Neuro examination

hrhodes's version from 2015-10-20 01:49


Question Answer
How many points make up the MMSE?30
What is the MMSE an assessment of and how is it interpreted?Cognition. >27 normal, 19-26 - mild cog impairment, 10-18 moderate impairment, >=9 severe cognitive impairment
What are the domains MMSE assess?Orientation - 5 marks time, 5 marks place, Registration 3 marks, Attention/calculation 5 points, recall 3marks, language (naming) 2 marks, repetition 1 mark, Commands 5 - follow a three stage command 3 , read and follow command 1, draw 1

Eye assessment

Question Answer
Conjugate deviationaway from side of brainstem lesion
Conjugate rovingmetabolic coma
Oculocephalic (Doll’s eye)movement shows intact vestibular/brainstem
Oculovestibular reflex (caloric)cold irrigation of ears = eyes to that side = normal

Conjugate gaze


Question Answer
Horizontal gaze is determined by which muscles and CNs?Lateral rectus - CN VI, plus MLF -> contralateral CN 3 -> Medial rectus
Medial rectus cranial nerve CN 3 Occulomotor
Lateral rectus cranial nerveCN 6 aBducens
What part of the system is affected if you have internuclear palsy? MLF. This means the ipsilateral eye cannot aDDuct

Localising insult in comatose patient

Question Answer Column 3 Column 4 Column 5
Insult RespirationMotorPupilsEye movement
ForebrainCheyne StokesLocalisesmall symmetrical and reactive
MidbrainHyperventilationDecorticateFixed mid positionUpper CN III, lower CN IV
PonsApneuresisDecerebrateSymmetrical, pin point, reactive, away from lesionCN VI
MedullaApneoaAtaxicIrregular, large, non reactive


Question Answer
List order of areas of insultsForebrain, midbrain, pons, medulla
What signs suggest a forebrain insult in a comatose patient?Cheyne Stokes respiration, localise motor, symmetrical reactive pupils
What signs suggest a midbrain insult in a comatose patientHyperventilation, decorticate, fixed mid position, CN III -upper, CNIV lower
What signs suggest a pons insult in a comatose patientApneuresis, decerebrate, reactive, away from side of lesion, CN VI
What signs suggest a medullary insult in a comatose patientApnoea, ataxia, asymmetrical and non reactive pupils


Question Answer
List three causes of coma with bilateral mitosisPontine lesions, Thalamic haemorrhage, Metabolic encephalopathy, Organophosphate, Other cholinergic agents (e.g. donezepil for Alzheimers) Opioids, barbituates, GHB, clonidine, Mushroom intoxication (cholinergic effect)

Cause of coma

Question Answer
List broad differential diagnoses categories of coma Cerebral, Oxygen/acid base, Metabolic, Alcohol and drugs, Systemic sepsis
Further list cerebral categories Trauma, ICB - subdural, extradural, intraparenchymal, CNS infection, post octal
Oxygen categoriesHypoxia, hypercapneoa, acidosis
Metabolic catergoryAll the Es. Electrolytes, endocrine-pancreas, thyroid, adrenal, encephalopathy, environmental
Alcohol and other drugsAlcohols - all, anticholinergics, TCAs, opiates, GHB

UMN lesions

Question Answer
List the features of UMN lesions hyperreflexia, positive Babinksi, increased tone
List the features of LMN lesions wasted muscle, hyporeflexia, fasciculations (spontaneous muscle contractions)


Question Answer
How can you remember the bottom front dermatome?C5 Clavicle5
Big bit on back of head?C2
C7 is mainly on the back of arm, how to remember?Number 7 looks like a broken hunched back

A: C4, B C5, C T3, D T2, E C6, F T1, G C7, H C8, L C4, M T2, N C5, P C6, Q C8, R C7

Myotomes and reflexes

Question Answer
BicepsC5, C6
Achilles TendonS1

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