EXAMINATION OF NERVOUS SYSTEM
• Higher Mental Functions
• Examination of Cranial nerves
• Motor system
• Sensory system
• Autonomic nervous system
• Signs of meningeal irritation
• Examination of peripheral nerve
• Examination of skull & spine
HIGHER MENTAL FUNCTION
• Educational status • Level of consciousness
• Occupation • Orientation
• Handedness • Attention
• Knowledge of languages • Memory
• Speech
• Intelligence
• Appearance & behavior
• Mood, delusions & hallucinations
LEVEL OF CONSCIOUSNESS
• Alert - Fully aware of oneself & surroundings
• Confusion - Unable to think with customary speed & clarity
• Delirious - Confusional state with increased psychomotor activity
• Lethargic/Drowsy - Unable to sustain wakeful state in absence of external stimulus
• Obtunded - Answers only in response to painful stimulus
• Stupor - Groans to painful stimulus
• Coma - No response even with deep painful stimuli
Altered sensorium + Hemiparesis
• Intracerebral bleed
• Large cerebral infarct
• Brainstem stroke
• CVT with a hemorrhagic infarct
• EDH, SDH
• Tuberculoma, Cerebral abscess
ORIENTATION
• Time : Approximate time, day, date, month & year
• Place : Place, Floor, Town, State, Country
• Person : Himself, Bystander, Treating doctor
Disorientation in Stroke
• Thalamic stroke (involving anterior nucleus)
• Frontal lobe infarct (Hyperactivity, akinetic mutism)
ATTENTION
• Is he attentive to questions ?
• Can he engage in a continuous conversation ?
• Serially subtract 3/5/7 from 100
MEMORY
• Immediate memory : 5 digits forward, 3 digits backward
• Recent memory : What did you have for breakfast ?
• Remote memory : Schooling
Stroke with impaired memory
• Thalamic stroke involving anterior or dorsomedial nucleus
• Posterior cerebral artery stroke causing medial temporal involvement
• Multi-infarct state
SPEECH
• Fluency
• Comprehension
• Repetition
• Naming & word finding
• Reading
• Writing
Is the patient having normal speech, dysarthria, aphasia, dysphonia
Fluency
• Word output
• Word finding difficulty
• Initiation difficulty
• Circumlocution
• Grammar
• Prosody
• Paraphasias
• Neologism
Comprehension
• Single step command
• Multi step
• Yes or No questions
Repetition
• Raman ivide undayirunenkil
avane chanthaykku paranju vidamayirunnu
Naming & word finding
• Colors
• Body parts
• Objects
Reading
• Words/Sentences/Paragraphs
• Can comprehend what he is reading
Writing
• Words, letters & numbers to dictation
• Short sentence describing the disease
• Copying a sentence
Language in Stroke
• Broca’s aphasia - Superior division of MCA
• Wernicke’s aphasia - Inferior division of MCA
• Global aphasia - Stem of MCA
• Anomic aphasia - Distal branch of Inferior division of MCA
• Transcortical aphasia - Watershed infarct
• Conduction aphasia
• Dysarthria - UMN, LMN
INTELLIGENCE
• Based on educational status
• Sibling comparison
• Vocabulary
APPEARANCE & BEHAVIOR
• Well dressed
• Clean/Shabby
• Co-operative/Indifferent/Uninhibited
MOOD
• Normal
• Euphoric
• Depressed
• Unstable
Delusions, Hallucinations, Illusions
HIGHER MENTAL FUNCTION
• Educational status • Level of consciousness
• Occupation • Orientation
• Handedness • Attention
• Knowledge of languages • Memory
• Speech
• Intelligence
• Appearance & behavior
• Mood, delusions & hallucinations
