| |
| |
|
|
|
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: Buy Website Internet Traffic. Website online advertising. Buy full page popunder advertising and increase website traffic to your sites. Bad Credit Loans - Loans for people with bad credit. Access online government grants and financial credit services instantly online. Digital Streaming Radio On Your Mobile Phone - La Vella Mobile Radio. La Vella Mobile Radio Gives You Access To Over One Hundred Of The Hottest Streaming Radio Stations From Around The World And Brings Them To The Palm Of Your Hand, Right On Your Mobile Phone. Get Streaming Radio On Your Cell Phone! Audio And Video Streaming For Multimedia Purposes. This Is A Complete Step By Step Guide To The Beginners Who Want To Install And Setup Audio And Video Streaming For Multimedia Purposes On The Internet.
|
|
|
|
RELATED ARTICLES
Alcohol Rehabilitation Centers - Take An Informed Decision Alcohol rehabilitation centers in the United States offer a wide range of treatment programmes for your recovery from alcoholism.They provide services such as detoxification, residential treatment, day care and outpatient alcohol rehabilitation programs. Implant Dentistry - The Convenient and Safe Alternative to Dentures If you are missing a tooth or a group of teeth, you may find that you are afraid to smile, you don't like to speak because you think you sound funny, or you may not be able to eat certain foods that you enjoy. Until recently, your only option was to replace these missing teeth with dentures. Phenylpropanolamine (PPH) Lawyer: Decongestant Causes Stroke Phenylpropanolamine, or PPH, used to be an active ingredient in many over the counter nasal decongestants and weight control drug products. The FDA pulled phenylpropanolamine off the market in May of 2000 when a Yale University School of Medicine study found that patients using PPH were at a higher risk of hemorrhagic stroke, or bleeding of the brain. Questions to Your Physician or Psychotherapist According to ongoing research about the needs of patients with emotional problems misinformation or shame to speak about the problem with the doctor or psychotherapist is a major limitation to treatment success. However, transparency, good information and participation in the course of the therapy is the most important factor for a lasting positive result. 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. Bee Propolis: Synergisitc Health Care for the 21st Centruy For well over a century modern science has progressed at a startling rate. With this increase in knowledge has come medicinal and healthcare benefits that have seen ages peak and diseases eradicated. Using Blood Pressure Monitors To Maintain Your Health Many people today realize the importance of keeping their blood pressure under control. Blood pressure monitors are now available for home use. How To Save Money On Prescription Medications If you are a regular user of prescription medications, you know that these drugs can be costly to purchase. Cutting back on drugs can be dangerous to your health, but if you are on a fixed income your choices can seem limited. Prevent Foot Problems When Walking Americans are on the go. According to a NSGA Survey, 71 million American adults are exercise walkers, making walking the top sport in the United States. Generic Drugs: How They Cost You Less? If you are wondering why the chemist has charged much less than what you expected then it is not because he has developed sudden liking for you or the government decided to subsidized your medical bill.It is possible because you are getting cheaper generic alternative of some expensive brand name medication. Zicam Side Effects: Shortens Colds But Permanently Destroys Sense of Smell Zicam is a homeopathic intranasal zinc remedy that is intended to reduce the length of a cold. It is either taken in a spray or a swab. Treatment for High Blood Pressure The treatment of high blood pressure is one of the most important areas of modern medicine. Good quality care and blood pressure treatment can reduce the risk of death, the risk of stroke and the risk of heart attack or coronary disease. When Your John Doe Is Homeless The patient, known only as John Doe, was difficult to see under the hodgepodge of tubing, the quiet clicking of the ventilator the room's only sound.From all appearances he was homeless, but in the opinion of his nurse, who has had vast experience in dealing with patients just like him, everyone has a mother or a father, a son or a daughter, and homeless or not, it's a nurse's responsibility to do what he can to help find them. NIH Official Altered Drug Study NIH Official Altered Drug StudyDr. Edmund Tramont, director of the National Institute of Allergy and Infectious Disease Division of AIDS, altered the conclusions from a safety report on pregnant women taking the drug nevirapine in order to cover up its negative side effects. Lunesta Dependence Lunesta is a newly released sleeping pill. Marketed as a revolutionary sleep aid, Lunesta is the only medication approved by the FDA for long term treatment of insomnia symptoms. 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. 10 Steps To Detoxification Technology. We live in a grand time of technological development. A Very Medical Miracle Madeline Mann once weighed less can a can of soda making her the tiniest surviving newborn known to medicine. Next week, she enters high school as something even more exrtaordinary- a honor student who likes to play violin and Rollerblade. Redux Lawyer Discusses Fen-Phen Fad In the early nineties, Redux was the original miracle diet pill. A predecessor to fenphen, Redux was just the "fen", fenfluramine in the form dexfenfluramine. Can Mexican Pharmacy Purchases Be Trusted? Purchasing drugs from a Mexican pharmacy is, for the most part, a very safe and inexpensive way of getting the medical supplies that you require. Since the laws in Mexico are very different than in the US, as most drugs are readily available without a prescription (except for some controlled substances and all narcotics), purchasing drugs from a Mexican pharmacy should be a fairly painless process.
|
