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evidence of anxiety, depression, or hypochondriasis? |
Are there any clues to defects in language, memory, |
insight, or inappropriate behavior? |
A screening examination done |
in this way can be completed in 3–5 min. |
Several additional points about the examination are |
worth noting. |
A single small-amplitude movement of the finger is |
sufficient for a normal response. |
CN VII (facial) |
Look for facial asymmetry at rest and with spontaneous |
movements. |
Test eyebrow elevation, forehead wrin- |
kling, eye closure, smiling, and cheek puff. |
Any suspected problem should |
be followed up with formal audiometry. |
11, |
17, and 24, respectively. |
MOTOR EXAMINATION |
• The bare minimum: Look for muscle atrophy and check |
extremity tone. |
Tap the biceps, patellar, and Achilles reflexes. |
Test |
for lower extremity strength by having the patient walk |
normally and on heels and toes. |
The motor examination includes observations of mus- |
cle appearance, tone, strength, and reflexes. |
Check for muscle fasciculations, tenderness, and atrophy |
or hypertrophy. |
Tone |
Muscle tone is tested by measuring the resistance to |
passive movement of a relaxed limb. |
Decreased |
tone is most commonly due to lower motor neuron or |
peripheral nerve disorders. |
It is also helpful to palpate accessible muscles |
as they contract. |
The |
normal reflex consists of plantar flexion of the toes. |
Normally, the umbilicus |
will pull toward the stimulated quadrant. |
With upper |
motor neuron lesions, these reflexes are absent. |
In many instances stroking the |
back of the hand will lead to its release. |
Check double simultaneous stimulation using |
light touch on the hands. |
With patients |
who are uncooperative or lack an understanding of |
the tests, it may be useless. |
The examination should be |
focused on the suspected lesion. |
The Romberg |
maneuver is primarily a test of proprioception. |
A loss of balance |
with the eyes closed is an abnormal response. |
Coordination refers to the orchestration and fluid- |
ity of movements. |
Part of this integration |
relies on normal function of the cerebellar and basal |
ganglia systems. |
In the lower limb, the patient rapidly taps the foot |
against the floor or the examiner’s hand. |
For all these |
movements, the accuracy, speed, and rhythm are noted. |
Watching the patient walk is the most important part |
of the neurologic examination. |
4); or (4) elec- |
trophysiologic studies (Chap. |
5). |
17. |
Daniel H. |
Lowenstein |
11 |
Knowledge of the basic neurologic examination is |
an essential clinical skill. |
THE NEUROLOGIC SCREENING EXAM |
CHAPTER 2 |
Martin A. |
VIDEO ATLAS OF THE DETAILED NEUROLOGIC |
EXAMINATION |
CHAPTER 3 |
William P. |
A computer calculates a “back projection” image from |
the 360° x-ray attenuation profi le. |
Multidetector CT (MDCT) is now standard in most |
radiology departments. |
4-1B and C). |
CTA images are |
postprocessed for display in three dimensions to yield |
angiogram-like images (Fig. |
4-1C, 4-2 E and F, and |
see Fig. |
27-4). |
CTA has proved useful in assessing the |
cervical and intracranial arterial and venous anatomy. |
COMPLICATIONS |
CT is safe, fast, and reliable. |
Care must be taken to reduce exposure when imaging |
children. |