Neurological Examination

A neurological exam is a systematic assessment of cognitive, sensory Sensory Neurons which conduct nerve impulses to the central nervous system. Nervous System: Histology, and motor Motor Neurons which send impulses peripherally to activate muscles or secretory cells. Nervous System: Histology responses to identify pathologies of the nervous system Nervous system The nervous system is a small and complex system that consists of an intricate network of neural cells (or neurons) and even more glial cells (for support and insulation). It is divided according to its anatomical components as well as its functional characteristics. The brain and spinal cord are referred to as the central nervous system, and the branches of nerves from these structures are referred to as the peripheral nervous system. Nervous System: Anatomy, Structure, and Classification. A neurological exam allows for the localization of neurologic lesions to narrow the differential diagnosis and focus Focus Area of enhancement measuring < 5 mm in diameter Imaging of the Breast on subsequent laboratory and imaging examinations. The exam should include assessments of the subject's mental status, speech, 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 Motor Neurons which send impulses peripherally to activate muscles or secretory cells. Nervous System: Histology system, deep tendon reflexes, sensation, balance, and coordination Coordination Cerebellar Disorders.

Last updated: 9 Jun, 2022

Editorial responsibility: Stanley Oiseth, Lindsay Jones, Evelin Maza

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
    • 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 Affect The feeling-tone accompaniment of an idea or mental representation. It is the most direct psychic derivative of instinct and the psychic representative of the various bodily changes by means of which instincts manifest themselves. Psychiatric Assessment:
    • 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 Abstract reasoning Psychiatric Assessment: 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

Related videos

Cranial Nerves

A basic understanding Understanding Decision-making Capacity and Legal Competence 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.

Table: Examination of 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
Cranial nerve (CN) Examination
CN I: olfactory nerve Olfactory nerve The 1st cranial nerve. The olfactory nerve conveys the sense of smell. It is formed by the axons of olfactory receptor neurons which project from the olfactory epithelium (in the nasal epithelium) to the olfactory bulb. Nose and Nasal Cavity: Anatomy Test olfaction Olfaction The sense of smell, or olfaction, begins in a small area on the roof of the nasal cavity, which is covered in specialized mucosa. From there, the olfactory nerve transmits the sensory perception of smell via the olfactory pathway. This pathway is composed of the olfactory cells and bulb, the tractus and striae olfactoriae, and the primary olfactory cortex and amygdala. Olfaction: Anatomy of the subject using nonirritant substances.
CN II: optic nerve Optic nerve The 2nd cranial nerve which conveys visual information from the retina to the brain. The nerve carries the axons of the retinal ganglion cells which sort at the optic chiasm and continue via the optic tracts to the brain. The largest projection is to the lateral geniculate nuclei; other targets include the superior colliculi and the suprachiasmatic nuclei. Though known as the second cranial nerve, it is considered part of the central nervous system. The 12 Cranial Nerves: Overview and Functions
  • Visual acuity Visual Acuity Clarity or sharpness of ocular vision or the ability of the eye to see fine details. Visual acuity depends on the functions of retina, neuronal transmission, and the interpretative ability of the brain. Normal visual acuity is expressed as 20/20 indicating that one can see at 20 feet what should normally be seen at that distance. Visual acuity can also be influenced by brightness, color, and contrast. Ophthalmic Exam: Evaluate using a Snellen chart.
  • Visual field Visual Field The Visual Pathway and Related Disorders: Evaluate using confrontation test Confrontation Test Ophthalmic Exam.
  • Pupillary light reflex Pupillary Light Reflex Constriction of the pupil in response to light stimulation of the retina. It refers also to any reflex involving the iris, with resultant alteration of the diameter of the pupil. Pupil: Physiology and Abnormalities is tested by shining a light into the subject’s eyes:
    • Normal finding: prompt, consensual constriction in both pupils
    • Abnormal finding: anisocoric dilation (not equal in both pupils)
  • Fundoscopic examination:
    • Normal finding: pink optic disc Optic disc The portion of the optic nerve seen in the fundus with the ophthalmoscope. It is formed by the meeting of all the retinal ganglion cell axons as they enter the optic nerve. Eye: Anatomy
    • Abnormal findings: optic disk cupping ( 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), papilledema Papilledema Swelling of the optic disk, usually in association with increased intracranial pressure, characterized by hyperemia, blurring of the disk margins, microhemorrhages, blind spot enlargement, and engorgement of retinal veins. Chronic papilledema may cause optic atrophy and visual loss. Idiopathic Intracranial Hypertension (elevated intracranial pressure Intracranial Pressure Idiopathic Intracranial Hypertension), optic neuritis Optic neuritis Inflammation of the optic nerve. Commonly associated conditions include autoimmune disorders such as multiple sclerosis, infections, and granulomatous diseases. Clinical features include retro-orbital pain that is aggravated by eye movement, loss of color vision, and contrast sensitivity that may progress to severe visual loss, an afferent pupillary defect (Marcus-Gunn pupil), and in some instances optic disc hyperemia and swelling. Inflammation may occur in the portion of the nerve within the globe (neuropapillitis or anterior optic neuritis) or the portion behind the globe (retrobulbar neuritis or posterior optic neuritis). Cranial Nerve Palsies (infection, multiple sclerosis Sclerosis A pathological process consisting of hardening or fibrosis of an anatomical structure, often a vessel or a nerve. Wilms Tumor)
CN III: oculomotor nerve Oculomotor nerve The 3D cranial nerve. The oculomotor nerve sends motor fibers to the levator muscles of the eyelid and to the superior rectus, inferior rectus, and inferior oblique muscles of the eye. It also sends parasympathetic efferents (via the ciliary ganglion) to the muscles controlling pupillary constriction and accommodation. The motor fibers originate in the oculomotor nuclei of the midbrain. The 12 Cranial Nerves: Overview and Functions; CN IV: trochlear nerve Trochlear nerve The 4th cranial nerve. The trochlear nerve carries the motor innervation of the superior oblique muscles of the eye. The 12 Cranial Nerves: Overview and Functions; CN VI: abducens nerve Abducens nerve The 6th cranial nerve which originates in the abducens nucleus of the pons and sends motor fibers to the lateral rectus muscles of the eye. Damage to the nerve or its nucleus disrupts horizontal eye movement control. The 12 Cranial Nerves: Overview and Functions
  • Responsible for eye movement and accommodation Accommodation Refractive Errors
  • Eye movement: tested by asking the subject to follow the examiner’s finger
  • Accommodation Accommodation Refractive Errors:
    • Tested by moving a finger toward the subject’s eyes
    • The normal response is constriction of the pupil Pupil The pupil is the space within the eye that permits light to project onto the retina. Anatomically located in front of the lens, the pupil’s size is controlled by the surrounding iris. The pupil provides insight into the function of the central and autonomic nervous systems. Pupil: Physiology and Abnormalities.
CN V: trigeminal nerve Trigeminal nerve The 5th and largest cranial nerve. The trigeminal nerve is a mixed motor and sensory nerve. The larger sensory part forms the ophthalmic, mandibular, and maxillary nerves which carry afferents sensitive to external or internal stimuli from the skin, muscles, and joints of the face and mouth and from the teeth. Most of these fibers originate from cells of the trigeminal ganglion and project to the trigeminal nucleus of the brain stem. The smaller motor part arises from the brain stem trigeminal motor nucleus and innervates the muscles of mastication. The 12 Cranial Nerves: Overview and Functions
  • Responsible for facial sensation; tested by lightly touching different facial areas ( forehead Forehead The part of the face above the eyes. Melasma, cheek, jaw Jaw The jaw is made up of the mandible, which comprises the lower jaw, and the maxilla, which comprises the upper jaw. The mandible articulates with the temporal bone via the temporomandibular joint (TMJ). The 4 muscles of mastication produce the movements of the TMJ to ensure the efficient chewing of food. Jaw and Temporomandibular Joint: Anatomy) and comparing both sides
  • Innervates the anterior ⅔ of the tongue Tongue The tongue, on the other hand, is a complex muscular structure that permits tasting and facilitates the process of mastication and communication. The blood supply of the tongue originates from the external carotid artery, and the innervation is through cranial nerves. Lips and Tongue: Anatomy with general sensations ( pain Pain An unpleasant sensation induced by noxious stimuli which are detected by nerve endings of nociceptive neurons. Pain: Types and Pathways, temperature)
  • Innervates the muscles of mastication Mastication The act and process of chewing and grinding food in the mouth. Jaw and Temporomandibular Joint: Anatomy
  • Reflexes:
    • Masseter Masseter A masticatory muscle whose action is closing the jaws. Jaw and Temporomandibular Joint: Anatomy reflex:
      • Tapping the subject’s chin Chin The anatomical frontal portion of the mandible, also known as the mentum, that contains the line of fusion of the two separate halves of the mandible (symphysis menti). This line of fusion divides inferiorly to enclose a triangular area called the mental protuberance. On each side, inferior to the second premolar tooth, is the mental foramen for the passage of blood vessels and a nerve. Melasma with a reflex hammer while their mouth is slightly open
      • The normal finding is jaw Jaw The jaw is made up of the mandible, which comprises the lower jaw, and the maxilla, which comprises the upper jaw. The mandible articulates with the temporal bone via the temporomandibular joint (TMJ). The 4 muscles of mastication produce the movements of the TMJ to ensure the efficient chewing of food. Jaw and Temporomandibular Joint: Anatomy closure.
    • Corneal reflex:
      • Lightly touch the cornea Cornea The transparent anterior portion of the fibrous coat of the eye consisting of five layers: stratified squamous corneal epithelium; bowman membrane; corneal stroma; descemet membrane; and mesenchymal corneal endothelium. It serves as the first refracting medium of the eye. Eye: Anatomy with a cotton swab.
      • The normal finding is closing of the eyelid.
  • In trigeminal nerve Trigeminal nerve The 5th and largest cranial nerve. The trigeminal nerve is a mixed motor and sensory nerve. The larger sensory part forms the ophthalmic, mandibular, and maxillary nerves which carry afferents sensitive to external or internal stimuli from the skin, muscles, and joints of the face and mouth and from the teeth. Most of these fibers originate from cells of the trigeminal ganglion and project to the trigeminal nucleus of the brain stem. The smaller motor part arises from the brain stem trigeminal motor nucleus and innervates the muscles of mastication. The 12 Cranial Nerves: Overview and Functions injuries, the jaw Jaw The jaw is made up of the mandible, which comprises the lower jaw, and the maxilla, which comprises the upper jaw. The mandible articulates with the temporal bone via the temporomandibular joint (TMJ). The 4 muscles of mastication produce the movements of the TMJ to ensure the efficient chewing of food. Jaw and Temporomandibular Joint: Anatomy deviates toward the affected side.
CN VII: facial nerve Facial nerve The 7th cranial nerve. The facial nerve has two parts, the larger motor root which may be called the facial nerve proper, and the smaller intermediate or sensory root. Together they provide efferent innervation to the muscles of facial expression and to the lacrimal and salivary glands, and convey afferent information for taste from the anterior two-thirds of the tongue and for touch from the external ear. The 12 Cranial Nerves: Overview and Functions
  • Innervates the muscles responsible for facial expressions
  • Tested by asking the subject to perform certain movements ( forehead Forehead The part of the face above the eyes. Melasma wrinkling, closing the eyes tightly, inflating the cheeks Cheeks The part of the face that is below the eye and to the side of the nose and mouth. Melasma, smiling, whistling)
  • Innervates the anterior ⅔ of the tongue Tongue The tongue, on the other hand, is a complex muscular structure that permits tasting and facilitates the process of mastication and communication. The blood supply of the tongue originates from the external carotid artery, and the innervation is through cranial nerves. Lips and Tongue: Anatomy with special sensation (sweet, salty, and sour)
CN VIII: vestibulocochlear nerve Vestibulocochlear nerve The 8th cranial nerve. The vestibulocochlear nerve has a cochlear part (cochlear nerve) which is concerned with hearing and a vestibular part (vestibular nerve) which mediates the sense of balance and head position. The fibers of the cochlear nerve originate from neurons of the spiral ganglion and project to the cochlear nuclei (cochlear nucleus). The fibers of the vestibular nerve arise from neurons of scarpa’s ganglion and project to the vestibular nuclei. The 12 Cranial Nerves: Overview and Functions
  • A simple test to check hearing includes rubbing fingers together near the subject’s ears.
  • Tested using Weber and Rinne tests
CN IX: glossopharyngeal nerve Glossopharyngeal nerve The 9th cranial nerve. The glossopharyngeal nerve is a mixed motor and sensory nerve; it conveys somatic and autonomic efferents as well as general, special, and visceral afferents. Among the connections are motor fibers to the stylopharyngeus muscle, parasympathetic fibers to the parotid glands, general and taste afferents from the posterior third of the tongue, the nasopharynx, and the palate, and afferents from baroreceptors and chemoreceptor cells of the carotid sinus. Pharynx: Anatomy; CN X: vagus nerve Vagus nerve The 10th cranial nerve. The vagus is a mixed nerve which contains somatic afferents (from skin in back of the ear and the external auditory meatus), visceral afferents (from the pharynx, larynx, thorax, and abdomen), parasympathetic efferents (to the thorax and abdomen), and efferents to striated muscle (of the larynx and pharynx). Pharynx: Anatomy
  • Tested by evaluating the uvula Uvula A fleshy extension at the back of the soft palate that hangs above the opening of the throat. Peritonsillar Abscess:
    • Normal finding: centrally located
    • Abnormal finding: deviation toward the normal side
  • Responsible for the gag reflex Gag Reflex Cranial Nerve Palsies: tested by lightly touching the uvula Uvula A fleshy extension at the back of the soft palate that hangs above the opening of the throat. Peritonsillar Abscess with a spatula
  • CN IX innervates the posterior ⅓ of the tongue Tongue The tongue, on the other hand, is a complex muscular structure that permits tasting and facilitates the process of mastication and communication. The blood supply of the tongue originates from the external carotid artery, and the innervation is through cranial nerves. Lips and Tongue: Anatomy with general and special sensations.
  • Hoarseness Hoarseness An unnaturally deep or rough quality of voice. Parapharyngeal Abscess or an impaired cough reflex indicates damage to CN X.
CN XI: accessory nerve
  • Innervates the trapezius muscle: Ask the subject to elevate their shoulders 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.
  • Innervates the sternocleidomastoid Sternocleidomastoid Muscles of the Neck: Anatomy muscle: Ask the subject to rotate their head 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.
CN XII: hypoglossal nerve Hypoglossal nerve The 12th cranial nerve. The hypoglossal nerve originates in the hypoglossal nucleus of the medulla and supplies motor innervation to all of the muscles of the tongue except the palatoglossus (which is supplied by the vagus). This nerve also contains proprioceptive afferents from the tongue muscles. Lips and Tongue: Anatomy
  • Innervates the tongue Tongue The tongue, on the other hand, is a complex muscular structure that permits tasting and facilitates the process of mastication and communication. The blood supply of the tongue originates from the external carotid artery, and the innervation is through cranial nerves. Lips and Tongue: Anatomy muscles: Ask the subject to press against their cheek from the inside, while the examiner tests the strength from the outside.
  • In CN XII injury, the tongue Tongue The tongue, on the other hand, is a complex muscular structure that permits tasting and facilitates the process of mastication and communication. The blood supply of the tongue originates from the external carotid artery, and the innervation is through cranial nerves. Lips and Tongue: Anatomy deviates toward the site of injury.

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

  • 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 Tongue The tongue, on the other hand, is a complex muscular structure that permits tasting and facilitates the process of mastication and communication. The blood supply of the tongue originates from the external carotid artery, and the innervation is through cranial nerves. Lips and Tongue: Anatomy muscles

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 neuron lesions Upper motor neuron lesions Upper motor neurons (UMNs) and lower motor neurons (LMNs) combine to form a neuronal circuit for movement. UMN lesions cause damage to neurons above the motor nuclei of the cranial nerves in the brain stem or the anterior horn cells in the spinal cord. LMN lesions affect the nerve fibers traveling from the anterior horn of the spinal cord to the peripheral muscle. Motor Neuron Lesions from lower motor neuron lesions Lower motor neuron lesions Upper motor neurons (UMNs) and lower motor neurons (LMNs) combine to form a neuronal circuit for movement. LMN lesions affect the nerve fibers traveling from the anterior horn of the spinal cord to the peripheral muscle. Motor Neuron Lesions.
  • Reflexes are graded on a scale Scale Dermatologic Examination of 0–4 based on the magnitude of response:
  • 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:
  • 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.
Distracting the patient with the jendrassik maneuver

Distracting the subject using the Jendrassik maneuver may lead to more reliable reflex testing.

Image by Lecturio.

Clinically relevant upper limb reflexes

  • Biceps Biceps Arm: Anatomy reflex:
  • 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
    • 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
    • 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:

Upper Versus Lower Motor Neuron Lesions

Evidence of upper versus lower motor neuron lesions Lower motor neuron lesions Upper motor neurons (UMNs) and lower motor neurons (LMNs) combine to form a neuronal circuit for movement. LMN lesions affect the nerve fibers traveling from the anterior horn of the spinal cord to the peripheral muscle. Motor Neuron 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
Table: Upper versus lower motor neuron lesions Lower motor neuron lesions Upper motor neurons (UMNs) and lower motor neurons (LMNs) combine to form a neuronal circuit for movement. LMN lesions affect the nerve fibers traveling from the anterior horn of the spinal cord to the peripheral muscle. Motor Neuron Lesions
Upper motor Motor Neurons which send impulses peripherally to activate muscles or secretory cells. Nervous System: Histology neuron Lower motor neuron Lower Motor Neuron Motor Neuron Lesions
Site of lesion Brain Brain The part of central nervous system that is contained within the skull (cranium). Arising from the neural tube, the embryonic brain is comprised of three major parts including prosencephalon (the forebrain); mesencephalon (the midbrain); and rhombencephalon (the hindbrain). The developed brain consists of cerebrum; cerebellum; and other structures in the brain stem. Nervous System: Anatomy, Structure, and Classification, 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 Anterior horn Anterior horn One of three central columns of the spinal cord. It is composed of gray matter spinal laminae VIII and ix. Brown-Séquard Syndrome, nerve root, peripheral nerve
Muscle strength Weakness Weakness
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 Hypertonic Hypertonic Solutions that have a greater osmotic pressure than a reference solution such as blood, plasma, or interstitial fluid. Renal Sodium and Water Regulation Flaccid
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 Absent Present
Deep tendon reflexes Hyperreflexia Hyporeflexia Hyporeflexia Duchenne Muscular Dystrophy

Sensation

Table: Important examinations of the sensory Sensory Neurons which conduct nerve impulses to the central nervous system. Nervous System: Histology system
Sensation Pathway Examination Abnormal findings
Light touch Dorsal columns Dorsal Columns Posterior Cord Syndrome Touch the subject’s body at different locations bilaterally.
Vibration Dorsal columns Dorsal Columns Posterior Cord Syndrome Bony projections tested with a tuning fork Decreased sensation of vibration indicates peripheral nerve damage.
Proprioception Dorsal columns Dorsal Columns Posterior Cord Syndrome Identify the positional change of the big toe while moving it up and down. Abnormal proprioception indicates peripheral nerve damage.
Pain Pain An unpleasant sensation induced by noxious stimuli which are detected by nerve endings of nociceptive neurons. Pain: Types and Pathways and temperature Spinothalamic tract
  • Use a sharp object to test for pain Pain An unpleasant sensation induced by noxious stimuli which are detected by nerve endings of nociceptive neurons. Pain: Types and Pathways.
  • Use objects with different temperature to test for perception Perception The process by which the nature and meaning of sensory stimuli are recognized and interpreted. Psychiatric Assessment of temperature.
Abnormal perception Perception The process by which the nature and meaning of sensory stimuli are recognized and interpreted. Psychiatric Assessment of pain Pain An unpleasant sensation induced by noxious stimuli which are detected by nerve endings of nociceptive neurons. Pain: Types and Pathways and temperature indicates peripheral nerve damage.
Stereognosis Cerebral cortex Cerebral cortex The cerebral cortex is the largest and most developed part of the human brain and CNS. Occupying the upper part of the cranial cavity, the cerebral cortex has 4 lobes and is divided into 2 hemispheres that are joined centrally by the corpus callosum. Cerebral Cortex: Anatomy Ask the subject to identify a familiar object with their eyes closed. Inability to identify a familiar object
Graphesthesia Cerebral cortex Cerebral cortex The cerebral cortex is the largest and most developed part of the human brain and CNS. Occupying the upper part of the cranial cavity, the cerebral cortex has 4 lobes and is divided into 2 hemispheres that are joined centrally by the corpus callosum. Cerebral Cortex: Anatomy Trace a familiar symbol on the subject’s palm while their eyes are closed. Inability to identify the symbol
Tactile extinction Extinction The procedure of presenting the conditioned stimulus without reinforcement to an organism previously conditioned. It refers also to the diminution of a conditioned response resulting from this procedure. Psychotherapy Cerebral cortex Cerebral cortex The cerebral cortex is the largest and most developed part of the human brain and CNS. Occupying the upper part of the cranial cavity, the cerebral cortex has 4 lobes and is divided into 2 hemispheres that are joined centrally by the corpus callosum. Cerebral Cortex: Anatomy Apply a tactile stimulus on each side of body and then bilaterally, and compare perception Perception The process by which the nature and meaning of sensory stimuli are recognized and interpreted. Psychiatric Assessment. Asymmetry Asymmetry Examination of the Upper Limbs of perception Perception The process by which the nature and meaning of sensory stimuli are recognized and interpreted. Psychiatric Assessment or inability to perceive stimulus on 1 side of the body

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:

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).
Testing for gait ataxia

Testing for gait 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 is often performed by simply having the subject ambulate across the room.

Image by Lecturio.

Abnormalities

Many cerebellar syndromes can manifest with gait abnormalities.

Table: Clinically significant abnormalities of gait/when stationary
Gait Description Associated signs Causes
Cerebellar
  • Ataxic
  • Staggering
  • Wide based
  • Dysdiadochokinesia Dysdiadochokinesia Difficulty with rapid alternating movements Cerebellar Disorders
  • Dysmetria Dysmetria Cerebellar Disorders
  • Nystagmus Nystagmus Involuntary movements of the eye that are divided into two types, jerk and pendular. Jerk nystagmus has a slow phase in one direction followed by a corrective fast phase in the opposite direction, and is usually caused by central or peripheral vestibular dysfunction. Pendular nystagmus features oscillations that are of equal velocity in both directions and this condition is often associated with visual loss early in life. Albinism
  • Positive Romberg sign only if external inputs are introduced
  • Cerebellar degeneration
  • Stroke
  • Alcohol intoxication Alcohol intoxication An acute brain syndrome which results from the excessive ingestion of ethanol or alcoholic beverages. Alcohol Use Disorder
  • Vitamin B12 deficiency Vitamin B12 deficiency A nutritional condition produced by a deficiency of vitamin B12 in the diet, characterized by megaloblastic anemia. Since vitamin B12 is not present in plants, humans have obtained their supply from animal products, from multivitamin supplements in the form of pills, and as additives to food preparations. A wide variety of neuropsychiatric abnormalities is also seen in vitamin B12 deficiency and appears to be due to an undefined defect involving myelin synthesis. Folate and Vitamin B12
Sensory Sensory Neurons which conduct nerve impulses to the central nervous system. Nervous System: Histology
  • Wide based
  • High stepping
  • Positive Romberg sign
  • Absence of deep tendon reflexes
  • Impaired proprioception
Damage to peripheral nerves Peripheral Nerves The nerves outside of the brain and spinal cord, including the autonomic, cranial, and spinal nerves. Peripheral nerves contain non-neuronal cells and connective tissue as well as axons. The connective tissue layers include, from the outside to the inside, the epineurium, the perineurium, and the endoneurium. Nervous System: Histology, dorsal roots, or posterior columns
Vestibular Unsteady, falling to 1 side
  • Nausea Nausea An unpleasant sensation in the stomach usually accompanied by the urge to vomit. Common causes are early pregnancy, sea and motion sickness, emotional stress, intense pain, food poisoning, and various enteroviruses. Antiemetics, vertigo Vertigo Vertigo is defined as the perceived sensation of rotational motion while remaining still. A very common complaint in primary care and the ER, vertigo is more frequently experienced by women and its prevalence increases with age. Vertigo is classified into peripheral or central based on its etiology. Vertigo
  • Normal sensation
  • Normal reflexes
Parkinsonian
  • Short steps
  • Shuffling
  • Narrow based
  • Bradykinesia Bradykinesia Parkinson’s Disease
  • Resting tremor Resting Tremor Parkinson’s Disease
  • Postural instability
  • Decreased arm Arm The arm, or “upper arm” in common usage, is the region of the upper limb that extends from the shoulder to the elbow joint and connects inferiorly to the forearm through the cubital fossa. It is divided into 2 fascial compartments (anterior and posterior). Arm: Anatomy swing
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
Steppage gait Foot Foot The foot is the terminal portion of the lower limb, whose primary function is to bear weight and facilitate locomotion. The foot comprises 26 bones, including the tarsal bones, metatarsal bones, and phalanges. The bones of the foot form longitudinal and transverse arches and are supported by various muscles, ligaments, and tendons. Foot: Anatomy drop while walking Distal sensory Sensory Neurons which conduct nerve impulses to the central nervous system. Nervous System: Histology loss and weakness Motor Motor Neurons which send impulses peripherally to activate muscles or secretory cells. Nervous System: Histology neuropathy Neuropathy Leprosy
Trendelenburg gait Trendelenburg Gait Legg-Calvé-Perthes Disease/sign Pelvis Pelvis The pelvis consists of the bony pelvic girdle, the muscular and ligamentous pelvic floor, and the pelvic cavity, which contains viscera, vessels, and multiple nerves and muscles. The pelvic girdle, composed of 2 “hip” bones and the sacrum, is a ring-like bony structure of the axial skeleton that links the vertebral column with the lower extremities. Pelvis: Anatomy drops to the unaffected side. Weakness in the gluteus medius Gluteus medius Gluteal Region: Anatomy and gluteus minimus Gluteus minimus Gluteal Region: Anatomy muscles Damage to the superior gluteal nerve Superior gluteal nerve Gluteal Region: Anatomy
Spastic Slow, stiff, and labored movements Scissoring of the legs
  • Lesions of the upper motor Motor Neurons which send impulses peripherally to activate muscles or secretory cells. Nervous System: Histology neuron
  • Cerebral palsy Cerebral palsy Cerebral palsy (CP) refers to a group of conditions resulting in motor impairment affecting tone and posture and limiting physical activity. Cerebral palsy is the most common cause of childhood disability. It is caused by a nonprogressive CNS injury to the fetal or infant brain. Cerebral Palsy

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 Optic Neuropathy Glaucoma. 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, cogwheel 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, and speech difficulties.

References

  1. Gelb, D. (2021). The detailed neurologic examination in adults. Retrieved November 18, 2021, from https://www.uptodate.com/contents/the-detailed-neurologic-examination-in-adults
  2. Mendez, M. (2021). The mental status examination in adults. Retrieved November 18, 2021, from https://www.uptodate.com/contents/the-mental-status-examination-in-adults
  3. Shahrokhi M, Asuncion, RM.D. Neurologic Exam. [Updated 2021 Apr 29]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 January. Retrieved November 18, 2021, from https://www.ncbi.nlm.nih.gov/books/NBK557589/
  4. Ooman, K. (2021). Neurological History and Physical Examination. Retrieved November 18, 2021, from https://emedicine.medscape.com/article/1147993-overview

USMLE™ is a joint program of the Federation of State Medical Boards (FSMB®) and National Board of Medical Examiners (NBME®). MCAT is a registered trademark of the Association of American Medical Colleges (AAMC). NCLEX®, NCLEX-RN®, and NCLEX-PN® are registered trademarks of the National Council of State Boards of Nursing, Inc (NCSBN®). None of the trademark holders are endorsed by nor affiliated with Lecturio.

Study on the Go

Lecturio Medical complements your studies with evidence-based learning strategies, video lectures, quiz questions, and more – all combined in one easy-to-use resource.

Learn even more with Lecturio:

Complement your med school studies with Lecturio’s all-in-one study companion, delivered with evidence-based learning strategies.

Details