The document describes the process for examining the central nervous system. It outlines the steps to examine higher functions, cranial nerves, sensory and motor systems, reflexes, gait, and special signs. For each section, it provides details on specific tests, including using Snellen's chart to test visual acuity, Ishihara plates for color vision, and Rinne's test, Schwabach test and Weber test to evaluate hearing. The document serves as a guide for performing a thorough neurological examination.
18. Field of vision – Confrontation
Test
• This is done with the help of Perimeter.
• Principle used in this test is that the field of vision of
doctor's right eye is same as field of vision of left
eye of patient . patient sits at a distance of 1 m. ThenÂ
eyeball movements are tested
• - Patient is instructed not to move his neck butÂ
patient has to move only eyeballs, as doctor isÂ
moving his finger. (We test the movements, such as -Â
abduction, adduction, elevation, depression, internalÂ
rotation and external  rotation)
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19. Examination of Optic Nerve –
Confrontation Test
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20. Trochlear Nerve – Pupillary Reflex
• (4) Trochlear Nerve - To test pupillary reflex isÂ
also a part of examination of 3rd cranial nerve.
• For this Light Reflex and accommodationÂ
reflex should be tested
• For testing the Light Reflex doctor will throw
light on the patients eye and doctor will look
for the response i.e. constriction of pupil.
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91. Examination of Nutrition of Muscle
• In the same manner, for the upper extremity -Â
circumference of forearm and arm musclesÂ
can be compared from a fixed bonyÂ
prominence like olecranon process
• When circumference of both right and left
sides is normal it indicates nutrition of these
muscles is normal
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93. Examination of Nutrition of Muscle
• In right sided person circumference of rightÂ
sided muscle can be slightly more. This isÂ
physiological
• Atrophy of muscle is seen in LMN lesion like
polio myelitis
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94. Tone of Muscle
• Tone of a muscle is a partial state of
contraction. It is maintained by stretch reflex.
• Tone of the muscle is tested by 2 ways
• (a) By examining feel of the muscle
• (b) Tone can be seen by Resistance offered toÂ
passive Movements.
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95. Tone of Muscle
Tone of Leg Muscle Tone of Thigh Muscle
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96. Tone of Muscle
• Doctor can feel muscle at its bulk and he canÂ
compare the feel on right and left sideÂ
• e.g. doctor can observe the feel of calf
muscles, thigh and muscles of bicep and
triceps
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97. Tone of Muscle
Bicep Muscle Tone Tone –Forearm muscle
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99. Tone of Muscle
• Doctor can do passive movements at kneeÂ
joint to test the tone of flexors and extensorsÂ
of knee
• When doctor is doing flexion of knee, he is
testing tone in extensors. When doctor is
doing extension at knee he is testing Tone of
flexors
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101. Tone of Muscle
• For testing upper extremities, sameÂ
movements can be done at elbow
• Doctor can test Tone of biceps and triceps andÂ
he can compare the Tone at other side. When
doctor is carrying flexion at elbow he is
testing Tone in triceps. When doctor is
carrying extension in elbow he is testing tone
in biceps
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102. Tone of Muscle
Elbow Flexion Elbow Extension
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103. Tone of Muscle
• In lower and upper extremities, whenÂ
resistance offered is moderate, it indicatesÂ
tone is normal
• Hypertonia is seen in UMN lesion
• Hypotonia is seen in LMN lesion
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131. Advantage of
Motor System Examination
• Advantage of motor system examination, overÂ
sensory system examination is that ---Â
• (1) Even if patients cooperation is not there
we can draw few conclusions like - UMNÂ
lesion, LMN lesion, Parkinsonism, Cerebellar
• ataxia ,Sensory ataxia.
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132. Advantage of
Motor System Examination
• (2) In sensory system examination, if patient isÂ
non-co-operative then he can not answer theÂ
doctor's questions and then examination is ofÂ
no value
• However, sensory system examination is
important to detect the level of damage in
spinal cord.
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133. Superficial Reflexes – Root values
Sr.No Reflex Root Value
1 Conjunctival reflex 5th and 7th cranial nerve
2 Corneal reflex 5th and 7th cr. N
3 Pharyngeal reflex 9th, 10th, 11th cr. N
4 Abdominal reflex T6 to L1
5 Plantar reflex L5, Si, S2
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149. Superficial Reflex – Plantar Reflex
• Normal response is plantar flexion of all toes
• If dorsiflexion of great toe and fanning of
other toes is seen then diagnosis is positiveÂ
Plantar reflex or positive Babinski's sign
• This will be seen UMN lesion like hemiplegia
or in meningeal irritation (Meningitis)
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161. Deep Reflex – Ankle Jerk
Right Ankle Jerk Left Ankle Jerk
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162. Importance of Testing Reflexes
• Examination of the reflexes is most imp part inÂ
examination of the nervous system.
• Advantage of this examination than motor andÂ
sensory examination is that - "It does not requireÂ
patient's co-operation."
• Various diseases, specially UMN lesion and LMN
lesion can be differentiated by examination of deep
reflexes
• Even if patient is unconscious, non-cooperative -
These reflexes will give important clues.
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163. Importance of Testing Reflexes
• In UMN lesions - Deep reflexes are
exaggeratedÂ
• (Jerks will be very much prominent)
• Even clonus can be seen at knee and ankleÂ
(where muscle jerk oscillates for longer time)
• Clonus is always pathological. It is seen in
UMN lesion
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164. Examination of Spine & Cranium
• Spine is to be inspected from cervical to sacralÂ
region for noticeing abnormality
• With knuckles of fingers ,doctor can give
deep pressure on spine and ask the patient
whether he gets pain sensation.
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165. Examination of Spine & Cranium
Cervical to Sacral With knuckles
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166. Examination of Spine & Cranium
• For testing cranium deep pressure is to be
given on skull, from all angles and patient isÂ
asked, "Whether he gets pain sensation" ?
• If there are abnormalities of the spine, ifÂ
there are conditions like hydrocephalus. ThisÂ
test will give intense pain.
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167. Examination of Spine & Cranium
Deep pressure from all angles Deep pressure from all angles
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