Шаблон неврологического осмотра: Медицинские бланки скачать бесплатно

Оценка неврологического статуса — описание методики, фотографии, стоимость

Оценка неврологического статуса является ведущим средством нейромониторинга. Объясняется это двумя причинами. Первая – это то, что в большинстве реанимационных отделений динамический неврологический осмотр является единственным быстрым и доступным способом оценки состояния головного мозга и определения эффективности проводимой терапии. Вторая причина особого внимания к неврологическому осмотру заключается в том, что конечная цель любых лечебных мероприятий – не достижение тех или иных показателей внутричерепного давления и церебральное перфузионное давление, содержание кислорода и метаболитов, а улучшение функционального состояния головного мозга и исхода болезни.

НЕВРОЛОГИЧЕСКИЙ СТАТУС

Представлены основные симптомы и синдромы которые оценивает невролог при осмотре пациента.

Общемозговые симптомы

Норма: Сознание ясное – пациент контактен, полностью ориентирован в собственной личности, времени и месте, адекватен, выполняет все инструкции.

степень угнетения сознания (по классификации А. Н. Коновалова):

• оглушение (поверхностное, глубокое) – потеря внимания, затруднения концентрации, ответы на вопросы после их многократных повторений, быстрая истощаемость при беседе и др.
• сопор – открывание глаз при громком обращении или тормошении, болевой стимуляции; локализация источника тормошения (целенеправленная двигательная реакция) ;
• кома I – отсутствие открывания глаз в ответ на любые раздражители; нецеленаправленные двигательные реакции;
• кома II – отсутствие открывания глаз и двигательных реакций в ответ на любые раздражители;
• кома III – отсутствие открывания глаз и двигательных реакций в ответ на любые раздражители; атония мышц, арефлексия, отсутствие менингеального синдрома, нарушение функций дыхания и сердечно-сосудистой системы.

Ориентация в месте, времени, собственной личности. Доступность продуктивному речевому (вербальному) контакту.

Головная боль – локализация, характер, периодичность, сопутствующие симптомы, в какое время суток.
Несистемное головокружение — чувство проваливания, зыбкости, неустойчивости.

Системное головокружение — кажущиеся движения окружающих предметов или собственного тела.

Тошнота, рвота.

Менингеальные симптомы

Ригидность задних мышц шеи; симптом Кернига; симптом Брудзинского (верхний, средний, нижний).
Скуловой симптом Бехтерева; симптом Мондонези.
Фотофобия, фонофобия; головная боль; гиперестезия кожных покровов и слизистых.

Очаговые симптомы

Черепные нервы:

I пара (n. olfactorius). Обоняние не нарушено; гипосмия, аносмия (справа, слева) ; дизосмия, гиперосмия; обонятельные галлюцинации – есть, нет.
II пара (n. opticus). Острота зрения – не нарушена; амблиопия (снижение остроты зрения), амавроз (слепота) ; Поля зрения – не нарушены; скотома (выпадение участка поля зрения) ; гемианопсия: гомонимная (справа, слева), гетеронимная (битемпоральная, биназальная) ;
Зрительные галлюцинации – есть, нет.
III (n. oculomotorius) IV (n. trochlearis), VI (n. abducens). Произвольные движения глаз – в полном объеме, страбизм (косоглазие): сходящееся, расходящееся, по вертикали.
Зрачки OD > < = OS, деформированы; ширина зрачков: соответствует освещенности, миоз (узкие), мидриаз (широкие).
Фотореакции прямая, содружественная: сохранена, снижена, отсутствует (справа, слева).
Парез взора, тоническое отведение глаз: вправо, влево.
V (n. trigeminus). Чувствительность на лице – сохранена, снижена: невральный тип (I, II, III ветви) ; сегментарный тип (внутренняя, средняя, наружная скобки) ; проводниковый тип (справа, слева).
Сила жевательных мышц – сохранена; снижена (справа, слева).
Корнеальные рефлексы – сохранены, снижены, отсутствуют (справа, слева).
Мандибулярный рефлекс – не изменен, повышен.
VII (n. facialis). Мимическая мускулатура. Лицо симметрично, парез мимических мышц: центральный – сглажена носогубная складка, периферический – невозможность поднять бровь, зажмурить глаз, сглажена носогубная складка (справа, слева).
Нарушение вкуса на передних 2/3 языка (справа, слева) ;
Лакримация (слезотечение), сухость склеры; гиперакузия (повышенное звуковосприятие).
VIII (n. vestibulocohlearis). Слух сохранен, снижен, отсутствует (справа, слева). Вестибулярный синдром – отсутствует; системное головокружение; тошнота, рвота; нистагм (горизонтальный, вертикальный, ротаторный, крупно- мелко-размашистый), атаксия, снижение мышечного тонуса.
IX (n. glossopharingeus), X (n. vagus). Глотание – сохранено, а- дисфагия. Фонация –сохранена, а- дисфония. Артикуляция – сохранена, а- дизартрия.
Бульбарный синдром – парез мягкого неба (справа, слева), снижение глоточного рефлекса (справа, слева). Псевдобульбарный синдром – парез мягкого неба с 2-х сторон (есть, нет), повышение глоточных рефлексов (есть, нет), рефлексы орального автоматизма (дистанс–оральный, ладонно-подбородочный, назо-лабиальный, хоботковый), насильственный смех или плач. Нарушение вкуса на задней 1/3 языка (справа, слева). Сухость во рту (есть, нет) .
XI (n. accessorius). Сила трапецевидной мышцы, сила кивательной мышцы (не изменена, снижена, справа, слева).
XII (n. hypoglossus). Язык по средней линии, девиация языка вправо, влево; гипотрофия языка, фибрилляции (есть, нет).

Двигательная система

Объем активных движений в конечностях – полный, ограничен (проба Барре верхняя и нижняя; проба с противоудержанием, пронационный феномен, сиптом ротираванной стопы Боголепова и др. )
Гемипарез, монопарез, тетрапарез, парапарез со снижением мышечной силы до___ баллов в руке и ___ баллов в ноге (справа, слева).
Мышечный тонус – не изменен, повышен: спастический, пластический; снижен (в каких группах мышц).
Сухожильные рефлексы – не изменены, снижены, повышены (с сухожилия бицепса С5-6, трицепса С7-8, коленный L2-4, ахиллов S1-2) справа, слева.
Клонусы – подбородка, кисти, ягодичных мышц, коленной чашечки, стопы, (справа, слева).
Периостальные рефлексы – карпо-радиальный С5-8 (не изменен, снижен, повышен, справа, слева).
Поверхностные рефлексы – брюшные, кремастерный, подошвенные (не изменены, снижены).
Патологические рефлексы – разгибательные (Бабинского, Оппенгейма, Гордона, Шеффера и др. ), сгибательные (Якобсона-Ласка, Россолимо, Бехтерева I и II, Жуковского и др. ).
Защитные рефлексы – укоротительный, удлинительный (уровень с которого вызывается рефлекс).
Патологические синкинезии – глобальная, координаторная, имитационная.
Фасцикуляции, фибрилляци (в каких группах мышц).
Гипоторофия, гипертрофия (в каких группах мышц).
Тремор (в покое, при движениях, частота).
Гиперкинезы – хорея, атетоз, тремор, миоклонии, тики (простые/сложные; моторные, вокальные), дистонии (блефароспазм, оромандибулярная, ларингеальная, спастическая кривошея, писчий спазм, дистония стопы, торсионная дистония).

Система координации

Статическая атаксия – поза Ромберга, проба на синергию Бабинского.
Динамическая атаксия – пальценосовая, пяточноколенная, указательная проба, симптом Стюарта-Холмса, проба Шильдера, проба на диадохокинез, пробы на дисметрию (отрицательные, положительные).
Скандированная речь. Нистагм. Микро- или мегалография.
Походка – не изменена, атактическая, степпаж, штампующая, проба «звезды».

Система чувствительности

Виды чувствительности:

• Поверхностная чувствительность: болевая, температурная, тактильная;
• Глубокая чувствительность: суставно-мышечное чувство, вибрационная, кинестетическая, чувство давления и веса;
• Сложные виды чувствительности: дискриминационная чувствительность, чувство локализации, двумерно-пространственное чувство.

Характер нарушений чувствительности:

• Анестезия – полная потеря того или иного вида чувствительности;
• Гепестезия – снижение того или иного вида чувствительности;
• Гиперестезия – повышение того или иного вида чувствительности;
• Гиперпатия – извращение чувствительности с неприятной болью;
• Дизестезия – извращение чувствительности (холодное кажется, горячим; прикосновение – как боль) ;
• Парестезии – ощущение холода, онемения, покалывания, ползания «мурашек» возникающее без нарушения внешних раздражений;
• Боли – ноющие, тупые, колющие, пульсирующие, режущие и др.

Типы распределения нарушений чувствительности:

• невральный – указать нерв;
• полиневритичекий – «носки» и/или «перчатки»;
• сегментарный (корешковый) – указать сегмент, наличие боли, симптомов натяжения;
• сегментарный диссоциированный – указать сегмент;
• проводниковый спинальный – моно, геми, пара, тетра тип; уровень поражения по сегментам;
• проводниковый церебральный – моно, геми тип, тетра тип.

(Рис. 1)

Высшие психические функции

Афазии:

• Эфферентная моторная (Брока) – полное отсутствие экспрессивной речи/эмбол/персеверации;
• Афферентная моторная – нарушение произнесения близкоартикулируемых звуков (стол-слон-стон) ;
• Сенсорная (Вернике) – нарушение экспрессивной речи и импрессивной речи (литеральные и вербальные парафазии «словесный салат») ;
• Оптико-мнестическая – нарушения связей между зрительным образом предмета и его названием;
• Акустико-мнестическая – снижение слухо-речевой памяти, невозможность запомнить серию из 3-5-10 слов, обеднение речи;
• Семантическая – нарушение понимания сложных логико-граматических конструкций («Отец брата, брат отца. Один и тот же человек?») временных и сравнительных отношений («Квадрат под кругом, круг над квадратом. Какой предмет выше?»), предлогов.
• Динамическая – отсутствует развернутая речь, нет даже элементарных фраз.
• Тотальная; сенсо-моторная.

Апраксии:

• Кинетическая – тест «кулак-ребро-ладонь»;
• Кинестетическая – тест «перенес позы».

Агнозии: зрительная (предметная, лицевая, буквенная, симультантная), слуховая, обонятельная, вкусовая, астереогнозия, анозогнозия, аутотопогнозия.

Амнезии: нарушение краткосрочной памяти, нарушения долгосрочной памяти.

Вегетативная система

Дермографизм – красный, белый, разлитой, возвышенный.
Симптом Бернара-Горнера (симпатическая денервация глаза) – сужение глазной щели, миоз, гипогидроз 1/2 лица (справа, слева).
Клиностатическая проба – ЧСС, АД стоя ЧСС, АД лежа .
Ортостатическая проба – ЧСС, АД лежа ЧСС, АД стоя ,

90000 Neurological Examination Templates — NeurologyResidents 90001 90002 90003 GEN 90004: NAD, pleasant, cooperative 90005 90002 90003 CVS 90004: RRR, no carotid bruit 90005 90002 90003 CHEST 90004: No signs of resp distress, on room air 90005 90002 90003 ABD 90004: Soft, NTTP 90005 90002 90003 NEURO 90004 90005 90002 90003 MENTAL STATUS: 90004 AAOx3, memory intact, fund of knowledge appropriate 90005 90002 90003 LANG / SPEECH 90004: Naming and repetition intact, fluent, follows 3-step commands 90005 90002 90003 CRANIAL NERVES: 90004 90005 90002 II: Pupils equal and reactive, no RAPD, no VF deficits, normal fundus 90005 90002 III, IV, VI: EOM intact, no gaze preference or deviation, no nystagmus.90005 90002 V: normal sensation in V1, V2, and V3 segments bilaterally 90005 90002 VII: no asymmetry, no nasolabial fold flattening 90005 90002 VIII: normal hearing to speech 90005 90002 IX, X: normal palatal elevation, no uvular deviation 90005 90002 XI: 5/5 head turn and 5/5 shoulder shrug bilaterally 90005 90002 XII: midline tongue protrusion 90005 90002 90003 MOTOR 90004: 90005 90002 5/5 muscle power in Rt shoulder abductors / adductors, elbow flexors / extensors, wrist flexors / extensors, finger abductors / adductors.5/5 in Rt hip flexors / extensors, knee flexors / extensors, ankle dorsiflexors and planter flexors. 90005 90002 90005 90002 5/5 muscle power in Lt shoulder abductors / adductors, elbow flexors / extensors, wrist flexors / extensors, finger abductors / adductors. 5/5 in Lt hip flexors / extensors, knee flexors / extensors, ankle dorsiflexors and planter flexors. 90005 90002 90005 90002 90003 REFLEXES 90004: 2/4 throughout, bilateral flexor planter response, no Hoffman’s, no clonus 90005 90002 90003 SENSORY 90004: 90005 90002 Normal to touch, pinprick, vibration, temp all limbs 90005 90002 No hemineglect, no extinction to double sided stimulation (visual & tactile) 90005 90002 Romberg absent 90005 90002 90003 COORD 90004: Normal finger to nose and heel to shin, no tremor, no dysmetria 90005 90002 90003 STATION 90004: normal stance, no truncal ataxia 90005 90002 90003 GAIT 90004: Normal; patient able to tip-toe, heel-walk.90005 .90000 Sample Write-Ups 90001 90002 Sample Write-Ups 90003 90004 Sample Neurological H & P 90005 90006 CC: 90007 90008 The patient is a 50-year-old right-handed woman with a history of chronic headaches who complains of acute onset of double vision and right eyelid droopiness three days ago. 90009 90006 History of present illness: 90007 90008 Mrs. Smith states that on Sunday evening (7/14/03) about 20 minutes after sitting down to work at her computer, she developed blurred vision, which she describes as the words on the computer looking fuzzy and seeming to run into each other.When she looked up at the clock on the wall, she had a hard time making out the numbers. At the same time, she also noted a strange sensation in her right eyelid. She went to bed and upon awakening the following morning, she was unable to open her right eye. When she lifted the right eyelid with her fingers, she had double vision with the objects appearing side by side. The double vision was most prominent when she looked to the left, but was also present when she looked straight ahead, up, down, and to the right, and went away when she closed either of her eyes.She also noted that she had pain in both of her eyes that increased if she moved her eyes around, especially on looking to the left. She was seen in the Alton Memorial Hospital ER and subsequently transferred to BJH by ambulance. 90009 90008 Mrs. Smith also notes that for the past two to three weeks, she has been having intermittent pounding bifrontal headaches that worsen with straining, such as when coughing or having a bowel movement. The headaches are not positional and are not worse at any particular time of day.She rates the pain as 7 or 8 on a scale of 1 to 10, with 10 being the worst possible headache. The pain lessened somewhat when she took Vicodin that she had lying around. She denies associated nausea, vomiting, photophobia, loss of vision, seeing flashing lights or zigzag lines, numbness, weakness, language difficulties, and gait abnormalities. Her recent headaches differ from her «typical migraines,» which have occurred about 4-6 times per year since she was a teenager and consist of seeing shimmering white stars move horizontally across her vision for a couple minutes followed by a pounding headache behind one or the other eye, photophobia, phonophobia, and nausea and vomiting lasting several hours to two days.She has never taken anything for these headaches other than ibuprofen or Vicodin, both of which are partially effective. The last headache of that type was two months ago. 90009 90008 Her visual symptoms have not changed since the initial presentation. She denies previous episodes of transient or permanent visual or neurologic changes. She denies head trauma, recent illness, fever, tinnitus or other neurologic symptoms. She is not aware of a change in her appearance, but her husband notes that her right eye seems to protrude; he thinks that this is a change in the last few days.90009 90006 Past medical history: 90007 90020 90021 Migraine headaches, as described in HPI. 90022 90021 Depression. There is no history of diabetes or hypertension. 90022 90025 90006 Medications: 90007 90008 Zoloft 50 mg daily, ibuprofen 600 mg a few times per week, and Vicodin a few times per week. 90009 90006 Allergies: 90007 90008 None. 90009 90006 Social history: 90007 90008 The patient lives with her husband and 16-year-old daughter in a 2-story single-family house and has worked as a medical receptionist for 25 years.She denies tobacco or illicit drug use and rarely drinks a glass of wine. 90009 90006 Family history: 90007 90008 Her mother had migraines and died at the age of 70 after a heart attack. Her maternal grandfather had a stroke at age 69. There is no other family history of stroke or vascular disease, but she has no information about her father’s side of the family. 90009 90006 Review of systems: 90007 90008 She states that she had an upper respiratory infection with rhinorrhea, congestion, sore throat, and cough about 6 weeks ago.She denies fever, chills, malaise, weight loss, neck stiffness, chest pain, dyspnea, abdominal pain, diarrhea, constipation, urinary symptoms, joint pain, or back pain. Neurologic complaints as per HPI. 90009 90006 General physical examination: 90007 90008 The patient is obese but well-appearing. Temperature is 37.6, blood pressure is 128/78, and pulse is 85. There is no tenderness over the scalp or neck and no bruits over the eyes or at the neck. There is no proptosis, lid swelling, conjunctival injection, or chemosis.Cardiac exam shows a regular rate and no murmur. 90009 90006 Neurologic examination: 90007 90008 90053 Mental status: 90054 90055 The patient is alert, attentive, and oriented. Speech is clear and fluent with good repetition, comprehension, and naming. She recalls 3/3 objects at 5 minutes. 90009 90008 90053 ranial nerves: 90054 90055 CN II: Visual fields are full to confrontation. Fundoscopic exam is normal with sharp discs and no vascular changes. Venous pulsations are present bilaterally.Pupils are 4 mm and briskly reactive to light. Visual acuity is 20/20 bilaterally. 90009 90008 CN III, IV, VI: At primary gaze, there is no eye deviation. When the patient is looking to the left, the right eye does not adduct. When the patient is looking up, the right eye does not move up as well as the left. She develops horizontal diplopia in all directions of gaze especially when looking to the left. There is ptosis of the right eye. Convergence is impaired. 90009 90008 CN V: Facial sensation is intact to pinprick in all 3 divisions bilaterally.Corneal responses are intact. 90009 90008 CN VII: Face is symmetric with normal eye closure and smile. 90009 90008 CN VII: Hearing is normal to rubbing fingers 90009 90008 CN IX, X: Palate elevates symmetrically. Phonation is normal. 90009 90008 CN XI: Head turning and shoulder shrug are intact 90009 90008 CN XII: Tongue is midline with normal movements and no atrophy. 90009 90008 90053 Motor: 90054 90055 There is no pronator drift of out-stretched arms. Muscle bulk and tone are normal.Strength is full bilaterally. 90009 90081 90082 90083 90084 90085 90084 Deltoid 90085 90084 Biceps 90085 90084 Triceps 90085 90084 Wrist extension 90085 90084 Finger abduction 90085 90084 Hip flexion 90085 90084 Hip extension 90085 90084 Knee flexion 90085 90084 Knee extension 90085 90084 Ankle flexion 90085 90084 Ankle extension 90085 90108 90083 90084 L 90085 90084 5 90085 90084 5 90085 90084 5 90085 90084 5 90085 90084 5 90085 90084 5 90085 90084 5 90085 90084 5 90085 90084 5 90085 90084 5 90085 90084 5 90085 90108 90083 90084 R 90085 90084 5 90085 90084 5 90085 90084 5 90085 90084 5 90085 90084 5 90085 90084 5 90085 90084 5 90085 90084 5 90085 90084 5 90085 90084 5 90085 90084 5 90085 90108 90161 90162 90008 90053 Reflexes: 90054 90055 Reflexes are 2+ and symmetric at the biceps, triceps, knees, and ankles.Plantar responses are flexor. 90009 90008 90053 Sensory: 90054 90055 Light touch, pinprick, position sense, and vibration sense are intact in fingers and toes. 90009 90008 90053 Coordination: 90054 90055 Rapid alternating movements and fine finger movements are intact. There is no dysmetria on finger-to-nose and heel-knee-shin. There are no abnormal or extraneous movements. Romberg is absent. 90009 90008 90053 Gait / Stance: 90054 90055 Posture is normal. Gait is steady with normal steps, base, arm swing, and turning.Heel and toe walking are normal. Tandem gait is normal when the patient closes one of her eyes. 90009 90006 Laboratory Data: 90007 90008 (Record here all available lab data; circle any abnormal values). 90009 90008 CT (non-contrast) 7/17: no abnormalities. Orbits not well seen. 90009 90008 MRI 7/18: Multi-focal areas of increased signal on T2 and FLAIR in the deep white matter bilaterally. These range in size from 1 to 10 mm and do not enhance after administration of gadolinium. There are no signal abnormalities in the brain stem or in the corpus callosum.No abnormalities in orbits, sinuses, or venous structures. 90009 90006 Assessment: 90007 90008 In summary, the patient is a 50-year-old woman with longstanding headaches who has had an acute onset of pupil-sparing partial third nerve palsy on the right (involving levator palpabrae, superior rectus, and medial rectus) associated with a bifrontal headache. Because this is an isolated third nerve palsy without involvement of other cranial nerves or orbital abnormalities, the lesion is localized to the nerve itself, e.g. in the subarachnoid space. Ophthalmoplegic migraine remains a likely diagnosis given the history of migraine with aura, even though the current headache is different in character from her usual headaches and is not associated with visual aura, nausea / vomiting, or photophobia. However, other potentially serious causes of third nerve palsy must be excluded. If a third nerve palsy is due to a compressive lesion, the pupillary fibers will generally become involved within about one week of the onset of symptoms.So the fact that her pupil is normal in size and reactive to light weighs against the diagnosis of a compressive lesion such as an aneurysm or tumor, but does not eliminate the possibility. 90009 90008 The MRI does not show evidence of a mass lesion, but an aneurysm can not be completely excluded without an angiogram. Another potentially serious cause of the third nerve palsy is meningitis. The patient is afebrile, has no meningeal signs, is well-appearing, and has been stable over three days, making bacterial meningitis highly unlikely, but atypical meningitis including fungal, Lyme, sarcoid or carcinomatous meningitis are possibilities.Finally, the patient may have a vascular lesion of the third nerve due to unrecognized diabetes. 90009 90008 The appearance of the MRI abnormalities is non-specific. The lesions are potentially explainable by migraines, but are also consistent with hypertension or a vasculopathy. The patient denies a history of hypertension, is not currently hypertensive, and has no risk factors for vascular disease, but the possibility of a genetic disorder such as CADASIL can not be excluded given the lack of paternal history.90009 90006 Plan: 90007 90008 90053 Problem 1. R IIIrd nerve palsy. 90054 90055 The patient will undergo a cerebral angiogram to evaluate for an aneurysm, particularly a posterior communicating aneurysm. Patient has been informed of risks and benefits of this procedure and it is scheduled for AM. She will be kept NPO for the procedure. 90055 A lumbar puncture will be performed with opening pressure assessed and CSF sent for cell count and differential, protein, glucose, cultures and cytology.She will have her glucose and hemoglobin A1C drawn to evaluate for diabetes. 90055 She will have close observation for possible neurologic worsening including neuro checks every 4 hours for first 24 hours. 90055 She will be given an eye patch for comfort to eliminate the diplopia. 90009 90008 90053 Problem 2. Headache. 90054 90055 She will be given a trial of naprosyn 400 mg po bid; if this is ineffective, she may require narcotic analgesia while her evaluation is being completed. If the cerebral angiogram and lumbar puncture are negative and her headache does not improve, she may be a candidate for IV dihydroergotamine treatment.Despite the infrequency of her migraines, the occurrence of a debilitating migraine with neurological deficits warrants the use of a prophylactic agent. A tricyclic antidepressant would be a good choice given her history of depression. 90009 90008 90053 Problem 3. Depression. 90054 90055 The patient denies current symptoms and will continue Zoloft at current dose. 90009 90008 90053 Problem 4. Obesity. 90054 90055 The patient requests referral to a dietician. 90009 .90000 Neurological Exam — Learn Medical Neuroscience 90001 90002 90003 90004 90005 90002 Featured Video: Cranial Nerve VII -Motor Examination by DrBlogger, The University of Utah. 90005 90008 Neurological exam 90009 90002 The Neurological exam is vital in clinical neurology. Here are a few sites with excellent information on the Neurological exam and its possible components. For the Neuroanatomy needed for sound Neurological exam it is good to take a look at the Virtual lab, Unit A: Neuroanatomy 90005 90008 NeuroLogical Cases 90009 90014 90015 NeuroLogical Cases by University of Utah.On the NeuroLogic Exam Videos by University of Utah; Neurological Cases is especially relevant. The site presents four neurological cases. Of each case there is: 90014 90015 Case history 90018 90015 Neurological Examination 90018 90015 (Mental Status Exam, Cranial Nerve Exam, Coordination Exam, Sensory exam, Motor Exam, Gait, with video material) 90018 90015 Checklist of findings 90018 90015 Localize the Level (s) of the Lesion, Identify the Damaged Structures 90018 90015 Case Discussion 90018 90029 90018 90029 90008 Stroke Model 90009 90008 Clinical Neurology Videos 90009 90008 Neurological Phenomena 90009 90008 Dealing with Neurological Constraints 90009 90002 People that have to deal with neurological constraints give us an inside look in their life.It becomes clear that people can often adapt to great constraints and live a full life. You must never underestimate the power of the brain and the nervous system to recover and undergo plastic change. 90005 90042 Cochlear Implant 90043 90002 A Cochlear Implant Success Story. YouTube Video by SJC tv. This is an informative and touching short video. In the video Helen, who has been living with a cochlear implant for over a decade, tells her story. The implant enables her to take part in the hearing world at a very high level.Helen studies at a top university for a demanding science degree and even takes part in a dance sport team. But in the video Helen is also honest about the limitations of the technology. She reminds us that the implantation is a fairly major surgical intervention — nobody’s idea of ​​fun. 90005 90042 Proprioception 90043 90002 The Man Who Lost His Body. This man suffered a viral neuropathy at 19, and as a result he lost all large thick fibers in his DCML tract, from the neck down. Of course, this means no discriminative touch, and no proprioception (which seems to use the thickest fibers of them all).As a result he initially lost all ability to move. Not just standing or walking, but to move at all. He had to re-learn how to control his body, and he co-opted his vision to do the job of proprioception. He had to watch his limbs to be able to control them, especially his trunk and legs: he claims he has to wake up and see his body in order to turn at night! 90005 90042 Spinal Cord Injury 90043 90002 Searching for Answers: Spinal Cord Injury by BrainFacts.org. Meet a man living with a spinal cord injury and learn about the medical and technological breakthroughs that may aid his recovery.90005 90042 Broca’s aphasia 90043 90002 Dealing with Broca’s aphasia: Expressive aphasia, nine months after the stroke, YouTube video by SymphU and Expressive aphasia, five years after the stroke, YouTube video by SymphUK. 90005 90042 Parkinson’s disease 90043 90002 Parkinson Dances is an uplifting, poetic and emotional evocation of how the magic of dance helps people face the daily challenges of Parkinson’s and live life to the fullest. The English National Ballet helps Parkinson’s patients.Results of research on Parkinson and Dance are reported in this article: Effects of dance practice on functional mobility, motor symptoms and quality of life in people with Parkinson’s disease: a systematic review with meta-analysis. 90005 90042 Locked in syndrome 90043 90002 Harshada Rajani joined the MedNeuro Learning Communty in 2016. Harshada is a stroke survivor. She suffered a spontaneous vertebral artery dissection leading to a massive pontine stroke. Several monthsshe spent in hospital completely paralyzed bilaterally from head to toe.She has a condition called locked in syndrome, which is as horrifying and inescapable as the name implies — an intact brain trapped in a lifeless body with no movement and no voice. Ever since, she has spent every day in physical therapy, made some great progress, but still has a long way to go. With the support of family and friends, she is fighting furiously to regain her voice and her muscles, but in the meantime, she has found an even more powerful voice through her writing for the Huffington Post.90005 90042 Awake craniotomy 90043 90002 A video of a patient diagnosed with a glioblastoma, one of the most deadly forms of brain cancer, remain completely conscious while the neurosurgeon performs brain surgery to remove his tumor. Experience this precise surgery where the patient must stay awake to protect his language function and learn about the revolutionary brain tumor vaccine that is only available at a handful of medical centers nationwide 90005 90042 Copyright 90043 90002 Respect the copyright of the sites this page links to.Refrain from sharing images from Sinauer publications (Neuroscience and Biological Psychology). Images in OpenStax College publications have Creative Commons 4.0 License. Featured videos: only YouTube and Vimeo videos with a «Share» button have been embedded. If the owner enables the Share button, it means that they allow others to embed the video. If the copyright owner of the video has made a mistake and does not want the video embedded despite the Share button, please inform me. I will remove the video immediately.-Ellen- 90005 .90000 Upper Limb Neurological Examination · Neurology · OSCE Skills · Medistudents 90001 90002 Foreword 90003 90004 The upper limb examination is another skill to elicit neurological signs, such as nerve problems that supply the arms and hands. Patients may present with a number of complaints including altered sensation, for example: pins and needles or numbness or loss of power of a limb, it may be intermittent such as multiple sclerosis or permanent such as in motor neurone disease.90005 90004 Neuropathies can also occur and can be mono such as wrist drop or Erb’s palsy or poly such as «glove and stocking» which can occur in diabetes mellitus. 90005 90004 A full neurological examination therefore includes assessment of both the motor and sensory systems of the legs. In exams you may be asked to focus on one part, such as the sensory or the motor. For reference, this guide, will include both. 90005 90004 See Lower Limb Neurological Examination for how to perform this on the lower limbs.90005 90012 90004 90002 Procedure Steps 90003 90005 90017 Step 01 90018 90004 As with all examinations, the best method is your own — one with which you are comfortable and familiar. The one explained here takes the following format: 90005 90021 90022 Tone. 90023 90022 Power. 90023 90022 Reflexes. 90023 90022 Function. 90023 90022 Sensation. 90023 90032 90017 Step 02 90018 90004 Wash your hands, introduce yourself to the patient and clarify their identity.Explain the procedure you about to perform and and obtain consent. 90005 Advertisement 90037 90017 Step 03 90018 90004 The upper body should be exposed for this examination. Initially, observe the patient’s arms, look for any muscle wasting, fasciculations or asymmetry. 90005 90042 Observe the patients arms, look for any muscle wasting, fasciculations or asymmetry 90017 Step 04 — Tone 90018 90004 Start proximally at the shoulder, feeling how easy the joint is to move passively.Then move down to the elbow, wrist and hand joints, again assessing each one’s tone in turn. 90005 90047 Assess arm tone 90048 Assess elbow, wrist and hand joints 90017 Step 05 — Power 90018 90004 Start at the shoulder asking the patient to abduct and adduct against your hand so you can assess how much force they can overcome.Do the same for flexion and extension at the elbow and wrist, as well as the fingers; also checking abduction and adduction of the thumb. 90005 90053 Assess power of the shoulders 1 90054 Assess power of the shoulders 2 90055 Elbow flexion 90056 Elbow extension 90057 Wrist flexion 90058 Wrist extension 90059 Finger flexion 90060 Finger extension 90061 Finger abduction 90062 Abduction of the thumb 90063 Biceps Reflex 90064 90004 The biceps reflex is tested by supporting the patient’s arm, with it flexed at roughly 60 degrees, placing your thumb over the biceps tendon and hitting your thumb with the tendon hammer.It is vital to get your patient to relax as much as possible and for you to take the entire weight of their arm. 90005 90067 Bicep reflex test right 90068 Bicep reflex test left 90063 Triceps Reflex 90064 90004 The triceps reflex is elicited by resting the patient’s arm across their chest and hitting the triceps tendon just proximal to the elbow.90005 90073 Triceps reflex test right 90074 Triceps reflex test left 90063 Supinator Reflex 90064 90004 Finally, with their arm rested on their abdomen, locate the supinator tendon as it crosses the radius, place three fingers on it and hit the fingers. This should give the supinator reflex.If you struggle with any of these reflexes, asking the patient to clench their teeth should exaggerate the reflex. 90005 90079 Supinator reflex test right 90080 Supinator reflex test left 90017 Step 10 — Function 90018 90004 To assess the upper limb, you should ask the patient to touch their head with both hands and then ask them to pick up a small object such as a coin which each hand.90005 90017 Step 11 — Sensation 90018 90004 You should test light touch, pin prick, vibration, and joint position sense, or proprioception. 90005 90063 Light Touch 90064 90004 Ask the patient to place their arms by their sides with their palms facing forwards. Lightly touch the patient’s sternum with a piece of cotton wool so that they know how it feels. 90005 90004 Then, with the patient’s eyes shut, lightly touch their arm with the cotton wool.The places to touch them should test each of the dermatomes — make sure you know these! Tell the patient to say «yes» every time they feel the cotton wool as it felt before. 90005 90095 Touch sensation with cotton wool 90063 Pin Prick 90064 90004 Repeat the last step using a light pin prick. 90005 90100 Touch sensation with pin prick 90063 Vibration 90064 90004 To assess vibration you should use a sounding tuning fork.Place the fork on the patient’s sternum to show them how it should feel. 90005 90004 Now place it on the bony prominence at the base of their thumb and ask them if it feels the same. If it does, there is no need to check any higher. If it feels different you should move to the radial stylus and then to the olecranon until it feels normal. 90005 90107 Vibration test using a sounding tuning fork 90063 Proprioception 90064 90004 Finally assess proprioception.Hold the distal phalanx of the thumb on either side so that you can flex the interphalangeal joint. 90005 90004 Show the patient that when you hold the joint extended, that represents 90113 Up 90114 whereas when you hold it flexed that represents 90113 Down 90114. Ask the patient to close their eyes and, having moved the joint a few times hold it in one position — up or down. Ask the patient which position the joint is in. 90005 90118 Thumb position up 90119 Thumb position down 90002 Conclusion 90003 90004 Allow the patient to dress and thank them.90005 90004 Wash your hands and report your findings to the examiner. 90005 Advertisement 90037 .