| |
| |
|
Medicine Information |
|
|
|
The Neurological Exam: Evaluating the Master Organ
How does a mind contemplate itself? That's a philosophical question I'll leave to minds smarter than mine, but what I can tell you is how to examine the brain and other parts of the nervous system. Most people are familiar with how doctors examine a heart or set of lungs. The physical exam of these organs consists mainly of using a stethoscope to listen to them in action. But when it comes to examining components of the nervous system-consisting of the brain, spinal cord, peripheral nerves and muscles-a stethoscope is pretty useless. The nervous system doesn't make sounds that the doctor can listen to (though the arteries in the neck that deliver blood to the brain can be usefully listened to). But because people can have medical disorders that damage the nervous system, it is every bit as important to have a method for evaluating this organ as for any other. The method is called the neurological exam. Because different parts of the nervous system do different things, the basic idea of the neurological exam is to put the patient through a number of mini-exams, each evaluating the function of a different component. And what a variety of functions there are! In fact, apart from exposure to an inspiring teacher, this is what drew me into the study of neurology in the first place-the sheer diversity of the neurological exam. This is an organ responsible for jobs as diverse as thinking, remembering, smelling, tasting, seeing, hearing, speaking, moving, walking, balancing, feeling and, yes, even contemplating itself-though I confess that my neurological exam doesn't include an assessment of self-contemplation. Moreover, the nervous system handles many infrastructure tasks like controlling body-temperature, pulse, blood-pressure, breathing and enabling a person to urinate at a time and place of their choosing. What's not to admire about an organ system that can do so many things! The many mini-tests of the neurological exam are bundled together in the following sub-groupings: mental status exam, cranial nerve exam, motor exam, sensory exam and evaluation of stance and walking. I'll provide a brief overview of each. The mental status exam focuses on the cerebrum which has a wrinkly, gray, outer surface usually shown in pictures of the brain. The cerebrum is divided into eight lobes which includes pairs of frontal lobes, parietal lobes, temporal lobes and-bringing up the rear-the occipital lobes. Each handles different mental tasks. In fact, even within a lobe, many different jobs are handled. So the usual mental status exam consists of observing the patient's behavior in the exam room and using a variety of standard tests to check the patient's orientation to time and place, attention, memory, speech, comprehension of language, memory, calculation and ability to track the relative positions of objects in space. The next grouping of mini-tests, the cranial nerve exam, also assesses the functioning of parts of the cerebrum, but additionally focuses on the brainstem. The brainstem is located at the base of the brain and connects the cerebrum above to the spinal cord below. The cranial nerve exam includes tests of smelling, vision, constriction of the pupils, eye-movement, facial sensation, facial movement, hearing, and action of certain muscles in the throat, tongue, neck and shoulders. I'll single out one item on the cranial nerve exam as deserving special mention, and that is the visual field exam. The visual fields are evaluated one eye at a time. While the patient stares at an unmoving object, the doctor asks if the patient can see objects (like the doctor's fingers) appearing in different locations of the patient's peripheral vision. In order to detect objects in the four corners of each eye's vision, the patient must have proper functioning of each of six lobes of the brain-both parietal lobes, both temporal lobes and both occipital lobes. In fact, this is the only portion of the entire neurological exam that checks the right temporal lobe. Despite its importance, the visual field exam sometimes gets skipped by medical students (in which case the ones under this author's supervision must endure hearing an earful). The motor exam includes some pretty obvious things like checking the strength of different muscles in the arms and legs, but also includes less obvious components like muscle tone, coordination, and the presence of involuntary movements. It also includes an inspection of muscles for loss of size or the presence of spontaneous twitches. Additionally, this is the part of the exam in which the doctor pulls out his or her rubber hammer and checks reflexes in the arms and legs. The motor exam also includes a briefly painful maneuver-called the Babinski test-in which the bottom of the foot is scraped with a metal object while the doctor observes for a reflexive response in certain foot-muscles. The sensory exam focuses on the processing of inputs from sensory nerve-endings in the patient's skin and joints. It can include awareness of light touch, pain, warmth, coldness and vibration. In addition, the doctor examines position-sense by moving the patient's toes and fingers up or down and asking the patient to say, without looking, which way they moved. Finally, we have those portions of the exam related to stance and walking, but also including the patients' ability to transfer in and out of their chair. While on their feet, patients are asked to walk in their usual fashion, as well as on tiptoes. They are also observed while doing a "tandem gait," known more commonly as the "state trooper test," in which they walk flat-footed in a straight line with the heel of the leading foot touching the toes of the trailing foot. Last, the doctor checks the patients' ability to remain standing after closing their eyes. This is called the Romberg test. That's about it. In the hands of experienced clinicians the neurological exam doesn't take much longer to perform than to describe, and yet provides a wealth of information about the functioning of the patient's nervous system. In this age of high-tech imaging devices the neurological exam might seem archaic or old-fashioned, but it is still indispensable, and provides diagnostic information that even a battery of CT or MRI scans might miss. (C) 2005 by Gary Cordingley Gary Cordingley, MD, PhD, is a clinical neurologist, teacher and researcher who works in Athens, Ohio. For more health-related articles, see his website at: http://www.cordingleyneurology.com
MORE RESOURCES:
Medicine - Google News |
|
|
|
RELATED ARTICLES
The Neurological Exam: Evaluating the Master Organ How does a mind contemplate itself? That's a philosophical question I'll leave to minds smarter than mine, but what I can tell you is how to examine the brain and other parts of the nervous system.Most people are familiar with how doctors examine a heart or set of lungs. 4 Reasons Why You Should Use Canadian Pharmacies Let's face it: purchasing prescription drugs in the U.S. Healthcare Providers -- Its Time for Your Physical I think this is a good time for a checkup, or physical as it is termed in the healthcare industry. I mean this is a good time to check the health of your site or setting. Pain in the Butt. How to Deal with Hemorrhoids? This is very sensitive area of your body. Too private. 5 Risks to Avoid When Purchasing Discount Medicines Online With the increasing price of prescription medications, many consumers are finding it more difficult to afford the price of prescriptions. Due to this, a large number of such consumers are looking for alternate ways to find affordable medications. An Introduction to Acid Reflux Disease Acid reflux disease, also known as Gastroesophageal Reflux Disease or GERD, afflicts millions of people. Many suffer from an occasional bout with heartburn, but acid reflux disease, as a diagnosis, should only be made if the heartburn causes impediments to your lifestyle due to severe, chronic discomfort over prolonged periods of time. Sinusitis: Sinus Infection Deals a Corporate KO Sinusitis and Sinus Infection Starts with a Little SniffleYes, I hear it too. A simple sniffle in a distant cubical. VIOXX Lawsuits Vioxx is a prescription medication that has been used primarily in the treatment of signs and symptoms of arthritis, but has also been prescribed to treat acute pain in adults and menstrual pain in women. It is a Cox-2 selective nonsteroidal anti-inflammatory drug or NSAID. Electric Wheelchairs When you search online for Electric Wheelchairs, like any other things, you will face a situation, where you will need to choose a provider out of so many companies that offer the service. The search engines will bring you thousands and thousands of results when you type the phrase "Electric Wheelchairs. Death by Fluoride A wee bit of fluoride makes teeth and dentists happy, we're told. Dr. Heel Pain - Ten Tips for Treatment The most common cause of heel pain is plantar fasciitis (plan * tar fash* ee * I * tis). If you experience a sharp pain in your heel when you first step down in the morning, it is most likely due to plantar fasciitis. "Foot Pain Relief At Last!" "As an arthritis specialist, one area that I see people complain about more often than almost any other, is their feet." So says Dr. Clinton on South Beach Diet Clinton's recent quadruple bypass surgery has been largely debated. Being on the South Beach Diet made everybody wonder how the former president's illness advanced so much as to need to be surgically corrected. I Hurt All Over... How to Ease Away the Pain of Fibromyalgia! At one moment, a life of activity consumed with enjoyable activities like biking, golfing, going to the movies, out to dinner. Then one day, it's gone. 195,000 Die Annually From Hospital Mistakes It just seemed too absurd to be true, but there it was in the August 2, 2004 edition of Newsweek I picked up the other day: "According to HealthGrades, the health-care-rating organization that conducted the study, needless deaths averaged 195,000 a year in 2000, 2001, and 2002. 'That's the equivalent of 390 jumbo jets full of people dying each year,' says Dr. Are Drug Companies Destroying The U.S. Health Care System? The U.S. Protopic Cancer Risk Lawyer The FDA issued a warning in July of 2005 on two skin creams, Elidel (pimecrolimus) and Protopic (tacrolimus) to all ages. Recent animal studies have found that Protopic causes lymphomas and skin cancers in an unknown percentage of users. Viga Lies Cause Potential Fatalities Viga and Viga for Women is a dietary supplement sold OTC and via the internet that marketed itself not as a prescription drug but as a dietary supplement pill. It was a dietary supplement version of Viagra, which is a drug for erectile dysfunction. Amazing Shoulder Pain Reversing Secrets! Whether you're a weekend athlete, or a gardener that overdid it, or a person with arthritis, there's hope for you. According to Dr. Signs of Suicide : Learn What They are and How to Deal with Them The true numbers are probably much higher because many suicides are reported as accidents or illnesses. Suicides are usually the result of a complex combination of emotional, social, and biological factors.
|
| home | site map |
| © 2006 |
