Makindo Medical Notes

Related Subjects: |Neurological History taking |Cortical functions |Motor System |Sensory System |Mental state Examination |Speech and Language Exam |Cranial nerves and examination |Assessing Cognition

🧠 Neurological diagnosis is 90% history + focused examination. Always tailor your exam to the clinical context (outpatient, acute unit, HDU/ICU). The key: localise the lesion, identify the cause, and decide management.

🔑 Introduction

• Exam varies depending on setting (clinic vs emergency vs ITU).
• Always link findings to neuroanatomy – e.g. bilateral leg weakness rarely from a single stroke.
• In OSCEs, you’ll often be asked to perform a focused part (cranial nerves, coordination, etc.) rather than the whole exam.

📝 Core Components

• Higher functions (cognition, language, behaviour)
• Motor (tone, power, reflexes, coordination)
• Sensory (light touch, pain, proprioception)
• Visual (acuity, fields, fundus)
• Cerebellar (coordination, gait, dysarthria)
• Cranial nerves
• Peripheral nerves

👀 Higher Level Assessment

• Observation: Alertness, eye contact, orientation.
• Appearance: Grooming, clothing, neglect (e.g. hemineglect in stroke).
• Behaviour: Inappropriate actions, disinhibition, aggression, neglect.
• Look for subtle clues: flat affect (frontal lesion), labile mood (pseudobulbar palsy).

💤 Comatose Patient – Glasgow Coma Scale (GCS)

• Developed 1970s to guide neurosurgical referral.
• Score trends 📉 are more important than single values.
• Interpret in context – e.g. an aphasic stroke may score low but remain alert.
• GCS Components: Eye opening (E), Verbal (V), Motor (M). Max = 15, Min = 3.

😵 Assessing Confusion

• Start with GCS (confused but rousable patients should score >12).
• Distinguish between dysphasia (language disorder) vs delirium (fluctuating attention + disorientation).
• Ask simple orientation Qs: name, age, DOB, date/time, location.
• Confusion in elderly = poor prognostic sign (often delirium → ↑ mortality).

🧾 Mental Test Score (MTS)

• Quick bedside tool (10 points):
• Age (1), Time (nearest hour) (1)
• Address recall (e.g. “42 West Street”) (1)
• Year (1), Location (hospital/home) (1)
• Recognise 2 people (1)
• DOB (day + month) (1)
• Historic date (WW1 start) (1)
• Current monarch/PM (1)
• Count backwards 20 → 1 (1)

📊 Alternative Cognitive Assessment

• Mini-Mental State Examination (MMSE) 📝 – more detailed tool covering orientation, attention, recall, language, visuospatial ability.
• Other modern options: MoCA (Montreal Cognitive Assessment) for early dementia screening.