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CDHB

Neurological Examination

Some points to remember are:

Dilatation of the pupils by mydriatic drops should be avoided in neurology patients, particularly those who are ill and at risk of brain herniation.

A quick routine test of mental function such as the Mental Status Quotient, may be useful in the elderly but is not sensitive enough in most younger patients. If there is any doubt about mentation in this latter group, more specific tests of mental function will be needed, including tests for dysphasia, dysgraphia and the like.

Mental Status Quotient (MSQ)

• Age.
• Time (to nearest hour).
• Address for recall at end of test - this should be repeated by the patient to ensure it has been heard correctly: e.g., 42 West Street.
• Year.
• Name of hospital.
• Recognition of 2 persons (doctor, nurse, etc).
• Date of birth.
• Year First World War started.
• Name of present Monarch.
• Count backwards 20-1.

Reflexes

• The principal spinal segments responsible for the most commonly tested reflexes are:
  • Biceps jerk: C5, C6 (Musculocutaneous nerve)
  • Brachioradialis reflex: C5, C6 (Radial nerve)
  • Triceps jerk: C7, C8 (Radial nerve)
  • Knee jerk: L2, L3, L4 (Femoral nerve)
  • Ankle jerk: S1, S2 (Tibial nerve)

Segmental Innervation

• The segmental innervation of the skin is illustrated. This can be more readily recalled by remembering certain “key” dermatomal levels, e.g.:
  • C5: Skin over deltoid muscle
  • C6: Thumb
  • C7: Middle finger
  • C8: Little finger
  • T10: Umbilicus
  • L1: Groin
  • L3: Knee
  • L5: Anterolateral calf and dorsum of foot
  • S1: Lateral foot and little toe

Dermatome Distribution

Topic Code: 1498