What is it about ?
The nervous system is made up of a central part (brain and spinal cord) and a peripheral part (peripheral nerves and autonomic nervous system). The brain is housed in the skull. The spinal cord runs along the vertebrae from the head to the lower back.
Peripheral nerves are branches of the spinal cord. Part of them are motor nerves, which keep muscles functioning. Another part are sensory nerves, which are responsible for sensations such as pain, pressure, heat, cold, sense of touch, etc.
Finally, there is still a complex system of autonomic nerves. These are nerves that automatically perform a number of functions that we do not consciously control, such as adjusting blood pressure to activities, heart function, sweat production, bowel function, etc. Each of these systems can experience hiccups.
That’s why there is a whole battery of tests to determine what is wrong. The neurological examination combines all these tests.
What does the neurological examination consist of?
The most important part of the neurological exam is a detailed questionnaire about the nature of your complaints. The doctor can thus assess your level of consciousness, get an idea of your language skills and mental state, and assess your orientation in time and space. This step can often avoid unnecessary additional examinations.
Then the doctor will perform the actual neurological examination. It will examine:
- your vital functions (heart function, blood pressure, breathing),
- your higher brain functions (thinking, memory, planning),
- your cranial nerves (e.g. facial muscles, tongue),
- your motor functions (power and movement),
- your coordination,
- your reflexes,
- your sensitivity (your feelings).
This exam usually follows a fixed pattern, so that nothing can be overlooked. The doctor always compares the right side and the left side of the body.
Below is a selection of the main tests performed during a neurological exam.
Upright
You are asked to walk back and forth, take 10 steps in a straight line, and walk on your toes and heels several times. The doctor monitors, for example, a possible deviation from the straight line (loss of balance) or difficulty starting.
Romberg’s test also assesses balance. For this test, you stand with one foot against the other and your arms stretched out in front of you, palms up, first with your eyes open, then with your eyes closed.
Sitting down
Examining eye movements (you follow the doctor’s finger with your eyes, without moving your head) and the photomotor reflex (your pupils constrict when directly exposed to a light source) provides information about certain nerves in particular. the skull (for example, the optic nerve). The function of the optic nerve can also be checked by the confrontation test. In this case, you stare at the doctor’s nose as he moves his fingers through all quadrants of your visual field and you have to indicate which way the fingers are moving.
The facial nerve needs to be functioning properly for you to show your teeth and close your eyes.
To test the hypoglossal nerve (under the tongue), the doctor will ask you to stick out your tongue and push it in several times.
The auditory nerve is checked, among other things, by means of the Weber test: the doctor hits a tuning fork and places it in the middle of your head, then asks you where you hear the vibrations best.
The strength of the muscles is tested by a grip strength assessment: the doctor asks you to squeeze his fingers as hard as possible. Again, it will compare the right side and the left side.
The finger-to-nose test: with your eyes first open, then closed, you alternately bring your left and right index fingers up to your nose. If there is a lesion in the cerebellum, you will perform this movement in a jerky manner. Sometimes a person cannot touch the tip of their nose.
Diadokokinesis (the ability to quickly perform rotational movements by alternating two hands) is slowed or awkward in some situations, such as damage to the cerebellum.
Strengthened tendon reflexes (hyperreflexia) indicate abnormalities in the central nervous system, while weakened reflexes suggest damage to nerve roots or peripheral nerves. There are different tests for tendon reflexes: the biceps reflex (when the doctor taps the biceps tendon with his hammer, the elbow bends), the patellar reflex (when the doctor taps the knee tendon, the leg tightens) and the Achilles reflex (when the doctor taps the Achilles tendon, the foot makes a downward motion).
Layer
Neck stiffness can be tested using Brudzinski’s sign and Kernig’s sign. If the meninges are irritated, the knees will spontaneously bend when bending the neck in the test using Brudzinski’s sign. In the test using Kernig’s sign, extending the knee with the hip bent 90 ° will be painful.
The Mingazzini test (you have to keep your legs raised for 30 seconds with your eyes closed) and the heel-to-knee test (you have to put the heel of one foot on the knee of the other leg and slide it towards the knee. bottom, eyes closed) assess movement control of both legs. The Barré test is similar to the Mingazzini test, but it assesses the motor skills of the arms (you should keep your arms straight, eyes closed).
When the doctor walks the sole of the foot with a semi-pointed object, the big toe should normally bend (plantar skin reflex). If the big toe straightens and the other toes fan out, the test is abnormal (Babinski’s sign) and suggests spinal cord injury.
Sensitivity is only tested when the doctor suspects it is disturbed (for example, the doctor pricks you with a sharp object and asks if it is sharp or blunt).
Additional tests
Depending on the observations made during the neurological examination, the doctor may order additional examinations, such as a CT scan or an MRI. They will usually refer you to a neurologist for the diagnosis.
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