Near Response

If the pupils react to light, they will react to near. 2. If the pupils do not react to light, it is important to know whether the near response is also abnormal. 3. If there is a defect in adduction, it is important to know whether or not convergence is present. (See the section on Internuclear Ophthalmoplegia in Chapter 7.) You can verify the patient's efforts to converge by the attendant miosis, which means she is trying. 4. In any bilateral paresis of external ocular muscles, convergence...

Tremor

Cerebellar tremor is an action or intention tremor and disappears when the part is completely supported and at rest. It results from disease of the dentate nucleus or its connections. The stationary outstretched upper limbs may show a rhythmic constant tremor. This can be a flexion-extension tremor at the wrist at three or four per second or of the whole arm at the shoulder, somewhat slower and more coarse. When the patient is sitting, a tremor of about the same frequency may involve the head....

Upper Limb Abnormalities

The upper limb is of about the same importance in neurological assessment as eye movements and vision. Diseases of the upper motor neuron, parietal lobe, cerebellum, and basal ganglia may each produce characteristic changes in the tone, power, posture, or function of the limb and are dealt with elsewhere. Diseases of the spinal cord, nerve roots, brachial plexus, and individual nerves present their own distinctive problems. Herewith are a few comments on plexus and peripheral nerve lesions.

Common Diseases With Abnormal Gait Parkinsonism

In patients with parkinsonism, walking is slower than normal, cautious, and contained. The steps get smaller and the patient will eventually shuffle. In more advanced disease, she is flexed at the knees and hips and walks on her toes while sliding her feet forward. Her arms are adducted and flexed at the elbow, with her hands held in front of her thigh or abdomen. Small unevenness of the floor or ground can trip her her recovery of balance is poor and slow, with frequent falls. A disturbance of...

Twopoint Discrimination

The ability to tell one from two touches that are close together may be defective in lesions of peripheral nerves, the posterior columns of the spinal cord, and the cerebrum. A pair of dividers with dull points or an unwound wire paper clip can be used to test this sensation. The normal threshold on the lip is probably 1 mm, on the tip of the index finger is 3-5 mm, and on the back is several centimeters. The two points of the dividers are placed on the skin simultaneously with equal pressure....

Hypertension

There are several systems for grading the fundus changes in hypertension (eg, grade I or grade II). Do not do this describe what you see. Hypertension produces a number of changes and signs in the fundus 1. Diffuse and focal or segmental constriction of the retinal arteries The older the patient, the less significant is the arterial narrowing. The earliest narrowing occurs in the retinal periphery. Tortuousity of the arteries is most evident at the disc edge, and this change is...

Disorders of Speech

Aphasia is a loss or impairment of language caused by disease of the cerebrum. In this sense, language means speaking, writing, reading, and listening. The words aphasia and dysphasia are used interchangeably. The parkinsonian patient with low-amplitude, monotone, arrhythmic speech or the patient with cerebellar disease and staccato speech are not aphasic they are dysarthric. The patient with bilateral vocal cord paresis is aphonic. Stammering or stuttering is not aphasia. Some psychotic or...

Causes and Types of Abnormal Pupils

Argyll-Robertson Pupils Argyll-Robertson pupils are usually bilateral and result from tertiary syphilis of the nervous system, diabetes, or the late signs of bilateral tonic pupils (see the section on Adie's Syndrome). The pupils are small, irregular, and unequal. They do not react to light, they do react to near vision, they respond poorly to mydriatics, and they do not dilate in the dark. However, they can be made to constrict even more by the use of mi-otics. The poor light response and good...

Anterior or Frontal or Volitional Saccadic Center

The caudal part of the middle frontal gyrus (part of Brodmann's area 8) is concerned with voluntary eye movements and is independent of visual stimuli. If the lesion is 1. Irritative, that is, epileptic seizure, the eyes and head will turn to the opposite side. This phenomenon has been reproduced experimentally, although the direction of the turn is not to the opposite side 100 of the time. 2. Destruction of the frontal cortex or its connections through the internal capsule, the eyes are...

Lateral Rectus

Primary Function The lateral rectus muscle is supplied by the sixth cranial nerve (the abducens). 1. Its primary function is abduction, the most common extraocular paresis you will encounter. 2. Head posture is important. With paresis of the left lateral rectus, the chin is turned toward the left shoulder as the patient faces you. The eyes are thus out of the area of control of the left lateral rectus. 3. Images are side by side the outside image, farther from the patient's nose (the paralytic,...

Vibration Sense

Use a tuning fork that vibrates at 128 per second. A normal adult can feel a vigorously vibrating tuning fork for 12-15 s at the ankle and for 15-20 s on the distal phalanx of the index finger. Instruct the patient as you place the handle of the vibrating fork on his sternum or jaw. Tell him you want to know when the vibration stops. Demonstrate this by grasping the vibrating tines of the fork with your other hand while the handle is firmly against his sternum. This will stop the vibration....

Biceps Reflex

Biceps Reflex

Musculocutaneous Nerve Sixth Cervical Root, Biceps and Brachialis Muscles The patient should be supine with his arms at his sides and his elbows flexed to 30-45 degrees. His arms are supine. Stand on the right side of the examining table to examine the right biceps reflex. Put your left index and middle fingers on the biceps tendon as shown in Figure 13-2A. Push your lingers into the antecubital fossa and partially supinate your hand, stretching the skin in the antecubital fossa. This lengthens...

Cochlear Nerve

Lesions of this special sensory nerve cause deafness. Nerve cells are in the spiral ganglion of the cochlea. Their peripheral connections are to the auditory cells of the organ of Corti, and their central connections are to the cochlear nucleus. The next-order neuron is the lateral lemniscus. When impulses concerned with sound have reached the cochlear nucleus, their further passage is bilateral (ie, a unilateral lesion above the level of the nucleus cannot cause deafness). Deafness Does the...

Some Diseases Of The Visual System Retina and Optic Nerve Lesions

Retrobulbar Neuritis Retrobulbar neuritis typically presents in young adults, with onset over 24-48 hr, a large central scotoma, and a painful eye on palpation and movement. There may be a past history of episodes of multiple sclerosis or this illness may be the first manifestation of it. The fundus is usually normal. Afferent pupillary defect is commonly present. Optic Neuritis The presentation of optic neuritis is like that of retrobulbar neuritis, except that it may be painless. The terms...