Neurology
Mini-Mental Status Exam
Scoring: 30 points possible (10 – 20 = moderate; <10 = severe).
QUICK MENTAL STATUS: FOGS (Family story, Orientation, General information, Spelling). Count backwards from 100 by 7’s. Ask patient to recall 3 objects after several minutes.
CRANIAL NERVES:
CN1: Smell two scents
CN2: Visual acuity, gross visual fields, opthalmascopic exam.
CN3, 4, 6: Pupillary light response, lateral and vertical gaze.
CN5: Corneal blink reflex.
CN7: Smile, frown, puff cheeks, wrinkle brow.
CN8: Whisper test.
CN9/10: Gag reflex.
CN11: Shoulder elevation
CN12: Stick out tongue
MOTOR: Check for upper extremity grip. Hand grasp, strength, and toe and foot dorsiflexion. Perform muscle strength tests on each muscle group.
SENSORY: Using ten and doe objects test sensory of R vs. L on hands and feet. Proprioception in big toe. Check for dermatomes for pin and light touch.
COORDINATION: Finger to nose, slide heel up shin. Rapid alternating movements of hand and foot Romberg, heel\ toe walk.
REFLEXES: Biceps. Triceps. Patellar. Achilles. Babinsky.
NEURO:
Tract Cross-Over Sense
1. Lateral Cortical Spinal Medulla Motor pathways (UMNs)
2. Vesiculaus Graculus Medulla Sensory lower limbs and trunk
3. Vesicular cunnilatis Medulla Sensory upper limbs and trunk
4. Dorsal Spinal cerebellar Unconscious position sense
5. Laterial Spinal flamatic Cord Pain and temperature
6. Sensory
7. Dorsal Root Motor
8. Ventral Root
Characteristics of upper neuron motor deficit:
- Spastic weakness
- No significant muscle atrophy
- No vascillations or fibberlations
- Hyperreflexia
- abinski may be present
Characteristics of lower motor neuron deficits:
- Placid weakness
- Significant atrophy
- Fasciculation and fiibularations
- Hyporeflexia
- o Babinski reflex
REFLEXES:
- Biceps C5, 6
- Triceps C6,7
- Brachioradialus C5, 6
- Patellar L2, 3, 4
- alcaneal S1
Glasgow Coma Scale: (GCS less than or equal to 8: intubate)
Infant Child/Adult
Eye Opening:
4 - spontaneously 4 - spontaneously
3 – to speech 3- to command
2 - to pain 2 – to pain
1 – no response 1 – no response
Best Verbal Response:
5 – coos/babbles 5 – orientated
4 – irritable/cries 4 - confused
3 - cries to pain 3 – inappropriate words
2 – moans/grunts 2 – incomprehensible
1 – no response 1 – no response
Best Motor Response:
6 - spontaneous 6 – obeys command
5 – localizes pain 5 – localizes pain
4 – withdraw from pain 4 - withdraws from pain
3 – flexions (decorticate) 3 - flexion (decorticate)
2 – extension (decerebrate) 2 – extension (decerebrate)
1 – no response 1 – no response
Peripheral nerves and their deficits
Radial (C5- C8): Elbow and wrists extensions, finger extension at MCT, triceps reflex
Median (C6-T1): Wrist, thumb, index and middle finger flexion, thumb opposition, forearm pronation, wrists abduction, atrophy of thenar imminence
Ulnar (C8-T1): flexion of writs, ring, and little finger, opposition of little finger, wrist adduction, ad and abduction of fingers, atrophy of hypothenar imminence
Musculocutaneous (C5-C6): elbow flexion (bicep), forearm supination, bicep reflex
Axillary (C5-C6): Upper arm movement (deltoid atrophy)
Long Thoracic (C5-C6): Horizontal arm movement (patient will have scapular winging)
Femeral (L2- L3): Knee extension, hip flexion, knee jerk
Uptoatoer (L2-L4): Hip adduction
Sciatic (L4-S3): Knee flexion plus tibulo and peroneal deficits
Tibula(L4-S3): Foot inversion, ankle planter flexion, ankle jerk
Peroneal (L4-S2): Foot eversion, ankle and toes dorsal flexion (foot drop)
Cranial Nerves: S = sensory and M = motor
CN1: Olfactory nerve S Smell
CN2: Optic nerve S Vision
CN3: Oculomotor nerve M Ocular movement (downward, upward, and
nasal movement) pupil constriction, open eyelid
CN4: Trocilar nerve (SO4) M Ocular movement (down and out)
CN5: Trigeminal nerve MS facial sensation and mastication
CN6: Heppdusons nerve (LR6) M ocular movement (adduction)
CN7: Facial Nerve MS facial motor. Close eye. Taste
anterior 2/3 atone
CN8: Vestibular cochlear S Hearing and position sense
CN9: Colon glossopharyngeal MS palatine rinse/pharynx taste posterior
1/3 of tongue
CN10: Vagus MS motor palate feraanz, feranx, sensory
farranx, larnex, (gag)
CN11: Accessory M External clitomastiode and trapisios
CN12: Hypoglassal M Tongue movement
Comatose Patient Exam:
Vital signs. Hand drop from overhead. PERL. Abnormal eye movements. Grimasin. Withdraw from noxious stimuli. Babinski. Blink reflex to corneal touch, check for dolls eyes. Supplemental: cold colorax (Normal = nystagna with slow components toward water no net eye deviation. Upfoudnation = net eye deviation towards water with or without nystagnus, coma = no movement)
MRI reveals tumors of brain.
MRA (magnetic resonance angiogram) of normal brain showing circulation.
MRI showing brain infarction and degeneration.
Coronal section of brain revealing hydrocephalus.
