to satisfactorily resolve a proposed hypothetical scenario utilizing good judgment Judgment The process of discovering or asserting an objective or intrinsic relation between two objects or concepts; a faculty or power that enables a person to make judgments; the process of bringing to light and asserting the implicit meaning of a concept; a critical evaluation of a person or situation. Psychiatric Assessment

Cranial Nerves

A basic understanding of the underlying neuroanatomy of the head and neck Neck The part of a human or animal body connecting the head to the rest of the body. Peritonsillar Abscess is required before discussing the components of examining the cranial nerves Cranial nerves There are 12 pairs of cranial nerves (CNs), which run from the brain to various parts of the head, neck, and trunk. The CNs can be sensory or motor or both. The CNs are named and numbered in Roman numerals according to their location, from the front to the back of the brain. The 12 Cranial Nerves: Overview and Functions.

Motor System

Motor Motor Neurons which send impulses peripherally to activate muscles or secretory cells. Nervous System: Histology system examination includes the following:

• Inspection Inspection Dermatologic Examination
• Passive motion ( muscle tone Muscle tone The state of activity or tension of a muscle beyond that related to its physical properties, that is, its active resistance to stretch. In skeletal muscle, tonus is dependent upon efferent innervation. Skeletal Muscle Contraction)
• Active motion (muscle power)

Inspection Inspection Dermatologic Examination

• Gait
• Gross movements and coordination Coordination Cerebellar Disorders
• Abnormal movements (e.g., tics Tics Habitual, repeated, rapid contraction of certain muscles, resulting in stereotyped individualized actions that can be voluntarily suppressed for only brief periods. They often involve the face, vocal cords, neck, and less often the extremities. Examples include repetitive throat clearing, vocalizations, sniffing, pursing the lips, and excessive blinking. Tics tend to be aggravated by emotional stress. When frequent they may interfere with speech and interpersonal relations. Conditions which feature frequent and prominent tics as a primary manifestation of disease are referred to as tic disorders. Tics and Tourette Syndrome, tremors, chorea Chorea Involuntary, forcible, rapid, jerky movements that may be subtle or become confluent, markedly altering normal patterns of movement. Hypotonia and pendular reflexes are often associated. Conditions which feature recurrent or persistent episodes of chorea as a primary manifestation of disease are referred to as choreatic disorders. Chorea is also a frequent manifestation of basal ganglia diseases. Huntington Disease, myoclonus, hemiballismus)
• Abnormal posture
• Atrophy Atrophy Decrease in the size of a cell, tissue, organ, or multiple organs, associated with a variety of pathological conditions such as abnormal cellular changes, ischemia, malnutrition, or hormonal changes. Cellular Adaptation versus hypertrophy Hypertrophy General increase in bulk of a part or organ due to cell enlargement and accumulation of fluids and secretions, not due to tumor formation, nor to an increase in the number of cells (hyperplasia). Cellular Adaptation
• Contractures Contractures Prolonged shortening of the muscle or other soft tissue around a joint, preventing movement of the joint. Wound Healing
• Tremors
• Fasciculations Fasciculations Involuntary contraction of the muscle fibers innervated by a motor unit. Fasciculations may be visualized as a muscle twitch or dimpling under the skin, but usually do not generate sufficient force to move a limb. They may represent a benign condition or occur as a manifestation of motor neuron disease or peripheral nervous system diseases. Polyneuropathy:
  • Lower motor neuron Lower Motor Neuron Motor Neuron Lesions sign
  • Spontaneous contraction affecting a small number of muscle fibers
  • Mostly seen in tongue muscles Tongue Muscles Lips and Tongue: Anatomy

Passive motion

• Examined by moving the subject’s limbs and individual muscles through a range of motion Range of motion The distance and direction to which a bone joint can be extended. Range of motion is a function of the condition of the joints, muscles, and connective tissues involved. Joint flexibility can be improved through appropriate muscle strength exercises. Examination of the Upper Limbs
• Note abnormalities:
  • Atonia (flaccidity, no resistance Resistance Physiologically, the opposition to flow of air caused by the forces of friction. As a part of pulmonary function testing, it is the ratio of driving pressure to the rate of air flow. Ventilation: Mechanics of Breathing to passive motion)
  • Hypotonia Hypotonia Duchenne Muscular Dystrophy (focal or generalized weakness)
  • Hypertonia ( rigidity Rigidity Continuous involuntary sustained muscle contraction which is often a manifestation of basal ganglia diseases. When an affected muscle is passively stretched, the degree of resistance remains constant regardless of the rate at which the muscle is stretched. This feature helps to distinguish rigidity from muscle spasticity. Megacolon, resistance Resistance Physiologically, the opposition to flow of air caused by the forces of friction. As a part of pulmonary function testing, it is the ratio of driving pressure to the rate of air flow. Ventilation: Mechanics of Breathing to passive motion)
  • Contracture (fixed resistance Resistance Physiologically, the opposition to flow of air caused by the forces of friction. As a part of pulmonary function testing, it is the ratio of driving pressure to the rate of air flow. Ventilation: Mechanics of Breathing to passive motion)

Active motion

• Examined by asking the subject to flex and extend their extremities against resistance Resistance Physiologically, the opposition to flow of air caused by the forces of friction. As a part of pulmonary function testing, it is the ratio of driving pressure to the rate of air flow. Ventilation: Mechanics of Breathing
• Strength is graded on a scale Scale Dermatologic Examination of 0–5 based on the quality Quality Activities and programs intended to assure or improve the quality of care in either a defined medical setting or a program. The concept includes the assessment or evaluation of the quality of care; identification of problems or shortcomings in the delivery of care; designing activities to overcome these deficiencies; and follow-up monitoring to ensure effectiveness of corrective steps. Quality Measurement and Improvement of response:
  • 0: no muscle activation
  • 1: trace/minor muscle activation, such as a twitch Twitch An isolated, rapid contraction followed by rapid relaxation Skeletal Muscle Contraction, without achieving full range of motion Range of motion The distance and direction to which a bone joint can be extended. Range of motion is a function of the condition of the joints, muscles, and connective tissues involved. Joint flexibility can be improved through appropriate muscle strength exercises. Examination of the Upper Limbs
  • 2: muscle activation with gravity eliminated while achieving full range of motion Range of motion The distance and direction to which a bone joint can be extended. Range of motion is a function of the condition of the joints, muscles, and connective tissues involved. Joint flexibility can be improved through appropriate muscle strength exercises. Examination of the Upper Limbs
  • 3: muscle activation against gravity, full range of motion Range of motion The distance and direction to which a bone joint can be extended. Range of motion is a function of the condition of the joints, muscles, and connective tissues involved. Joint flexibility can be improved through appropriate muscle strength exercises. Examination of the Upper Limbs
  • 4: muscle activation against some resistance Resistance Physiologically, the opposition to flow of air caused by the forces of friction. As a part of pulmonary function testing, it is the ratio of driving pressure to the rate of air flow. Ventilation: Mechanics of Breathing, full range of motion Range of motion The distance and direction to which a bone joint can be extended. Range of motion is a function of the condition of the joints, muscles, and connective tissues involved. Joint flexibility can be improved through appropriate muscle strength exercises. Examination of the Upper Limbs
  • 5: muscle activation against examiner’s full resistance Resistance Physiologically, the opposition to flow of air caused by the forces of friction. As a part of pulmonary function testing, it is the ratio of driving pressure to the rate of air flow. Ventilation: Mechanics of Breathing, full range of motion Range of motion The distance and direction to which a bone joint can be extended. Range of motion is a function of the condition of the joints, muscles, and connective tissues involved. Joint flexibility can be improved through appropriate muscle strength exercises. Examination of the Upper Limbs

Deep Tendon Reflexes

Reflex testing and grading Grading Methods which attempt to express in replicable terms the level of cell differentiation in neoplasms as increasing anaplasia correlates with the aggressiveness of the neoplasm. Grading, Staging, and Metastasis

• In healthy subjects, briskly striking a muscle tendon with a reflex hammer results in immediate muscle contraction.
• Muscle contraction is due to a 2-neuron reflex arc involving the spinal cord Spinal cord The spinal cord is the major conduction pathway connecting the brain to the body; it is part of the CNS. In cross section, the spinal cord is divided into an H-shaped area of gray matter (consisting of synapsing neuronal cell bodies) and a surrounding area of white matter (consisting of ascending and descending tracts of myelinated axons). Spinal Cord: Anatomy and/or brainstem segment innervating the muscle(s).
• A test of reflexes is, therefore, a test of the function of these 2 neurons Neurons The basic cellular units of nervous tissue. Each neuron consists of a body, an axon, and dendrites. Their purpose is to receive, conduct, and transmit impulses in the nervous system. Nervous System: Histology and the innervated muscle(s).
• The deep tendon reflex test can help distinguish upper motor Motor Neurons which send impulses peripherally to activate muscles or secretory cells. Nervous System: Histology neuron lesions from lower motor neuron Lower Motor Neuron Motor Neuron Lesions lesions.
• Reflexes are graded on a scale Scale Dermatologic Examination of 0–4 based on the magnitude of response:
  • 0: no reflex
  • 1: hyporeflexia Hyporeflexia Duchenne Muscular Dystrophy
  • 2: low normal reflex
  • 3: high normal reflex
  • 4: hyperreflexia
• Decreased reflexes (0–1) may indicate:
  • Peripheral nerve ( lower motor neuron Lower Motor Neuron Motor Neuron Lesions) lesions
  • Hypometabolic state (e.g., hypothyroidism Hypothyroidism Hypothyroidism is a condition characterized by a deficiency of thyroid hormones. Iodine deficiency is the most common cause worldwide, but Hashimoto’s disease (autoimmune thyroiditis) is the leading cause in non-iodine-deficient regions. Hypothyroidism)
  • Normal finding with advanced aging
• Exaggerated reflexes (4) may indicate:
  • CNS (upper motor Motor Neurons which send impulses peripherally to activate muscles or secretory cells. Nervous System: Histology neuron) lesions
  • Hypermetabolic state (e.g., hyperthyroidism Hyperthyroidism Hypersecretion of thyroid hormones from the thyroid gland. Elevated levels of thyroid hormones increase basal metabolic rate. Thyrotoxicosis and Hyperthyroidism)
• General notes on eliciting deep tendon reflexes:
  • Apprehension or anticipation Anticipation The apparent tendency of certain diseases to appear at earlier age of onset and with increasing severity in successive generations. Huntington Disease in the subject may lead to misleading reflex findings.
  • Distract the subject’s attention Attention Focusing on certain aspects of current experience to the exclusion of others. It is the act of heeding or taking notice or concentrating. Psychiatric Assessment using the Jendrassik maneuver or ask them to relax the group of tested muscles to obtain a more reliable response.

Clinically relevant upper limb reflexes

• Biceps Biceps Arm: Anatomy reflex:
  • Nerve root: C5–C6
  • Place the thumb on the biceps Biceps Arm: Anatomy tendon and strike it.
  • Notice flexion Flexion Examination of the Upper Limbs at the elbow.
• Brachioradialis Brachioradialis Forearm: Anatomy reflex:
  • Nerve root: C5–C6
  • Strike the brachioradialis Brachioradialis Forearm: Anatomy tendon at the distal end of the radius Radius The outer shorter of the two bones of the forearm, lying parallel to the ulna and partially revolving around it. Forearm: Anatomy with the wrist in a flexed, dependent position.
  • Notice subtle elbow flexion Flexion Examination of the Upper Limbs and supination Supination Applies to movements of the forearm in turning the palm forward or upward. When referring to the foot, a combination of adduction and inversion movements of the foot. Examination of the Upper Limbs of the forearm Forearm The forearm is the region of the upper limb between the elbow and the wrist. The term “forearm” is used in anatomy to distinguish this area from the arm, a term that is commonly used to describe the entire upper limb. The forearm consists of 2 long bones (the radius and the ulna), the interosseous membrane, and multiple arteries, nerves, and muscles. Forearm: Anatomy.
• Triceps reflex:
  • Nerve root: C7–C8 (predominantly C7)
  • Strike the triceps tendon below the triceps muscle complex in the olecranon Olecranon A prominent projection of the ulna that articulates with the humerus and forms the outer protuberance of the elbow joint. Arm: Anatomy fossa while the elbow is in a flexed, dependent position.
  • Notice extension Extension Examination of the Upper Limbs at the elbow joint Elbow joint The elbow is the synovial hinge joint between the humerus in the upper arm and the radius and ulna in the forearm. The elbow consists of 3 joints, which form a functional unit enclosed within a single articular capsule. The elbow is the link between the powerful motions of the shoulder and the intricate fine-motor function of the hand. Elbow Joint: Anatomy.

Clinically relevant lower limb reflexes

• Knee reflex:
  • Nerve root: L2–L4 (mainly L4)
  • Strike the patellar tendon below the patella Patella The flat, triangular bone situated at the anterior part of the knee. Knee Joint: Anatomy while the knee is in a flexed, dependent position.
  • Notice extension Extension Examination of the Upper Limbs at the knee joint Knee joint The knee joint is made up of the articulations between the femur, tibia, and patella bones, and is one of the largest and most complex joints of the human body. The knee is classified as a synovial hinge joint, which primarily allows for flexion and extension with a more limited degree of translation and rotation. Knee Joint: Anatomy.
• Ankle reflex:
  • Nerve root: S1 S1 Heart Sounds– S2 S2 Heart Sounds
  • Strike the Achilles tendon below the gastrocnemius Gastrocnemius Leg: Anatomy/ soleus Soleus Leg: Anatomy complex while the ankle is supported by the examiner in a position of slight dorsiflexion.
  • Notice plantar flexion Flexion Examination of the Upper Limbs at the ankle joint Ankle joint The ankle is a hinged synovial joint formed between the articular surfaces of the distal tibia, distal fibula, and talus. The ankle primarily allows plantar flexion and dorsiflexion of the foot. .

Upper Versus Lower Motor Neuron Lesions

Evidence of upper versus lower motor neuron Lower Motor Neuron Motor Neuron Lesions lesions may become evident during motor Motor Neurons which send impulses peripherally to activate muscles or secretory cells. Nervous System: Histology examination of the subject due to abnormalities in:

• Muscle tone Muscle tone The state of activity or tension of a muscle beyond that related to its physical properties, that is, its active resistance to stretch. In skeletal muscle, tonus is dependent upon efferent innervation. Skeletal Muscle Contraction
• Muscle strength
• Deep tendon reflexes
• Spontaneous muscle activity

Sensation

Cerebellar Function

A cerebellar examination should be performed in any subject exhibiting signs or symptoms of cerebellar pathology including:

• Dizziness Dizziness An imprecise term which may refer to a sense of spatial disorientation, motion of the environment, or lightheadedness. Lateral Medullary Syndrome (Wallenberg Syndrome)
• Loss of balance
• Poor coordination Coordination Cerebellar Disorders
• Gait or limb ataxia Ataxia Impairment of the ability to perform smoothly coordinated voluntary movements. This condition may affect the limbs, trunk, eyes, pharynx, larynx, and other structures. Ataxia may result from impaired sensory or motor function. Sensory ataxia may result from posterior column injury or peripheral nerve diseases. Motor ataxia may be associated with cerebellar diseases; cerebral cortex diseases; thalamic diseases; basal ganglia diseases; injury to the red nucleus; and other conditions. Ataxia-telangiectasia
• Tremors
• Pyramidal signs
• Myoclonus

There are many causes of cerebellar dysfunction, including:

•  Stroke
• Space-occupying lesions
• Multiple sclerosis Sclerosis A pathological process consisting of hardening or fibrosis of an anatomical structure, often a vessel or a nerve. Wilms Tumor
• Friedreich ataxia Ataxia Impairment of the ability to perform smoothly coordinated voluntary movements. This condition may affect the limbs, trunk, eyes, pharynx, larynx, and other structures. Ataxia may result from impaired sensory or motor function. Sensory ataxia may result from posterior column injury or peripheral nerve diseases. Motor ataxia may be associated with cerebellar diseases; cerebral cortex diseases; thalamic diseases; basal ganglia diseases; injury to the red nucleus; and other conditions. Ataxia-telangiectasia

Components of the exam

Cerebellar examination includes the following:

Coordination Coordination Cerebellar Disorders:

• Finger-to-nose test
• Heel-knee-shin test
• Rapid alternating movement test ( dysdiadochokinesia Dysdiadochokinesia Difficulty with rapid alternating movements Cerebellar Disorders)

Gait assessment:

• Ask the subject to walk a few steps backward and forward.
• Perform the Romberg test Romberg Test Vertigo to distinguish between sensory Sensory Neurons which conduct nerve impulses to the central nervous system. Nervous System: Histology and cerebellar ataxia Cerebellar ataxia Incoordination of voluntary movements that occur as a manifestation of cerebellar diseases. Characteristic features include a tendency for limb movements to overshoot or undershoot a target (dysmetria), a tremor that occurs during attempted movements (intention tremor), impaired force and rhythm of diadochokinesis (rapidly alternating movements), and gait ataxia. Cerebellar Disorders:
  • Ask the subject to stand with their feet together, raise their arms, and close their eyes.
  • Positive Romberg test Romberg Test Vertigo: The subject starts swaying after closing their eyes, indicating sensory Sensory Neurons which conduct nerve impulses to the central nervous system. Nervous System: Histology ataxia Ataxia Impairment of the ability to perform smoothly coordinated voluntary movements. This condition may affect the limbs, trunk, eyes, pharynx, larynx, and other structures. Ataxia may result from impaired sensory or motor function. Sensory ataxia may result from posterior column injury or peripheral nerve diseases. Motor ataxia may be associated with cerebellar diseases; cerebral cortex diseases; thalamic diseases; basal ganglia diseases; injury to the red nucleus; and other conditions. Ataxia-telangiectasia.
  • Negative Romberg test Romberg Test Vertigo: Closing the subject’s eyes does not result in increased swaying.
  • Uncontrollable swaying even when the eyes are open is indicative of dysfunction in peripheral sensation and/or poor transmission of peripheral inputs up the dorsal columns Dorsal Columns Posterior Cord Syndrome.
  • Cerebellar lesions may not manifest in the Romberg test Romberg Test Vertigo unless a perturbation of equilibrium Equilibrium Occurs when tumor cells survive the initial elimination attempt These cells are not able to progress, being maintained in a state of dormancy by the adaptive immune system. In this phase, tumor immunogenicity is edited, where T cells keep selectively attacking highly immunogenic tumor cells.This attack leaves other cells with less immunogenicity to potentially develop resistance to the immune response. Cancer Immunotherapy is introduced externally (e.g., the subject is unable to maintain equilibrium Equilibrium Occurs when tumor cells survive the initial elimination attempt These cells are not able to progress, being maintained in a state of dormancy by the adaptive immune system. In this phase, tumor immunogenicity is edited, where T cells keep selectively attacking highly immunogenic tumor cells.This attack leaves other cells with less immunogenicity to potentially develop resistance to the immune response. Cancer Immunotherapy if gently “pushed” off balance).

Abnormalities

Many cerebellar syndromes can manifest with gait abnormalities.

Clinical Relevance

The following conditions might be found during neurological examination:

• Glaucoma Glaucoma Glaucoma is an optic neuropathy characterized by typical visual field defects and optic nerve atrophy seen as optic disc cupping on examination. The acute form of glaucoma is a medical emergency. Glaucoma is often, but not always, caused by increased intraocular pressure (IOP). Glaucoma: a group of eye diseases marked by elevated intraocular pressure Intraocular Pressure The pressure of the fluids in the eye. Ophthalmic Exam (IOP) and resulting in optic neuropathy Neuropathy Leprosy. Glaucoma Glaucoma Glaucoma is an optic neuropathy characterized by typical visual field defects and optic nerve atrophy seen as optic disc cupping on examination. The acute form of glaucoma is a medical emergency. Glaucoma is often, but not always, caused by increased intraocular pressure (IOP). Glaucoma is a progressive disease that leads to a loss of retinal ganglion cell axons Axons Nerve fibers that are capable of rapidly conducting impulses away from the neuron cell body. Nervous System: Histology. Glaucoma Glaucoma Glaucoma is an optic neuropathy characterized by typical visual field defects and optic nerve atrophy seen as optic disc cupping on examination. The acute form of glaucoma is a medical emergency. Glaucoma is often, but not always, caused by increased intraocular pressure (IOP). Glaucoma manifests initially as visual field Visual Field The Visual Pathway and Related Disorders loss and may ultimately lead to irreversible blindness Blindness The inability to see or the loss or absence of perception of visual stimuli. This condition may be the result of eye diseases; optic nerve diseases; optic chiasm diseases; or brain diseases affecting the visual pathways or occipital lobe. Retinopathy of Prematurity if left untreated.
• Multiple sclerosis Sclerosis A pathological process consisting of hardening or fibrosis of an anatomical structure, often a vessel or a nerve. Wilms Tumor ( encephalitis Encephalitis Encephalitis is inflammation of the brain parenchyma caused by an infection, usually viral. Encephalitis may present with mild symptoms such as headache, fever, fatigue, and muscle and joint pain or with severe symptoms such as seizures, altered consciousness, and paralysis. Encephalitis disseminate): a chronic inflammatory autoimmune disease of the CNS that primarily affects younger women. Owing to its diverse symptoms, multiple sclerosis Sclerosis A pathological process consisting of hardening or fibrosis of an anatomical structure, often a vessel or a nerve. Wilms Tumor is known as a disease with many manifestations. Several neurologic abnormalities may be present on exam, which may wax and wane in severity and location over time.
• Parkinson disease Parkinson disease Parkinson’s disease (PD) is a chronic, progressive neurodegenerative disorder. Although the cause is unknown, several genetic and environmental risk factors are currently being studied. Individuals present clinically with resting tremor, bradykinesia, rigidity, and postural instability. Parkinson’s Disease: a progressive neurodegenerative disease with diverse clinical features that include neuropsychiatric and other nonmotor manifestations in addition to its motor Motor Neurons which send impulses peripherally to activate muscles or secretory cells. Nervous System: Histology symptomatology Symptomatology Scarlet Fever. Common neurologic abnormalities may include abnormal gait, tremors, cogwheel rigidity Cogwheel Rigidity Parkinson’s Disease, and speech difficulties.