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Disclosures
- NIH
- U10 NS 086494 (PI) NorCal RCC
- Ownership:
- MindRhythm, Inc
- Stock/Consulting
Medicine of Cycling: A practical teleneurology examination October - - PowerPoint PPT Presentation
Medicine of Cycling: A practical teleneurology examination October - - PowerPoint PPT Presentation
Medicine of Cycling: A practical teleneurology examination October 2020 Wade S. Smith, MD, PhD, FNCS Chief UCSF Neurovascular Division Professor, UCSF Department of Neurology Disclosures NIH U10 NS 086494 (PI) NorCal RCC
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1) Patient without neurological complaints
– “I don’t have a headache”
2) Patient with minor neurological complaints
– “I have a headache”
3) Patient in coma
– “If I were conscious, I would have a headache”
4) Patient in whom you doubt an organic etiology to their complaints
– “If one half of my body wasn’t numb, my headache would be
- n both sides”
Practical Neurological Examination
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2) Patient with minor neurological complaints Perform a screening neurological examination
- takes 2 minutes
- sensitive for central processes
- if normal, it is unlikely a neurologist would find something
significant
Neurological Examination
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Mild TBI (concussion) vs moderate or severe TBI
- Concussion
– Impaired neurological function following a head injury, GCS 15, stable exam – ± LOC, headache, poor balance, incoordination, dizziness, memory loss (retrograde, anterograde), repetitive questions
- More serious injury
– GCS < 15 – Deteriorating exam – Somnolence, stupor – Anisocoria – Potential spine injury
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Neurological Examination: Screening
- Mental Status
– Level of consciousness – Language – Neglect
– Alert – Fluent speech, follows commands – Orientated to date, DOW, current time – Memory (3 items, delayed recall) – Digits forward, backwards – Months in reverse order – Behavior- repetitive questions
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Neurological Examination: Screening
- Cranial Nerves
II- Visual Fields to confrontation III,IV,VI- Pupils, eye movements V- facial sensation VII- Smile, close eyes, look up IX- Palate X- ? Hoarse, swallow XI- Shoulder Shrug XII- tongue
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- Motor Examination
– Pronator Drift – Extensors of fingers and wrist – Dorsiflexors of feet
Neurological Examination: Screening
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- Gait
– Stand, walk on heels & toes and tandem walk – Romberg Test
Neurological Examination: Screening
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- Coordination
– Fast Finger Movements
- slow = upper motor neuron
- small = extrapyramidal
- irregular = cerebellar
– Finger-Nose-Finger
Neurological Examination: Screening
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Example Exam
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