The Neurologic Examination

Dr. Heidi BarnesNeurology Resident

Anatomic LocalizationEvery anatomic location has unique clinical signsNeurology examination tests for those clinical signsYou must perform and interpret the examination properly to have it help!

Rostral to the Foramen MagnumCerebrum/telencephalonThalmus/diencephalonMidbrain/mesencephalonPons/metencephalonMedulla oblongata/myelencephalonCerebellum/part of metencephalon

Lesion LocalizationTelencephalon/Diencephalon

Mentation changes: depression, dementia, stupor, comaSeizures (ALWAYS!!!)Basal Ganglia: LIMITED (cerebrospinal tracts) motor to limbs.

• Horse: lips, face• Dog: Upper forelimbs• Cat: Complete forelimbs• Human/Chimp: hands

Circling toward lesion, NO head tilt!Blindness: intact PLR, no menace

Localization for the BrainstemI. OlfactoryII. OpticIII. OculomotorIV. TrochlearV. TrigeminalVI. Abducens

VII. FacialVIII. VesibulocochlearIX. GlossopharingealX. VagusXI. Spinal AccessoryXII. Hypoglossal

Motor tracts (red nucleus, reticulospinal tracts) cross in midbrain.

Cranial Nerve Evaluation

Menace: II and VIIPLR: II and III (parasympathetic part)Strabismus

Static: III, IV, VIPositional: VIII

Nystagmus: VIII

Ear/lip/eye twitch: V and VIITemporal/masseter muscle: VGag: IX and XTrapezius muscle: XITongue movement: XII

Spinal Cord LocalizationDivided into cord segments based on the anatomic actionUpper motor neuron: cell body originating rostral to the foramen magnumLower motor neuron: cell body originating in the spinal cord

Spinal Cord SegmentsC1-C5: Upper Motor Neuron all 4 limbsC6-T2: Lower Motor Neuron front

limbs Upper Motor Neuron pelvic

limbsT3-L3: Upper Motor Neuron pelvic

limbsL4-S3: Lower Motor Neuron pelvic limbs

C1-C5 T3-L3 L4-S3C6-T2

Postural Reactions – Upper Motor Neuron Function

Hopping, placing, conscious proprioceptionNeed lower motor neurons intactBUT also uses white matter of spinal cord

Reflex Arch- Lower Motor Neuron Function

MuscleSensory

Motor

Spinal Reflexes – Thoracic Limb Biceps brachii: musculocutaneousTriceps: radial nerveExtensor Carpi radialis: radial nerveWithdrawal: axillary median/ulnar musculocutaneous radial

Spinal Reflexes – Pelvic LimbPatellar: Femoral (L4-5)Sciatic: Sciatic (L6-S2)

Cranial tibial: peroneal (L6-7)Gastrocnemius: tibial (L7-S1)

Withdrawal: Sciatic (L6-S2)

Withdrawal is not conscious!!Withdrawal is not conscious!!

Practice Makes Perfect