Neurological Exam

• Cerebrum:
• Language, Sensory Processing, Movement, Learning and Memory

• Cerebellum:
• Balance, motor learning, posture, sensorimotor relationships

• Brainstem:
• Connects motor and sensory signals from brain to rest of body- pain,
• temperature, touch, pressure reception, (medulla oblongata) CN III-XII; cardiac
• and respiratory function; consciousness, sleep cycle

• Frontal
• Parietal
• Occipital
• Temporal
• Limbic system

• •Voluntary skeletal movement
• •Fine repetitive movement
• •Control of eye movement
• •Emotions/Personality

• Processes sensory data
• --touching; soft/rough

Interprets visual data

• •Perception and interpretation of sounds
• •Integration of taste, smell, and balance
• ---seizure disorder: focus here; they may feel aura, taste along with it

• •Mediates behavior patterns for survival
• •Sense of smell
• --Emotions and instincts

• •Aids in integration of voluntary movement
• •Processes sensory information
• •Uses sensory data for reflex control
• •Muscle tone
• •Equilibrium
• •Posture
• --Controls voluntary movement, balance, reflex control; injury causes ataxia

• •Pathway between cerebral cortex and spinal cord
• •Controls many involuntary functions
• •Sympathetic nervous system
• •Parasympathetic nervous system (involuntary)

• Olfactory
• Fx- sensory: smell

• Test ability to identify familiar aromatic odors
• Anosmia

• Optic
• Fx-Sensory:vision

• Test vision with Snellen chart
•    -visual acuity & fields, gross vision
• Include periphery - make an H to hit all locations

• Oculomotor
• Fx-Motor: extraocular movement, upper eyelid; Parasympathetic: adjusts lens and pupil constriction

• Raise eyelids, extraocular movements, pupillary constriction (penlight), change lens shape
• PERRLA (III, IV, VI)

• Trochlear
• Fx-Motor: downward and inward movement of the eye
• Sensory: muscle sense

PERRLA

• Trigeminal
• Fx-Motor: muscles of mastication
• Sensory: touch, pain, and temperature in the eye, mucous membranes of the mouth and nose, scalp

• Inspect the face for atrophy, palpate jaw, test pain/sensation, corneal reflex with cotton whisk
• Sensory: cornea, iris, lacrimal glands, eyelids, forehead, nose, mouth, teeth, tongue, ear, facial skins

• Abducens
• Fx-Motor: lateral movement of eye
• Sensory: muscle sense (like trochlear)

PERRLA

• Facial
• Fx-Motor: facial movements, close eye and mouth
• Sensory: anterior two thirds of tongue, taste

Inspect facial symmetry, test tongue for salt and sweet; secretions (saliva, tears-don't norm test unless they say something)

• Vestibulocochlear (Acoustic)
• Fx-Sensory: hearing and balance

Test hearing, compare bone/air conduction with Weber/Rinne (tuning fork), vestibular function (Romberg test)

• Glossopharyngeal
• Fx-Motor:  swallowing, salivary glands
• Sensory: pharynx and posterior third of tongue, tase, carotid reflex

Voluntary muscles, gag reflex, taste (sour/bitter), secretion of salivary glands

• Vagus
• Fx-Motor: palate, pharynx, larynx
• Sensory: general sensation from pharynx, viscera, external auditory canal
• Autonomic: gastrointestinal, cardiac

• Sensation behind ear & external ear canal, digestive enzyme secretion, carotid reflex (HTN crisis; slow HR), involuntary action of heart, lungs, GI tract
• Inspect palate/uvula for symmetry, swallow difficulty, evaluate speech sounds

• Accessory
• Fx-Motor: voluntary swallowing, sternocleidomastoid, and trapezius muscles

Test trapezius and sternocleidomastoid strength

• Hypoglossal
• Fx-Motor: movements of the tongue

Inspect tongue for symmetry/tremors/atrophy, test tongue movement & strength, evaluate lingual speech sounds