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neurologic cases - sam99
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05-13-2009, 05:49 AM
hi all,
please its taking me about 7 minutes to finish CNS examination, i am worried as i will not have that time in exam. for example in a case of TIA, stroke or forgetfullnesshow do i go about finishing the examination in time
05-13-2009, 10:15 AM
7 minutes is impressive to perform a thorough neuro exam but I agree you need to save time. You can reduce the time by performing only a general neuro screen and then a more focused exam that explores the specific symptoms uncovered in the history. If the patient is moving around without difficulty and their neuro symptom is vertigo, there's no time to check motor strength in each major muscle group. Tell the SP that you can see by how they are moving about they have good motor strength in their extremities. Check for nystagmus, a Romberg, hearing with the whisper test, Weber and Rinne, Dix-Hallpike maneuver, some Cranial Nerves, etc. This is just an example. My advice to same time is to evaluate the symptoms, not the entire neurological system. Good luck from cmcases of competentmed.com
05-13-2009, 10:53 AM
Ask the patient to look directly at your nose while standing about 2 to 3 feet in front of them. Check hoizontal eye movements by asking them to follow your finger to one side, then the other. Normal saccadic eye rhythms (that's a quick movement of the eyes in the opposite direction that they are moving toward) are up to 3 beats of movement in each direction. More than 3 rapid movements is abnormal and indicates vestibular nerve or CNS problems. Lateral movement also checks CN VI. Have them look up and down to each side to check for vertical or rotary nystagmus while testing CN III and IV. This is more difficult to describe than to teach someone in person or to draw a picture. Try to find a picture of this on the internet. Good luck from cmcases of competentmed.com
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