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Suggests left hemispheric CVA in distribution of the left middle cerebral artery, with right-sided hemiparesis

Important Areas of Examination

■ Mental status: appearance and behavior, speech and language, mood, thoughts and perceptions, cognition

■ Cranial Nerves I through XII

■ Motor system: muscle bulk, tone, and strength; coordination, gait, and stance

■ Sensory system: pain and temperature, position and vibration, light touch, discrimination

■ Deep tendon, abdominal, and plantar reflexes

Three important questions govern the neurologic examination:

■ Is the mental status intact?

■ Are right-sided and left-sided findings symmetric?

■ And, if the findings are asymmetric or otherwise abnormal, does the causative lesion lie in the central nervous system or the peripheral nervous system?

In this section, you will learn the techniques for a practical and reasonably comprehensive examination of the nervous system. It is important to master the techniques for a thorough examination. At first these techniques may seem difficult, but with practice, dedication, and supervision you will come to feel comfortable evaluating neurologic symptoms and disease. You should be active in your learning and ask your instructors or even neurologists to review your skills.

The detail of an appropriate neurologic examination varies widely. As you gain experience, you will find that in healthy persons your examination will come to be relatively brief. When you detect abnormal findings, your examination will become more comprehensive. Be aware that neurologists may use many other techniques in specific situations.

For efficiency, you should integrate certain portions of the neurologic assessment with other parts of your examination. Survey the patient's mental status and speech during the interview, for example, even though you may wish to do further testing during your neurologic evaluation. Assess some of the cranial nerves as you examine the head and neck, and inspect the arms and legs for neurologic abnormalities while you also observe the peripheral vascular and musculoskeletal systems. Chapter 3 provides an outline for this kind of integrated approach. Think about and describe your findings, however, in terms of the nervous system as a unit.

Organize your thinking into five categories: (1) mental status, speech and language, (2) cranial nerves, (3) the motor system, (4) the sensory system, and (5) reflexes. If your findings are abnormal, begin to group them into patterns of central or peripheral disorders.

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