Health Blog

Neurological examination

Fri, 02 Apr 2010 23:52:59 +0000

This is especially true of the psychoneuroses. To avoid misunderstanding it is well to speak the language which the patient understands best. While a neurologist may be to make a psychological test the determination of intelligence quotients in mental defectives had better be left to trained psychologist.

Every patient, no matter whether one is confused with an obvious psychosis or equally obvious psychoneurosis should receive a careful neurological examination. In fact the more convinced one is that the case is functional, the more complete the physical examination should be. Aside from the fact that organic manifestation may be discovered when least expected, a trough physical examination not only convinces a psychoneurotic that he is taken seriously but serves as an excellent therapeutic measure. It is needless to add that every patient is to be undressed. In the case of women one may allow sufficient draping to pay the necessary tribute to modesty. Finally, the patient should be reexamined from time to time and notes made on the original history records.

Before making a meticulous examination of system a rapid survey may reveal a number of important points. Abnormal attitudes of postures, contraction, contractures and deformities, atrophies or hypertrophies (see below), flatfeet, hypnosis, scoliosis or lord sis, enlarged glands, especially the thyroid, varicose veins, hernia, eruptions and pigmentations, bed sores and other vasomotor or tropics disturbances, bodily and facial distributions of hair, fat distribution, color of skin, and tumor masses. The patient is asked to walk alone if he can, or he may be supported by the examiner if necessary. He is made to walk in a straight line, backward and sidewise, then on his toes and heels, and finally he is asked to run.

Delusion and Hallucinations

Fri, 19 Mar 2010 23:51:42 +0000

Both delusion and hallucinations frequently coexist and one may bring either to the surface or judicious inquiry for the one or the other. Many patients in fact most neurotic complain of loss of memory. A little inquiry immediately reveals the emptiness of the complaint. Such patients suffer from want of attention (there are too self-centered): therefore they do not remember. Memory consists of attention (association), retention and spontaneous recollection. In true memory defect there is no retention, no power of association of ideas in order that they be retained and obviously no recollection. Each of these can be tested. The patient is asked to exact date and place of birth, age, address, name of wife and children or parents, names of day of the week or month of the year, the even of the previous days, the names of important persons, of capital cities, of outstanding occurrences, and so on. He may be show figures and asked to repeat them, or told a word and a few minutes later asked to recall it. He is given at first simple, then complicated, problem in arithmetic. In all these questions the educational status of the patient is to be considered. Generally memory for recent events is loss first and there for remote events preserved for a long time. Occasionally, a patient fills in gaps in memory with recital or false events. Disorientation as to time, place and person is generally the result of marked impairment of memory.

This is not the place to go in to discussion of the dynamics of the psychoses or the psychology of emotively or to describe the standard associations test or the free associations of psychoanalysis. It may be stated however, that acquaintance with the psychoanalysis technique greatly helps in obtaining a satisfactory mental history.

Various Deviations

Thu, 07 Jan 2010 23:59:40 +0000

Also due to want of the cerebella check element (and hypotonic), the knee jerk become pendulous swinging back and forth instead of stopping after one or two kicks. Finally, ataxia is brought out with the patient in the recumbent position by the heel to knee test. With eyes open and closed he is asked to raise the foot high, touch the knee and carry the heel along the shin. The ataxia can also be demonstrated by asking the patient to touch an object with his toes.

Obviously all tests for in coordination are made bilaterally, all cerebella ataxia is gipsy lateral; most cerebral forms are contra lateral.

Pointing and past-pointing which really are vestibular and not pure cerebella tests, may be briefly considered here. The patient is asked to extend his arm and perform the movement at the shoulder. The examiner stands in front of him and the patient touches with the extended index finger the examiner’s two index fingers, which are held together in a fixed position. Normally with eyes open, there is no deviation. On closing the eyes and knowing the position of the examiner’s fingers, the patient should be able to touch the same spot every time. If he deviates to the right or the left there is said to be past pointing. Without entering here into a discussion of the meaning of the various deviations the following may be said:

Normally there is no deviations
In cases of irrigative labyrinthine lesions there is spontaneous deviation
Normally if the vestibular apparatus is stimulated by rotation or irrigation of the ears with cold or hot water, there is deviation or past pointing
In total or destructive lesions of the vestibular apparatus there is no past pointing on stimulation
The plan of past pointing is influenced by the position of the head during the tests.