Daily Bolus of LR: Neurology Examination Pearls

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November 1, 2012 by dailybolusoflr

“Take Homes” from ACEP

Thanks to Dr. Sara Jalali for her contribution of “Take Homes” from Dr. Greg Henry’s talk at ACEP
For suspected SAH, there are 3 important questions you must ask:
1. What was the rate of onset, and was MAX PAIN REACHED WITHIN 2 MINUTES? This question is 16-18x more indicative of SAH.
2. Is there a family history?
3. Was there LOC?

Location of pain is less helpful because both may occur (e.g. anterior vs posterior), but 1/3 of SAH originates from posterior circulation.

Low Back Pain:
Most LBP originates from L5 nerve
– Check L5 with great toe extension; also check sensation of inner thigh, cremaster, rectum
– There is NO REFLEX FOR L5 (Knee is L3), so don’t be falsely reassured by good knee-jerk
– Document bowel/bladder function
– Don’t forget about the abdomen as the source; e.g. 70 year old man comes in with new low back pain… check the belly!

CN exam – no one ever TRULY does the full CN exam (hence documenting CN 2-12 grossly intact is inaccurate). 
– Three most important things you should ALWAYS check/document are: EYES, SPEECH, GAIT

Pronator Drift Testing
– Check for 10 seconds
– Failing this is an EARLIER finding than grip strength for motor deficit
– The “searching arm” (one arm kind of waving around) is a lesion of the Non-dominant parietal lobe
– Motor impersistence (both arms drop once they close their eyes, as if they’ve given up) is an early sign of frontal dementia, because they can’t do it without the visual stimulus

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