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The Neurological Examination - Norwich GP STS Welcome：神经系统检查-诺维奇大奖赛的STS欢迎
* * * The sensory system Reduced: pain temperature C6 T7 L2 S2 Pain Temperature Sensory pathways in spinal cord – spinothalamic modalities Lateral spinothalamic tract Reduced: pain temperature vibration touch proprioception C6 T7 L5 S2 Cross sectional anatomy of the spinal cord * * * * * * * * * * * * * * * * * * * * * * * * * * * Visual Fields Test each eye separately Remember fields cross i.e. left visual field projects to right visual cortex and conversely Lesions affecting optic nerve cause monocular defects Lesions affecting optic chiasm may cause bitemporal field defects Pupillary light response Afferent limb optic nerve II Efferent limb oculomotor nerve III (via Edinger Westphal nucleus) Direct reflex Consensual (indirect) reflex Fundoscopy Examination of optic nerve and retina with ophthalmoscope Ocular movements- nerves III, IV, VI Horizontal and vertical eye movements Presence of nystagmus Trigerminal nerve, V Jaw clenching Pin prick and touch sensation on face Corneal reflex Trigeminal nerve V Motor (mandibular division) Muscles of mastication (masseter, pterygoids, temporalis) Sensory to face 3 divisions Ophthalmic V1 Maxillary V2 Mandibular V3 Patient shuts eyes Light touch temperature Corneal reflex Facial Nerve VII Close eyes Show teeth Facial weakness UMN vs LMN Upper face receives bilateral innervation UMN lesion Spares upper face Contralateral lower facial weakness LMN lesion Ipsilateral face is weak (both upper and lower parts) Facial Nerve VII Muscles of facial expression, stapedius, stylohyoid and posterior belly of digastric Parasympathetic Lacrimal gland Submandibular and sublingual glands Mucous membranes of pharynx and soft palate Taste Anterior 2/3 tongue Sensation Small area behind ear Concha of auricle Vestibulocochlear nerve VIII Perception of rubbing of fingers If impaired look in external auditory canals and perform Rinne and Weber’s tests Vestibulocochlear nerve VIII 2 components Vestibular (balance) Cochlear (hearing) A
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