Examination of nervous system
Higher mental function
Speech
Cranial nerves
Motor system
Sensory system
Cerebellum
Signs of Meningeal
1. Higher mental Functions
Concious Level : by GCS!
Eyeopening response
Spontaneous (4) Hallucination : False perception of
auditory and visual sensation in the
To speech (3) absence of external stimulus.
To painful stimulus (2) Delusion : False Belief to which
None (1) patient firmly adheres despite the
fact that their falsehood is proved
Verbal Response
Ilusion : misinterpretation of external
Oriented (5) stimulus
Confused (4)
In appropriate (3) Digital Dream
In comprehensive (2)
mond (1) Dyphasia : difficulty in
Motor Response comprehension or
production of speech.
Obeys the command (6) Dysarthria : difficulty in
articulation of speech
Localizeds the painful stimulus (5) Motor Speech Area
Withdraws (4) (Broca's Aphasia) -
"Expressive / non
Abnormal Flexion (3) fluent dysphasia"
Sensory Speech Area
Extensor Response (2) (Wernicke' Aphasia) -
None (1) "Receptive or fluent
Dyaphasia"
Digital Dream
, Cranial Nerves
1. Olfactory Nerve :
Ask the patient to close the eye and one nostril, present
(peppermint , cloveoil, keroseneoil, fruit , soap) and identify!
Interpretation:
ANOSMIA : loss of smell
PAROSMIA : perversion of smell
2. Optic Nerve :
Visual Acquity : Near Vision (10 inch) , Far Vision (6m) by
Snellen Chart. Followed by finger counting, hand movements
and light perception.
Color Vision : Ishihara Chart
Field of Vision : Perimetry or Confrontation test.
Interpretation of VFDs!
Retina : Hemianopia : loss of vision affecting one half of the
visual field
ON : complete loss of visionON : complete loss of vision
Optic chiasma: bitemporal (if crossed) binasal Hemianopia
(if uncrossed fibers)
Optic Tract : Homonymous Hemianopia
Optic Radiations: Temporal (Superior Quadrantanopia) ,
Parietal (Inferior Quadrantanopia)
Visual Cortex : (homonymous Hemianopia sparing Macula)
3. Occulomotor Nerve , Trochlear and Abducent Nerve :
Check and Compare the palpebral Fissure of both sides
Extraoccular movements by HTEST! (at distance of 2feet.
Check size and shape of pupil
Light Reflex (Check for direct and consensual light reflex)
Accomodation Reflex : (Ask the patient to look at far Object
and then look at his nose) there will be convergence of
eyeball and constriction of pupil
Eye does not move in direction of paralyzed muscle
Patient develops diplopia in that direction
, Interpretation:
Third Nerve
Ptosis
Eye deviated down and out
Cannot move medially, upward, or downward properly
Pupil dilated and fixed
Light reflex and accomodation reflex absent
(Do for 4rth and 6th nerve)
Causes : DM, Aneurysm of PCA , Midbrain and Pontine ,lesion , CST
PTOSIS Constricted :
Dilated Pupil
Third nerve palsy B/L: Old age, Pontine
B/L: Anxiety
MG lesion, Opiod overdose
U/L: Mydriatic , Third
Horner sx U/L: Miotics and
nerve Palsy
Horner sx
Digital Dream Digital Dream
Digital Dream
Lesion of Afferent Pathway :
Marcus Gunn : On direct reaction no response , on consensual -
both pupil constrict)
Lesion of Efferent Pathway : Pupil of affected eye will not
constrict, where as of normal side constricts .
Argyll robertson :small and irregular pupil, Accomodation
reflex is positive "Lesion in the Pretactal area of MB"
Adies Pupil :Pupil is large , LR absent , accomodation reflex
delayed. "Lesion is in the ciliary ganglion"
Horner syndrome : Ptosis (due to muller muscle ) , Miosis (
Dilator pupillae) , Enophthalmos (orbital muscle) and
Anhydrosis (Sweat Gland)
Nystagmus : Involuntary
Internuclear opthalmoplegia: rhythmic Oscillations of eye ball
One eye cannot adduct (move medially)
It can be vertical , Horizontal ,
and the other shows Nystygmus (when
asked to look laterally) jerky
Due to lesion in the ML bundle (on side of Lesion : Vestibular and
adduction weakness) cerebellar
Digital Dream Digital Dream
Higher mental function
Speech
Cranial nerves
Motor system
Sensory system
Cerebellum
Signs of Meningeal
1. Higher mental Functions
Concious Level : by GCS!
Eyeopening response
Spontaneous (4) Hallucination : False perception of
auditory and visual sensation in the
To speech (3) absence of external stimulus.
To painful stimulus (2) Delusion : False Belief to which
None (1) patient firmly adheres despite the
fact that their falsehood is proved
Verbal Response
Ilusion : misinterpretation of external
Oriented (5) stimulus
Confused (4)
In appropriate (3) Digital Dream
In comprehensive (2)
mond (1) Dyphasia : difficulty in
Motor Response comprehension or
production of speech.
Obeys the command (6) Dysarthria : difficulty in
articulation of speech
Localizeds the painful stimulus (5) Motor Speech Area
Withdraws (4) (Broca's Aphasia) -
"Expressive / non
Abnormal Flexion (3) fluent dysphasia"
Sensory Speech Area
Extensor Response (2) (Wernicke' Aphasia) -
None (1) "Receptive or fluent
Dyaphasia"
Digital Dream
, Cranial Nerves
1. Olfactory Nerve :
Ask the patient to close the eye and one nostril, present
(peppermint , cloveoil, keroseneoil, fruit , soap) and identify!
Interpretation:
ANOSMIA : loss of smell
PAROSMIA : perversion of smell
2. Optic Nerve :
Visual Acquity : Near Vision (10 inch) , Far Vision (6m) by
Snellen Chart. Followed by finger counting, hand movements
and light perception.
Color Vision : Ishihara Chart
Field of Vision : Perimetry or Confrontation test.
Interpretation of VFDs!
Retina : Hemianopia : loss of vision affecting one half of the
visual field
ON : complete loss of visionON : complete loss of vision
Optic chiasma: bitemporal (if crossed) binasal Hemianopia
(if uncrossed fibers)
Optic Tract : Homonymous Hemianopia
Optic Radiations: Temporal (Superior Quadrantanopia) ,
Parietal (Inferior Quadrantanopia)
Visual Cortex : (homonymous Hemianopia sparing Macula)
3. Occulomotor Nerve , Trochlear and Abducent Nerve :
Check and Compare the palpebral Fissure of both sides
Extraoccular movements by HTEST! (at distance of 2feet.
Check size and shape of pupil
Light Reflex (Check for direct and consensual light reflex)
Accomodation Reflex : (Ask the patient to look at far Object
and then look at his nose) there will be convergence of
eyeball and constriction of pupil
Eye does not move in direction of paralyzed muscle
Patient develops diplopia in that direction
, Interpretation:
Third Nerve
Ptosis
Eye deviated down and out
Cannot move medially, upward, or downward properly
Pupil dilated and fixed
Light reflex and accomodation reflex absent
(Do for 4rth and 6th nerve)
Causes : DM, Aneurysm of PCA , Midbrain and Pontine ,lesion , CST
PTOSIS Constricted :
Dilated Pupil
Third nerve palsy B/L: Old age, Pontine
B/L: Anxiety
MG lesion, Opiod overdose
U/L: Mydriatic , Third
Horner sx U/L: Miotics and
nerve Palsy
Horner sx
Digital Dream Digital Dream
Digital Dream
Lesion of Afferent Pathway :
Marcus Gunn : On direct reaction no response , on consensual -
both pupil constrict)
Lesion of Efferent Pathway : Pupil of affected eye will not
constrict, where as of normal side constricts .
Argyll robertson :small and irregular pupil, Accomodation
reflex is positive "Lesion in the Pretactal area of MB"
Adies Pupil :Pupil is large , LR absent , accomodation reflex
delayed. "Lesion is in the ciliary ganglion"
Horner syndrome : Ptosis (due to muller muscle ) , Miosis (
Dilator pupillae) , Enophthalmos (orbital muscle) and
Anhydrosis (Sweat Gland)
Nystagmus : Involuntary
Internuclear opthalmoplegia: rhythmic Oscillations of eye ball
One eye cannot adduct (move medially)
It can be vertical , Horizontal ,
and the other shows Nystygmus (when
asked to look laterally) jerky
Due to lesion in the ML bundle (on side of Lesion : Vestibular and
adduction weakness) cerebellar
Digital Dream Digital Dream
