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Neurological Examination
Neel Burton, John A Goodfellow
CHAPTER 1:
Clinical skills in neurology
1.1 The consultation
1.2 The neurological history
Meeting the patient
Presenting complaint
History of presenting complaint
Time course
Neurological systems review
Past medical history
Social history
Family history
Drug history
Systems review
1.3 The neurological examination
1.4 Case summary and synthesis
1.5 Presenting patients
1.6 The junior doctor's neurology toolkit
1.7 Ethicolegal considerations
Driving restrictions
Expectations of imaging
CHAPTER 2:
Gait and general inspection
2.1 Anatomy and physiology review
Sensory input
Pyramidal system
Basal ganglia/extrapyramidal system
Cerebellum
2.2 Clinical features and pathophysiology
General inspection
Syndromes
Non-neurological disease
Pronator drift
Wasting and fasciculations
Abnormal posture
Abnormal movement
Gait
Symmetrical abnormal gait
Asymmetrical gait
The functional gait
2.3 General inspection
Objective
Approach
Sequence
Key differential diagnoses
What happens next?
2.4 Abnormal posture and movements
Objective
Approach
Equipment
Sequence
Key differential diagnoses
Abnormal posture
Abnormal movement
What happens next?
2.5 Assessing gait
Objective
Approach
Equipment
Sequence
Key differential diagnoses
What happens next?
2.6 System summary
CHAPTER 3:
Head and neck (cranial nerves)
3.1 Objectives
3.2 Anatomy and physiology review
The pupillary reflexes
Light reflex
Accommodation reflex
3.3 Clinical features and pathophysiology
CN II
Swollen optic disc
Pale disc
Diabetic retinopathy
Hypertensive retinopathy
Central retinal artery occlusion
Central retinal vein thrombosis
Hemianopia
Pupils
Dilated pupil
Constricted pupil
CN III, IV, VI
Ptosis
Down and out
Tilted head
Lateral rectus palsy
CN V
Absent corneal reflex
Trigeminal neuralgia
Brisk jaw jerk
CN VII
Facial asymmetry
CN VIII
Conductive hearing loss
Sensorineural deafness
CN IX, X
Displaced uvula
Abnormal gag reflex
Laryngeal nerve palsy
CN XI
Weakness of trapezius or sternocleidomastoid
CN XII
Slow and spastic tongue
Wasted tongue
3.4 General observations
Objective
Approach
Equipment
Sequence
Key differential diagnoses
What happens next?
3.5 The nose (CN I)
Objective
Approach
Equipment
Sequence
Key differential diagnoses
What happens next?
3.6 The eyes: part 1 (CN II and III) (pupils, acuity, fields, fundi)
Objective
Approach
Equipment
Sequence
Pupils
Acuity
Colour vision
Fields
Fundoscopy
Key differential diagnoses
Pupils
Acuity
Visual field defects
Fundi
What happens next?
3.7 The eyes: part 2 (CN III, IV, VI)
Objective
Approach
Equipment
Sequence
Assessing saccades
Key differential diagnoses
What happens next?
3.8 The face (CN V, VII)
Objective
Approach
Equipment
Sequence
CN V
CN VII
Corneal reflex (CN V and VII)
Key differential diagnoses
CN V motor lesion
CN V sensory lesion
CN VII motor lesion
What happens next?
3.9 The ears (CN VIII)
Objective
Approach
Equipment
Sequence
Rinne's test
Weber's test
The vestibular nerve
Hallpike's manoeuvre
Key differential diagnoses
Deafness: sensorineural
Deafness: conductive
Vestibular lesion
What happens next?
The Epley manoeuvre
3.10 The mouth (CN IX, X, XII)
Objective
Approach
Equipment
Sequence
Key differential diagnoses
Findings
Central
Peripheral
What happens next?
3.11 The neck (CN XI)
Objective
Approach
Sequence
Key differential diagnoses
Central
Peripheral
Lymphadenopathy
What happens next?
3.12 System summary
CHAPTER 4:
Upper limbs
4.1 Objectives
4.2 Anatomy and physiology review
Upper and lower motor neurons
Musculocutaneous nerve
Axillary nerve
Radial nerve
Median nerve
Ulnar nerve
Brachial plexus
Sensory function
4.3 Clinical features and pathophysiology
General inspection
Patterns of weakness
Patterns of sensory disturbance
Pain
Paraesthesia
Sensory loss
4.4 General observations
Objective
Approach
Sequence
Key differential diagnoses
What happens next?
4.5 Tone
Objective
Sequence
Key differential diagnoses
What happens next?
4.6 Power
Objective
Approach
Sequence
Testing muscle strength
Key differential diagnoses
Flaccid weakness
Spastic weakness
What happens next?
4.7 Reflexes
Objective
Approach
Equipment
Sequence
Key differential diagnoses
What happens next?
4.8 Co-ordination
Sequence
Key differential diagnoses
What happens next?
4.9 Sensation
Objective
Approach
Equipment
Sequence
Lateral columns
Dorsal columns
Vibration
Proprioception
Key differential diagnoses
What happens next?
4.10 System summary
CHAPTER 5:
Lower limbs
5.1 Objectives
5.2 Anatomy and physiology review
Upper and lower motor neurons
Gluteal nerve
Femoral nerve
Obturator nerve
Sciatic nerve
Common peroneal
Tibial
The lumbosacral plexus
Intervertebral discs
5.3 Clinical features and pathophysiology
Intervertebral disc prolapse
Cervical and thoracic disc prolapse
Lumbar disc prolapse
5.4 General observations
Objective
Approach
Sequence
Key differential diagnoses
What happens next?
5.5 Tone
Objective
Sequence
Key differential diagnoses
What happens next?
5.6 Power
Objective
Approach
Sequence
Key differential diagnoses
UMN lesion
LMN lesion
What happens next?
5.7 Reflexes
Objective
Approach
Equipment
Sequence
Key differential diagnoses
What happens next?
5.8 Co-ordination
Objective
Sequence
Key differential diagnoses
What happens next?
5.9 Sensation
Objective
Approach
Equipment
Sequence
Lateral columns
Dorsal columns
Vibration
Proprioception
Key differential diagnoses
What happens next?
5.10 System summary
CHAPTER 6:
Cerebellum
6.1 Objectives
6.2 Anatomy and physiology review
6.3 Clinical features and pathophysiology
Vertigo
Ataxia
Nystagmus
Intention tremor
Speech disturbance
Hypotonia
Dysdiodochokinesia
6.4 General observations
Objective
Approach
Sequence
Key differential diagnoses
What happens next?
6.5 VANISHD
Objective
Approach
Sequence
Vertigo
Ataxia
Nystagmus
Intention tremor
Speech
Hypotonia
Dysdiodochokinesia
Key differential diagnoses
Developmental or hereditary
What happens next?
6.6 System summary
CHAPTER 7:
Higher cortical function
7.1 Objectives
The mini-mental state examination
The Revised Addenbrooke's Cognitive Examination
7.2 Anatomy and physiology review
Attention and orientation
Language
Visuoperceptual function and calculation
Memory
Executive function
7.3 Clinical features and pathophysiology
Attention and orientation
Language
Comprehension
Reading
Writing
Speech
Visuoperceptual function and calculation
Memory
Executive function
7.4 Bedside testing of cognitive domains
Objective
Approach
Equipment
Sequence
Orientation
Attention
Language
Visuoperceptual function and calculation
Memory
Executive function
Cortical release signs
Key differential diagnoses
Mild cognitive impairment
Alzheimer's disease
Vascular dementia
Frontotemporal dementia
Dementia with Lewy bodies
Progressive supranuclear palsy
Corticobasal degeneration
What happens next?
7.5 System summary
CHAPTER 8:
Autonomic nervous system
8.1 Objectives
8.2 Anatomy and physiology review
Sympathetic nervous system
Parasympathetic nervous system
8.3 Clinical features and pathophysiology
8.4 History
Objective
Approach
Sequence
8.5 Bedside examination and tests
Objective
Approach
Equipment
Sequence
Key differential diagnoses
What happens next?
8.6 System summary
CHAPTER 9:
Examining the stroke patient
9.1 Objectives
9.2 Anatomy and physiology review
9.3 Clinical features and pathophysiology
Lacunar syndrome
Partial anterior circulation syndrome
Total anterior circulation syndrome
Posterior circulation syndrome
Hemispheric dominance
9.4 Stroke history
Objective
Approach
Sequence
Key differential diagnoses
What happens next?
9.5 Stroke neurological examination
Objective
Approach
Equipment
Sequence
Key differential diagnoses
What happens next?
9.6 Stroke general examination
Objective
Equipment
Sequence
Cardiovascular
Respiratory
Gastrointestinal
What happens next?
CT
9.7 Thrombolysis
Objective
Approach
Equipment
Sequence
What happens next?
9.8 System summary
CHAPTER 10:
Examining the coma patient
10.1 Objectives
10.2 Anatomy and physiology review
10.3 Clinical features and pathophysiology
Brainstem lesions
Eyes
Pupils
Ocular reflexes
Breathing pattern
Cortical lesions
Posture
10.4 General observations
Objective
Approach
Equipment
Sequence
Key differential diagnoses
What happens next?
10.5 Eyes and reflexes
Objective
Approach
Equipment
Sequence
Key differential diagnoses
Gaze paresis and eye movements
Pupils
Tone and limb reflexes
Oculovestibular reflexes
What happens next?
10.6 System summary
CHAPTER 11:
The neurological screening examination in 4 minutes
11.1 Objectives
11.2 Sequence
CHAPTER 12:
The neurological examination in undergraduate exams
12.1 Objectives
12.2 Common conditions in examinations
12.3 Examination instructions
12.4 Questions and answers
Further reading
INDEX
TOC
Index
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