NEUROSURGICAL HISTORY

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NEUROSURGICAL HISTORY EXAMINATION

• Essam Elgamal FRCS(SN)

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• In conjunction with information from other
  systems,
• previous medical history,
• family and social history,
• current medications.
• Confirmation from relative or a friend.

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History

• Headache
• Visual disorder
• Loss of consciousness
• Speech disorder
• Motor disorder
• Sensory disorder
• Sphincter disorder

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History

• Lower cranial nerve disorder
• Mental disorder

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Onset
Duration
Course
Severity
HEADACHE
Timing
Character
Precipitating factors
Site
Relieving factors
features
Associated
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Course
Duration
Onset
Impairment
VISUAL DISORDER
Diplopia
Precipitating factors
Hallucinations
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Onset
Course
Duration
Tongue biting Incontinence Limb twitching
LOSS OF CONSCIOUSNESS
Precipitating factors
Alcohol/Drug Abuse
Cardiovascular or Respiratory symptoms
Head injury
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Onset
Duration
Course
SPEECH DISORDER
Articulation
Expression
Understanding
10
Onset
Duration
Course
Coordination
MOTOR DISORDER
Weakness
Precipitating Factors
Involuntary movement
Relieving factors
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Onset
Course
Duration
Pain
SENSORY DISORDER
Numbness
Precipitating factors
Site
Relieving factors
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Onset
Course
Duration
Incontinence Or Retention
SPHINCTER DISORDER
Bladder
Anal
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Duration
Onset
Course
Deafness
LOWER CRANIAL NERVE DISORDER
Tinnitus
Vertigo
Precipitating factors
Balance/staggering
Swallowing
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Onset
Course
Duration
Memory
MENTAL DISORDER
Intelligence
Behaviour
Personality
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Examination

• General
• Neurological disease systemic signs
• Systemic disease affect nervous system

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Examination

• Temperature
• Blood pressure
• Neck stiffness
• Pulse irregularity
• Carotid bruit/murmer
• Cyanosis
• Weight loss
• Breast lump

• Lymphadenopathy
• Hepatosplenomegaly
• Prostatic irregularity
• Septic source
• Skin marks
• Anterior fontanelle
• Head circumference

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Cranial Nerves
Conscious level Higher functions Cognitive
skills Memory Reasoning Emotional status
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Upper Lower Limbs Motor Status Tone Pow
er Reflexes Sensory Pain Touch Temperat
ure Proprioception Steriognosis Coordination
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GCS

• Eye Opening
• Spontaneous 4
• To speech 3
• To pain 2
• None 1

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GCS

• Verbal response
• Orientated 5
• Confused 4
• Words 3
• Sounds 2
• None 1

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GCS

• Motor response
• Obeys commands 6
• Localising to pain 5
• Flexing to pain 4
• Decorticated 3
• Decerebrated 2
• None 1

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Cognitive skills (Dominant Hemisphere)

• Listen to language
• Hesitant Expressive dysphasia
• Fluent Receptive dysphasia
• Doesnt understand Receptive
• Cannot name objects Nominal
• Doesnt read Dyslexia
• Doesnt write Dysgraphia
• Numerical calculation Dyscalculia
• Cannot recognise objects Agnosia

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Cognitive skills (Non-dominant Hemisphere)

• Doesnt find his way Geographical agnosia
• Cannot dress himself Dressing apraxia
• Copy geometric pattern Constructional apraxia
• Minimental function test

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Memory Test

• Immediate
• Recent
• Remote
• Verbal
• Visual
• Rretrograde amnesia
• Post-traumatic amnesia

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• Reasoning and problem solving
• Compare with expected abilities
• Emotional state
• Depressed
• Anxiety
• Apathy
• Uninhibited
• Slowness

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Cranial nerves

• I Olfactory
• II Optic
• Acuity
• Field
• Fundus
• Pupils
• III, IV, VI Oculomotor, Trochlear, Abducent
• Ocular movement
• Diplopia
• Nystagmus

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Cranial nerves

• V Trigeminal
• Sensory
• Motor
• VII Facial
• UMN weakness, LMN palsy
• VIII Auditory
• Cochlear component
• Webers test
• Conductive louder in affected ear
• Neural louder in normal ear
• Rinnes test

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Cranial nerves

• IX, X Glossopharyngeal Vagus
• Gag reflex
• XI Accessory
• Sternomastoid
• Trapezius
• XII Hypoglossal

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Motor system

• Asymmetry / deformity
• M. status
• M. tone
• Increased
• Clasp-knife
• Lead-pipe
• Cog-wheal
• Clonus

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Motor system

• Power
• Grade 5 Normal
• Grade 4 against some resistance
• Grade 3 against gravity but not resistance
• Grade 2 elimination of gravity
• Grade 1 flickers
• Grade 0 None

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Reflexes

• Upper Limb
• Biceps C5,C6
• Triceps C6,C7,C8
• Hoffman sign
• Co-ordination
• Finger-nose test
• Finger-finger test
• Dysadiadocholinesia
• Arm bounce
• Rebound phenomenon

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Reflexes

• Lower limb
• Knee
• Ankle
• Planter
• Coordination
• Rombergs test
• Gait

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Sensation

• Pain
• Touch
• Temperature
• Joint sensation
• Vibration
• Two point discrimination
• Sensory inattention (detect stimuli in both
  limbs)
• Streognosis
• Graphaesthesia

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Sphincters

• Distended bladder
• Evidence of incontinence
• Anal reflex

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Thank you