I – The neurological examination
Motor Examination
Evaluation of muscle strength

  • Find a motor deficit: failure to maintain the Member ‘in air’
  • Barre maneuver: the patient in the prone position, knees bent, and must keep the legs vertical to the upper limbs: horizontal arms, elbows outstretched wrists dorsiflexed maximum, we talk about deficits when the hand is widening.

Assessment of muscle tone
Search for hypo or hypertonia: passive movement of limbs and neck with someone relaxed
Assessment of voluntary movements
Tests of finger-nose, heel-knee puppets exceeded the goal, incoordination (cerebellar syndrome), slowed movement or stiff (piriformis syndrome)
Reflexes (ROT)
Search areflexia or exaggerated muscle contraction: relaxed person, members released the doctor struck with the reflex hammer and the tendon in question observed muscle contraction
Cutaneous plantar reflex (Babinski sign)
When scraping the plant externally using a blunt, there is flexion of the toes, if there is a slow and stately extension of the big toe, speaking of the pyramidal motor path



Study of walking
Done consistently, helping the person if necessary.
It then searches:
- Instability, loss of balance
- Steppage gait: drop your toes grip the ground that the person compensates by rising above the knee moderate motor deficit
- Loss of a swinging arm Parkinson
Consideration of the sensitivity
Systematically explored, the 4 members in the face, trunk.
- Search hypoesthesia: lack of sensitivity
- a paresthesia sensation painless
- Type stinging, tingling, electric shock, skin cardboard, liquid flowing …
- Deep sensibility:
- The doctor positions with members: the patient’s eyes closed and must say how it has its member
- Sensitivity superficial:
- Buffing the pad, eyes closed
- Sensitivity thermo-Algonkian
- Pique key, tube hot water – cold water
- Proprioceptive sensibility:
- Informed about the location of members is known in space, eyes closed is how our bodies
- Romberg’s sign: inability to keep balance in his feet together and eyes closed (cordonnal syndrome Post)



Visual examination
* Search homonymous hemianopia (HLH): amputation of the unilateral visual field damage in the contralateral cerebral hemisphere
* The doctor moves a finger in the 4 visual quadrants: the patient designates the quadrant moves a finger:
- Diameter and responsiveness of the pupil to light: mydriasis (pupil totally detract) or miosis (pupil fully retracted)
- Interrogation: decreased visual acuity united or bilateral blindness, diplopia (double vision)
Studies of higher functions
Testes:
- The temporo-spatial orientation (DTS)
- Memory
- Reasoning
- Language
Aphasia: all disturbances of written or oral (speaking and / or understanding reached without sensory or dementia)
Agnosia: inability to name an object, sound, color, whereas the sensory view is intact and there is no aphasia
Anosognosia: ignorance and denial by the person’s motor deficit
Aprox: inability to perform movements without paralysis or trouble understanding (greeting, combing, drawing a cube, put his shirt …)
Ataxia: loss of balance
II-neurological syndromes
Pyramidal syndrome
* Associated paralysis and hypertension, due to a partial or total disruption of the pyramidal tract
* Downlink of voluntary movement (cell bodies of neurons in the cortex prérolontique, axons in the anterior horns of the spinal cord)
* Signs vary by level of achievement: hemiplegia, cranial nerve damage, paraplegia …
Syndrome extrapyramidal
* Hypertonia, tremor, akinesia (inability or difficulty in moving)
* Achievement of basal ganglia: headquarters automatic movements and associated
Cerebellar syndrome (cerebellum)
* Disruption of the static and walking, the execution of movements, tone
* Achievement of the cerebellum or cerebellar pathways
Pseudo tumor cerebra
* Headache, vomiting, visual disturbances, dizziness, apathy, or even convulsions
* Reflects the increased pressure inside the skull
* Emergency neurosurgical

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