Skip to main content Accessibility help

We use cookies to distinguish you from other users and to provide you with a better experience on our websites. Close this message to accept cookies or find out how to manage your cookie settings.

Close cookie message
×
Hostname: page-component-78c5997874-8bhkd Total loading time: 0 Render date: 2024-11-09T07:32:08.403Z Has data issue: false hasContentIssue false

38 - Focal neurological examination

from Section 9 - Neurosurgery

Published online by Cambridge University Press:  05 July 2015

By
Harry Bulstrode ,
Yezen Sheena  and
Diederik O. Bulters
Edited by
Petrut Gogalniceanu ,
James Pegrum  and
William Lynn
Harry Bulstrode
Affiliation:
University College London
Yezen Sheena
Affiliation:
Plastic Surgery, Health Education East of England, Cambridge, UK
Diederik O. Bulters
Affiliation:
Honorary Senior Clinical Lecturer, Wessex Neurological Centre, Southampton, UK
Petrut Gogalniceanu
Affiliation:
Specialist Registrar, General and Vascular Surgery, London Deanery
James Pegrum
Affiliation:
Orthopaedic Registrar, Oxford Deanery
William Lynn
Affiliation:
Specialist Registrar, General Surgery, North East Thames
Get access

Summary

Neurological examination is traditionally divided into examination of the cranial nerves and examination of the peripheral nervous system. In fact the two routines are complementary, and serve a common primary goal: to localise pathology within the nervous system, central and peripheral. Together with an impression of the type of lesion, derived primarily from the history, this localising information is central to correct interpretation of subsequent cross-sectional imaging.

Examination of the cranial nerves

You may need to select appropriate components of the following examination routines according to the clinical scenarios and guidance provided by examiners. This is a test of frontal lobe function.

Checklist

CN I (olfactory nerve)

• Not routinely tested

CN II (optic nerve)

• Acuity: each eye individually

• Fields: four quadrants to confrontation

• Reflexes: accommodation; direct and consensual light reflex

• Ophthalmoscopy: visualise the disc, exclude papilloedema

CN III, CN IV, CN VI (oculomotor, trochlear, abducens nerves)

• Ask patient to report any double vision during testing.

• Instruct patient to keep the head still.

• Ask patient to follow finger with eyes and report any double vision.

• Move finger to all extremes of gaze in an H-shape, to confirm normal upgaze/downgaze in both eyes, in abduction and adduction.

CN V (trigeminal nerve)

• Assess fine touch sensation in the three divisions:

• ophthalmic (Va) over temple

• maxillary (Vb) over cheek

• mandibular (Vc) over angle of mandible

• Confirm masseter/temporalis contraction on clenching teeth.

• Elicit corneal reflex and jaw jerk.

CN VII (facial nerve)

• Ask patient to:

• raise eyebrows

• close eyes tightly

• puff out cheeks

• show teeth

CN VIII (vestibulocochlear nerve)

• Test recognition of whispered speech in each ear individually.

• Weber's and Rinne's tests.

CN IX (glossopharyngeal nerve)

• Offer to test gag reflex.

• Prompt the patient to cough, looking for a strong cough.

• Prompt the patient to swallow, observing for symmetry.

Type
Chapter
Information
Physical Examination for Surgeons
An Aid to the MRCS OSCE
 , pp. 332 - 352
Publisher: Cambridge University Press
Print publication year: 2015

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Save book to Kindle

To save this book to your Kindle, first ensure [email protected] is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about saving to your Kindle.

Note you can select to save to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

Available formats
×

Save book to Dropbox

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Dropbox.

Available formats
×

Save book to Google Drive

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive.

Available formats
×