This 42-year-old man complains of poor balance and frequent falls for 6 years. Imbalance has been progressive; he cannot ambulate independently at present. He experiences tremors and weakness. Imbalance has been progressive and he now cannot ambulate independently. He is in good general health except for heavy alcohol use. For the last 10 years, he has consumed a quart of vodka and 5 beers daily. On awakening, he feels "shaky" and calms himself with a morning drink. He has not had blackouts or delirium tremens but has had two seizures in the past. He smokes 1-2 packs/day but does not use drugs. Diagnostic imaging studies were done. (1st admission, 8-9-00). He was found unconscious in his home in a pool of bloody vomitus by his relatives. He had apparently been on the floor for several days. He was confused and disoriented. He had a left-sided hemiparesis, left lower facial weakness and a left Babinski sign. Admitting labs showed Hb 4-7, hematocrit 13. Liver enzymes and creatine phosphokinase were elevated. CT scan and MRI showed an acute ischemic infarct (2nd admission, 6-10-01).

This 42-year-old man complains of poor balance and frequent falls for 6 years. Imbalance has been progressive; he cannot ambulate independently at present. He experiences tremors and weakness. Viewing the video requires installation of the free QuickTime Plug-in. Disease diagnosis: degenerative. Clinical history: Imbalance has been progressive and he now cannot ambulate independently. He is in good general health except for heavy alcohol use. For the last 10 years, he has consumed a quart of vodka and 5 beers daily. On awakening, he feels "shaky" and calms himself with a morning drink. He has not had blackouts or delirium tremens but has had two seizures in the past. He smokes 1-2 packs/day but does not use drugs. Diagnostic imaging studies were done. (1st admission, 8-9-00). He was found unconscious in his home in a pool of bloody vomitus by his relatives. He had apparently been on the floor for several days. He was confused and disoriented. He had a left-sided hemiparesis, left lower facial weakness and a left Babinski sign. Admitting labs showed Hb 4-7, hematocrit 13. Liver enzymes and creatine phosphokinase were elevated. CT scan and MRI showed an acute ischemic infarct (2nd admission, 6-10-01).

This 42-year-old man complains of poor balance and frequent falls for 6 years. Imbalance has been progressive; he cannot ambulate independently at present. He experiences tremors and weakness. Imbalance has been progressive and he now cannot ambulate independently. He is in good general health except for heavy alcohol use. For the last 10 years, he has consumed a quart of vodka and 5 beers daily. On awakening, he feels "shaky" and calms himself with a morning drink. He has not had blackouts or delirium tremens but has had two seizures in the past. He smokes 1-2 packs/day but does not use drugs. Diagnostic imaging studies were done. (1st admission, 8-9-00). He was found unconscious in his home in a pool of bloody vomitus by his relatives. He had apparently been on the floor for several days. He was confused and disoriented. He had a left-sided hemiparesis, left lower facial weakness and a left Babinski sign. Admitting labs showed Hb 4-7, hematocrit 13. Liver enzymes and creatine phosphokinase were elevated. CT scan and MRI showed an acute ischemic infarct (2nd admission, 6-10-01).

The following tests of the neuro exam can be divided according to which system of the cerebellum is being examined: Vestibulocerebellum and spinocerebellum (midline): - Station - Walking - Tandem gait Cerebrocerebellum (appendicular): - Rapid alternating movements - Finger-to-nose - Toe-to-finger - Heel-to-shin - Rebound and check reflex – Speech. The first principle of neurologic diagnosis is regional or anatomical localization. In order to become skillful the student must understand how structure relates to function of the nervous system. The neurologic examination permits "dissection" of the nervous system and localizes the disease when present. Instead of simply memorizing the components of the exam, a logical and systematic approach to problem solving evolves from repeatedly asking, "Where is the lesion?"

Examiner pulls on actively flexed arm then suddenly releases. The patient should be able to check or stop the arm's movement when released. The first principle of neurologic diagnosis is regional or anatomical localization. In order to become skillful the student must understand how structure relates to function of the nervous system. The neurologic examination permits "dissection" of the nervous system and localizes the disease when present. Instead of simply memorizing the components of the exam, a logical and systematic approach to problem solving evolves from repeatedly asking, "Where is the lesion?"

The patient moves her pointer finger from her nose to the examiner's finger as the examiner moves his finger to new positions and tests accuracy at the furthest outreach of the arm. The first principle of neurologic diagnosis is regional or anatomical localization. In order to become skillful the student must understand how structure relates to function of the nervous system. The neurologic examination permits "dissection" of the nervous system and localizes the disease when present. Instead of simply memorizing the components of the exam, a logical and systematic approach to problem solving evolves from repeatedly asking, "Where is the lesion?"

Notice the atrophy and fasciculation of the right side of this patient's tongue. The tongue deviates to the right as well because of weakness of the right intrinsic tongue muscles. These findings are present because of a lesion of the right 12th cranial nerve. The first principle of neurologic diagnosis is regional or anatomical localization. In order to become skillful the student must understand how structure relates to function of the nervous system. The neurologic examination permits "dissection" of the nervous system and localizes the disease when present. Instead of simply memorizing the components of the exam, a logical and systematic approach to problem solving evolves from repeatedly asking, "Where is the lesion?"

Test for both light touch (cotton tip applicator) and pain (sharp object) in the 3 sensory divisions (forehead, cheek, and jaw) of CN 5. The first principle of neurologic diagnosis is regional or anatomical localization. In order to become skillful the student must understand how structure relates to function of the nervous system. The neurologic examination permits "dissection" of the nervous system and localizes the disease when present. Instead of simply memorizing the components of the exam, a logical and systematic approach to problem solving evolves from repeatedly asking, "Where is the lesion?"

The gag reflex tests both the sensory and motor components of CN 9 & 10. This involuntary reflex is obtained by touching the back of the pharynx with the tongue depressor and watching the elevation of the palate. The first principle of neurologic diagnosis is regional or anatomical localization. In order to become skillful the student must understand how structure relates to function of the nervous system. The neurologic examination permits "dissection" of the nervous system and localizes the disease when present. Instead of simply memorizing the components of the exam, a logical and systematic approach to problem solving evolves from repeatedly asking, "Where is the lesion?"

Vergence eye movements occur when the eyes move simultaneously inward (convergence) or outward (divergence) in order to maintain the image on the fovea that is close up or far away. Most often convergence is tested as part of the near triad. When a patient is asked to follow an object that is brought from a distance to the tip of their nose the eyes should converge, the pupil will constrict and the lens will round up (accommodation). The first principle of neurologic diagnosis is regional or anatomical localization. In order to become skillful the student must understand how structure relates to function of the nervous system. The neurologic examination permits "dissection" of the nervous system and localizes the disease when present. Instead of simply memorizing the components of the exam, a logical and systematic approach to problem solving evolves from repeatedly asking, "Where is the lesion?"

The patient has spasticity in the lower extremities greater than the upper extremities. The hips and knees are flexed and adducted with the ankles extended and internally rotated. When the patient walks both lower extremities are circumducted and the upper extremities are held in a mid or low guard position. This type of gait is usually seen with bilateral periventricular lesions. The legs are more affected than the arms because the corticospinal tract axons that are going to the legs are closest to the ventricles. The first principle of neurologic diagnosis is regional or anatomical localization. In order to become skillful the student must understand how structure relates to function of the nervous system. The neurologic examination permits "dissection" of the nervous system and localizes the disease when present. Instead of simply memorizing the components of the exam, a logical and systematic approach to problem solving evolves from repeatedly asking, "Where is the lesion?"

With muscular diseases, the proximal pelvic girdle muscles are usually the most weak. Because of this the patient will not be able to stabilize the pelvis as they lift their leg to step forward, so the pelvis will tilt toward the non-weight bearing leg which results in a waddle type of gait. The first principle of neurologic diagnosis is regional or anatomical localization. In order to become skillful the student must understand how structure relates to function of the nervous system. The neurologic examination permits "dissection" of the nervous system and localizes the disease when present. Instead of simply memorizing the components of the exam, a logical and systematic approach to problem solving evolves from repeatedly asking, "Where is the lesion?"

Have the patient walk heel-to-toe. The patient should be able to balance without falling or stepping to the side. The first principle of neurologic diagnosis is regional or anatomical localization. In order to become skillful the student must understand how structure relates to function of the nervous system. The neurologic examination permits "dissection" of the nervous system and localizes the disease when present. Instead of simply memorizing the components of the exam, a logical and systematic approach to problem solving evolves from repeatedly asking, "Where is the lesion?"

The occipital lobes are important for perception of visual information. Areas in the inferior temporal visual association cortex are important for recognition of color and shape as well as the recognition of faces. Projections from the occipital lobe to the superior temporal-parietal area are important for perceiving motion of objects. Tests that are used to examine the occipital lobes and its connections include visual fields (see Cranial Nerve 2), naming of objects, naming of colors and recognition of faces. The first principle of neurologic diagnosis is regional or anatomical localization. In order to become skillful the student must understand how structure relates to function of the nervous system. The neurologic examination permits "dissection" of the nervous system and localizes the disease when present. Instead of simply memorizing the components of the exam, a logical and systematic approach to problem solving evolves from repeatedly asking, "Where is the lesion?"

There is hypertrophy of this patient's left leg. Closer inspection of that extremity shows hyperpigmented skin lesions suggesting segmental neurofibromatosis. A thorough skin search can provide important clues to diagnosis especially in the neurocutaneous syndromes. The first principle of neurologic diagnosis is regional or anatomical localization. In order to become skillful the student must understand how structure relates to function of the nervous system. The neurologic examination permits "dissection" of the nervous system and localizes the disease when present. Instead of simply memorizing the components of the exam, a logical and systematic approach to problem solving evolves from repeatedly asking, "Where is the lesion?"

With an UMN lesion there is pronation and downward drift of the outstretched supinated arm. This is because the pronators overpower the weaker supinators. Another name for this sign is a pronator Babinski. The first principle of neurologic diagnosis is regional or anatomical localization. In order to become skillful the student must understand how structure relates to function of the nervous system. The neurologic examination permits "dissection" of the nervous system and localizes the disease when present. Instead of simply memorizing the components of the exam, a logical and systematic approach to problem solving evolves from repeatedly asking, "Where is the lesion?"

There is increased tone in the right upper extremity that is rate dependent with the clasp-knife phenomena noted when the arm is flexed. This is spasticity from an upper motor neuron lesion. The first principle of neurologic diagnosis is regional or anatomical localization. In order to become skillful the student must understand how structure relates to function of the nervous system. The neurologic examination permits "dissection" of the nervous system and localizes the disease when present. Instead of simply memorizing the components of the exam, a logical and systematic approach to problem solving evolves from repeatedly asking, "Where is the lesion?"

Clinical testing of the motor system: - Muscle strength - Tone - Reflexes - Pathological reflexes. The first principle of neurologic diagnosis is regional or anatomical localization. In order to become skillful the student must understand how structure relates to function of the nervous system. The neurologic examination permits "dissection" of the nervous system and localizes the disease when present. Instead of simply memorizing the components of the exam, a logical and systematic approach to problem solving evolves from repeatedly asking, "Where is the lesion?"

Spinal cord lesions often give UMN signs below the level of the lesion (from effect on the corticospinal tract) and LMN signs at the level of the lesion (from effect on the ventral horn or ventral nerve root). LMN signs are good for locating the level of a spinal cord lesion. The first principle of neurologic diagnosis is regional or anatomical localization. In order to become skillful the student must understand how structure relates to function of the nervous system. The neurologic examination permits "dissection" of the nervous system and localizes the disease when present. Instead of simply memorizing the components of the exam, a logical and systematic approach to problem solving evolves from repeatedly asking, "Where is the lesion?"