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Neurological Examination Videos from Temple Medical University
by: Temple Med.University
Introduction to the Neurological Exam
The neurologic exam includes a careful history and physical examination to determine if a lesion exists, its site and its cause. The careful appraisal of the history of complaints and symptoms will include time, mode, and progression of onset as well as a family history. Patient complaints may include weakness, pain, headache, seizures, dizziness, numbness, visual abnormality, etc. The exam involves an evaluation of mental status, cranial and spinal nerves, sensory, motor and reflex responses.
Locating the lesion is important to the physician as well as to the student in Neuroanatomy. Deducing the site of a CNS lesion requires the determination of the intersection of a) the transverse location, as demonstrated by the spinal cord or brainstem nuclei involved and b) the longitudinally running tracts. Of course other investigative techniques i.e., CT scans and MRI are invaluable. While the etiology of the lesion is important to the clinician it is usually not a concern for the first year medical student.
In Clinical Neurology, anatomic organization is of fundamental importance to the presentation of the symptoms of the disease, i.e., the site of the injury is more important to the development of symptoms than the cause of the injury. In evaluating symptoms it is well to remember that the disorder observed is not only the result of the loss of certain functions but also represents the activities of the remaining intact anatomic structures.
One clinical approach to neurologic diagnoses is by "pattern recognition", i.e., a familiar constellation of symptoms suggests the disorder. This method requires rote memorization of many specific facts related to known diseases. The method followed in teaching Neuroanatomy depends on a "logical" approach i.e., determining the site of a lesion based on knowledge of the anatomic details of the location of tracts and nuclei. Many neurologic diseases occur as a result of a lesion at a single anatomic site. For example, there are specific blood vessel disorders which lead to a recognizable symptoms; a localized tumor likewise can produce predictable symptoms based on the anatomy. One of the major goals of an introductory course of Neuroanatomy is to prepare the student to be able to identify the smallest possible single site of a lesion that will explain all of the symptoms described in sample cases.
The neurologic exam includes a careful history and physical examination to determine if a lesion exists, its site and its cause. The careful appraisal of the history of complaints and symptoms will include time, mode, and progression of onset as well as a family history. Patient complaints may include weakness, pain, headache, seizures, dizziness, numbness, visual abnormality, etc. The exam involves an evaluation of mental status, cranial and spinal nerves, sensory, motor and reflex responses.
Locating the lesion is important to the physician as well as to the student in Neuroanatomy. Deducing the site of a CNS lesion requires the determination of the intersection of a) the transverse location, as demonstrated by the spinal cord or brainstem nuclei involved and b) the longitudinally running tracts. Of course other investigative techniques i.e., CT scans and MRI are invaluable. While the etiology of the lesion is important to the clinician it is usually not a concern for the first year medical student.
In Clinical Neurology, anatomic organization is of fundamental importance to the presentation of the symptoms of the disease, i.e., the site of the injury is more important to the development of symptoms than the cause of the injury. In evaluating symptoms it is well to remember that the disorder observed is not only the result of the loss of certain functions but also represents the activities of the remaining intact anatomic structures.
One clinical approach to neurologic diagnoses is by "pattern recognition", i.e., a familiar constellation of symptoms suggests the disorder. This method requires rote memorization of many specific facts related to known diseases. The method followed in teaching Neuroanatomy depends on a "logical" approach i.e., determining the site of a lesion based on knowledge of the anatomic details of the location of tracts and nuclei. Many neurologic diseases occur as a result of a lesion at a single anatomic site. For example, there are specific blood vessel disorders which lead to a recognizable symptoms; a localized tumor likewise can produce predictable symptoms based on the anatomy. One of the major goals of an introductory course of Neuroanatomy is to prepare the student to be able to identify the smallest possible single site of a lesion that will explain all of the symptoms described in sample cases.