Ophthalmoscopy funduscopy: Direct examination of the Optic disk and retina with an Ophthalmoscope is an important step inside the neurological examination. This demands considerable training and has to be practiced perfectly.
Motor system: The muscle groups need to be examined with a view to solicit the following points:
Muscle bulk, tone, muscle strength, fasciculations, presence of involuntary movements, tendon reflexes, co-ordination and Gait.
In examining these parameters it is important that the expert has an idea of the normal bulk and strength of the various muscles associated to the general develop and age of the individual. Muscle strength has been graded as follows:
Grade 0: Complete paralysis
Grade 1: Only a flicker of contraction is present.
Grade 2: Patient may manipulate the limb whenever gravity is eliminated by suitable ranking.
Grade 3: Limb is moved against gravity, but not against further resistance.
Grade 4: There is some level of weakness varying from poor, fair or moderate strength.
Grade 5: Normal electricity is present.
Neurological motor handicap can take several designs.
Hemiplegia: Paralysis of both limbs of one side or the body with equally paralysis of the face area in many cases; this results from unilateral lesions of the pyramidal system above the brain stem.
Crossed Hemiplegia: Lower motor neuron paralysis of cranial self-control on one side and hemiplegia on the opposite side, this results from lesions inside the brainstem.
Paraplegia: Paralysis of both lower limbs.
Monoplegia: Paralysis of a particular limb.
Quadriplegia: Paralysis off 4 limbs.
Tendon reflexes
The tendon reflexes are monosynaptic reflexes. Sudden strike on a lightly stretched muscle tendon evokes a sharp contraction. Elicitation of these reflexes provides valuable clues regarding the corresponding motor units concerning the integrity of the afferent and efferent pathways and excitability of the anterior pathways and excitability of the anterior horn tissues. Several reflexes are prepared use of inside scientific examination. The fact that the motor units subserving tendon reflexes are found in different levels inside the spinal cord and brainstem has been prepared use of to look for the level of neurological lesion. From above downwards, these are:
1. Jaw jerk: Trigeminal nuclei inside the Pons
2. Biceps Jerk: C5 and 6 segments
3. Triceps Jerk: C6, C7 segments
4. Supinator jerk: C5, C6 segments
5. Knee Jerk: L2, 3 and 4 segments
6. Ankle Jerk: S1 and 2 segments.
Tendon jerks can be absent, usual or exaggerated truly brisk. Very quick tendon jerks can be accompanied by clonus.
Superficial reflexes
Several superficial reflexes is elicited by appropriate stimuli. These are equally changed inside upper and lower motor neuron lesions. These equally help in establishing the place of neurological lesion.
1. Abdominal reflexes: 7th to 12th thoracic segments of spinal cord
2. Cremasteric: L1 and L2 of the Lumbar segments of spinal cord
3. Scapular: C5 to T1
4. Anal: S3 and S4
5. Bulbocavernous: S3 and S4
6. Plantar: S1 and S2.
Coordination
This expression signifies the smooth recruitment, connection and cooperation of separate groups of muscles, that result in a smooth and definite motor act. Incoordination results inside imperfect performance of the motor act and causes ataxia. Coordination is effected by several factors including afferent propioceptive impulses from muscles spindles and joint receptors, cerebellar function and muscle tone. Ataxia can be due to loss of proprioceptive sensations or diseases of the cerebellum. In the case of sensory ataxia eg, tabes dorsalis, graphic impulses may pay to keep posture and movement to ensure that with eyes open, the patient can keep posture, but with eyes sealed, ataxia manifests. Ataxia happening inside cerebellar disease is not relying on graphic impulses.
Gait
Analysis of the gait provides valuable neurological information. Well-defined neurological disorders give rise to characteristic gaits.
1. Spastic gait: Indicates pyramidal system lesions including spastic paraplegia or hemiplegia.
2. Stamping gait: This occurs inside sensory ataxia inside that the patient stamps his foot on the ground with the heel touching initially. This gait is watched inside posterior line lesions.
3. Cerebellar gait: It is described as the bringing or drunken gait.
4. Festinant gait: It is watched inside florid parkinsonism.
5. Waddling gait: It resembles the git of the duck. This results from disorders inside maintaining posture due to weakness of the truncal and gluteal muscles. It is watched inside myopathies. A synonymous gait could happen inside bilaterla disease of the hip joints too.
6. High walking gait: In the patient lifts upwards his fet excellent to avoid tripping from the toes touching the ground bellboy . This kind of gait is watched inside people with foot drop, eg, peripheral neuropathy.
Sensory examination
Proper results are obtained only whenever the patient is alert and cooperative. Considerable talent needs to solicit the sensations properly without unduly tiring away the patient. When testing the sensation, it is better to proceed from the abnormal to the normal location. The primary modalities that are tested include:
1. Tactile sensibility, including light touch, pressure, tactile localization and discrimination:
2. Pain-superficial and deep;
3. Temperature heat and cold;
4. Position sense and understanding of passive movement.
5. Vibration; and
6. Stereognosis- recognition of size, form, weight, texture and kind of items.
Recording of neurological findings
The studies elicited on scientific examination should be systematically recorded. Numerous neurological disorders progress or solve in brief periods. Therefore the examination may need to be respected at regular intervals depending on the kind of the disorder. It is all the more important inside conditions including transient ischemic attacks TIAs, head injury, and meningitis.
