NEUROSURGICAL HISTORY & EXAMINATION Essam Elgamal FRCS(SN)
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Transcript of NEUROSURGICAL HISTORY & EXAMINATION Essam Elgamal FRCS(SN)
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NEUROSURGICAL NEUROSURGICAL HISTORY & EXAMINATIONHISTORY & EXAMINATION
Essam Elgamal FRCS(SN)
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In conjunction with information from other systems,
previous medical history, family and social history, current medications.Confirmation from relative or a friend.
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HistoryHistory
HeadacheVisual disorderLoss of consciousnessSpeech disorderMotor disorderSensory disorderSphincter disorder
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HistoryHistory
Lower cranial nerve disorderMental disorder
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HEADACHE
OnsetCourse
Duration
Severity
Character
features
Site
Relieving factors
Precipitating factors
Timing
Associated
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VISUAL DISORDER
Onset
CourseDuration
Impairment
Diplopia
Hallucinations
Precipitating factors
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LOSS OF CONSCIOUSNESS
Onset Course Duration
Tongue bitingIncontinence
Limb twitching
Alcohol/Drug Abuse
Head injury
Cardiovascularor
Respiratorysymptoms
Precipitating factors
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SPEECH DISORDER
Onset
CourseDuration
Articulation
ExpressionUnderstanding
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MOTORDISORDER
Onset
CourseDuration
Coordination
Weakness
Involuntary movementRelieving
factors
PrecipitatingFactors
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SENSORYDISORDER
Onset CourseDuration
Pain
Numbness
Site
Relievingfactors
Precipitatingfactors
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SPHINCTERDISORDER
OnsetCourse Duration
IncontinenceOr
Retention
Bladder
Anal
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LOWER CRANIAL
NERVEDISORDER
Onset Course Duration
Deafness
Tinnitus
Vertigo
Balance/staggering
Swallowing
Precipitating factors
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MENTALDISORDER
Onset Course Duration
Memory
Intelligence
Behaviour Personality
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ExaminationExamination
General: Neurological disease systemic signsSystemic disease affect nervous system
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ExaminationExamination
Temperature Blood pressure Neck stiffness Pulse irregularity Carotid bruit/murmer Cyanosis Weight loss Breast lump
Lymphadenopathy Hepatosplenomegaly Prostatic irregularity Septic source Skin marks Anterior fontanelle Head circumference
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Conscious levelHigher functions:Cognitive skills
MemoryReasoning
Emotional status
Cranial Nerves
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Upper & Lower Limbs:Motor;
StatusTonePowerReflexes
Sensory;PainTouchTemperatureProprioceptionSteriognosis
Coordination
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GCSGCS
Eye Opening:Spontaneous 4
To speech 3
To pain 2
None 1
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GCSGCS
Verbal response:Orientated 5
Confused 4
Words 3
Sounds 2
None 1
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GCSGCS
Motor response:Obeys commands 6
Localising to pain 5
Flexing to pain 4
Decorticated 3
Decerebrated 2
None 1
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Cognitive skills Cognitive skills (Dominant Hemisphere)(Dominant Hemisphere)
– Listen to languageHesitant Expressive dysphasiaFluent Receptive dysphasia
– Doesn’t understand Receptive – Cannot name objects Nominal– Doesn’t read Dyslexia– Doesn’t write Dysgraphia– Numerical calculation Dyscalculia– Cannot recognise objects Agnosia
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Cognitive skills Cognitive skills (Non-dominant Hemisphere)(Non-dominant Hemisphere)
Doesn’t find his way Geographical agnosia
Cannot dress himself Dressing apraxia
Copy geometric pattern Constructional apraxia
Minimental function test
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Memory TestMemory Test
ImmediateRecentRemoteVerbalVisualRretrograde amnesiaPost-traumatic amnesia
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Reasoning and problem solving
Compare with expected abilities Emotional state
Depressed
Anxiety
Apathy
Uninhibited
Slowness
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Cranial nervesCranial nerves
I Olfactory II Optic
Acuity
Field
Fundus
Pupils
III, IV, VI Oculomotor, Trochlear, AbducentOcular movement
Diplopia
Nystagmus
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Cranial nervesCranial nerves
V TrigeminalSensoryMotor
VII FacialUMN weakness, LMN palsy
VIII AuditoryCochlear component
Weber’s test Conductive; louder in affected earNeural; louder in normal ear
Rinne’s test
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Cranial nervesCranial nerves
IX, X Glossopharyngeal & Vagus
Gag reflex
XI Accessory Sternomastoid
Trapezius
XII Hypoglossal
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Motor systemMotor system
Asymmetry / deformityM. statusM. tone
Increased– Clasp-knife
– Lead-pipe
– Cog-wheal
– Clonus
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Motor systemMotor system
PowerGrade 5 Normal
Grade 4 against some resistance
Grade 3 against gravity but not resistance
Grade 2 elimination of gravity
Grade 1 flickers
Grade 0 None
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ReflexesReflexes
Upper LimbBiceps C5,C6
Triceps C6,C7,C8
Hoffman sign
Co-ordinationFinger-nose test
Finger-finger test
Dysadiadocholinesia
Arm bounce
Rebound phenomenon
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ReflexesReflexes
Lower limbKnee
Ankle
Planter
Coordination
Romberg’s test
Gait
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SensationSensation
Pain Touch Temperature Joint sensation Vibration Two point discrimination Sensory inattention (detect stimuli in both limbs) Streognosis Graphaesthesia
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SphinctersSphincters
Distended bladderEvidence of incontinenceAnal reflex
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