Neuro exam videos

1. Normal Exams
   1. Cranial Nerve Exam
   2. Upper Limb Neuro Exam
   3. Lower Limb Neuro Exam
2. Abnormal Findings
   1. Positive Babinski Sign
   2. Positive Hoffman Sign
   3. CN III Palsy
   4. CN VI Palsy
   5. CN IV Palsy
   6. Bell Palsy
   7. Stroke with facial paralysis and visual deficit
   8. Severe Expressive Aphasia
   9. Abnormal Rapid Alternating Movements
   10. Gait Abnormality in Parkinson Disease
   11. Abnormal Gait in Diabetic Neuropathy
   12. Steppage Gait
   13. Positive Romberg
   14. Hyperreflexia & Clonus

Normal Exams

These videos show a detailed neurologic exam aimed at medical students. OSCE stands for Objective Structured Clinical Examination, a standard way of testing medical students on their exam skills. These are British and there are some variations from what you are expected to do.

Cranial Nerve Exam

This covers the cranial nerve exam very thoroughly. (10 minutes)

Covers:

• CN I
  • asking if smell has changed
• CN II
  • inspection for conjugate gaze
  • visual acuity
  • pinhole testing
  • direct & consensual pupillary reflexes
  • swinging light test (with example of abnormal)
  • accommodation reflex
    • shows subtlety of change in size of pupil
  • color vision (not an objective)
  • visual neglect and extinction
  • visual fields
  • blind spot (not an objective)
• CN III, IV, VI
  • cardinal gaze
  • light reflex
  • cover test
• CN V
  • light touch & sharp sensation in different dermatomes
  • muscles of mastication
  • jaw jerk reflex (not an objective)
  • corneal reflex
• CN VII
  • various facial expressions
• CN VIII
  • whisper test
  • Rinne test using 512 Hz tuning fork
  • Weber test using 512 Hz tuning fork
• Turning test for balance (not an objective)
• CN IX & X
  • asking about voice or swallowing change
  • uvula and palate elevation
  • coughing
  • swallowing
  • gag reflex
• CN XI
  • shoulder shrug
  • head turning
• CN XII
  • tongue movements
  • tongue strength

Upper Limb Neuro Exam

Covers:

• Inspection
• Pronator drift (not an objective)
• Muscle tone
• Muscle strength (more detailed than you need)
• Biceps, triceps, and brachioradialis reflex (with a big hammer). Triceps reflex testing is fine, but not typical positioning.
• Light touch and sharp sensation in multiple dermatomes
• Vibration sensation using 128 Hz tuning fork
• Proprioception in thumb
• Finger-to-nose testing
• Rapid alternating movements (hand on palm)

(7.5 minutes)

Lower Limb Neuro Exam

Covers:

• Inspection
• Gait, including toe and heel walking and tandem gait
• Romberg
• Tone
• Ankle clonus
• Strength of multiple muscle groups (you only need quads and hamstrings)
• Patellar and ankle DTRs
• Plantar reflex
• Light touch and sharp sensation in multiple dermatomes
• Vibration sense using 128 Hz tuning fork
• Proprioception in great toe
• Heel-to-shin testing
  • typically we have heel slide up and down on shin
  • he asks the patient to rub his ankle along his shin instead of his heel

(8.5 minutes)

Abnormal Findings

Positive Babinski Sign

(20 seconds)

Documenting an abnormal (either works):

• abnormal plantar reflex
• positive Babinski sign

Whereas, other variations, such as “abnormal Babinski”, are ambiguous.

Positive Hoffman Sign

(1.5 minutes)

CN III Palsy

Pupil constriction may or may not be affected.

CN VI Palsy

(30 seconds)

CN IV Palsy

This is often very subtle. The first video shows a subtle palsy with positive cover test. The second video shows a more obvious example.

(1.5 minutes)

(1 minute)

Bell Palsy

The first video is slightly more subtle than the second when the patient is at rest. The second video discusses the pathophysiology as well.

(2 minutes)

The video above is a good example of all of the findings of Bell palsy. One subtle finding that is not pointed out is that he does not blink on the left side. When the deficit is incomplete, the patient may be able to blink on both sides, but the motion will be asymmetric, specifically the blink on the affected side will be noticeably slower.

(2.5 minutes)

Stroke with facial paralysis and visual deficit

(7.5 minutes)

• Abnormal visual fields with lack of response to confrontation on the left at 1:30
• Facial weakness with sparing of forehead at 1:50
• Left arm weakness at 2:15
• Left leg weakness at 2:40

Severe Expressive Aphasia

(7.5 minutes)

Demonstration of his speech deficit is best seen at about 4.5 minutes.

Abnormal Rapid Alternating Movements

(1 minute)

Gait Abnormality in Parkinson Disease

Abnormal Gait in Diabetic Neuropathy

(1.5 minutes)

Steppage Gait

(14 seconds)

Positive Romberg

(30 seconds)

Hyperreflexia & Clonus

(17 seconds)