Now, I'll perform the
complete neurologic exam. We'll do this starting from cranial nerves and then moving to upper and
lower extremities. Now, Frank, have you
noticed any changes in your sense of taste or smell? No. Okay. That's the
first cranial nerve. I'll talk to you a little
bit about what I'm doing as I'm going along
here. The next thing. Now, you can put your
glasses on here. And what I want you to do is
hold this about 14 " away, cover up your left eye, and tell me the lowest line of numbers that you can read here. I'd be 9, 3, 7, 8, 2, 6. All right. And now that is 2025. Now, if you can turn
to the other side, cover your right eye. 9, 3, 7, 8, 2, 6. Okay. And same thing. Now, you can take your
glasses off for a moment. Now, if you can
cover your right eye with your right hand there. And I'll do I'm going
to cover my left eye. And I want you to tell
me looking at my nose. Tell me how many
fingers you see here? Two. And here. Two. All right. And how many here? Five. And how many here? One. Okay. Now, you can
switch to the other side. I'll use the same numbers, one, two or five fingers. Okay. All right. And
again, tell me? One. And here. Five. And tell me over here. Two. And here. Five. Okay. And recheck here. Two. All right. Now you can leave your glasses there
for a moment, if you may. I'm going to look in
the back of your eye here with an ophthalmoscope. Yeah, you can just look ahead at a point on the wall there. I'm going to rest my hand on your forehead and I'll come
in here from the side. I'll come in fairly close looking at the back of your eye. All right, looking
at blood vessels and the back of the nerve there. Now, I'll come to
the other side here. I'm going to rest my
hand on your head again and come in here closely. All right. Everything
looks good there. That was the second
cranial nerve. Next, I'm going to check
cranial nerve III, 1V and VI together. First III. Now, can you close
your eyes for me? Open them back up again. I'm watching for eyelids, make sure your eyelids
raise equally. Now I'm going to check
pupillary response here, so I'm going to bring
the light over here. You can just look into
the distance here. I'm going to check right eye first here and then left eye. And go back and forth
between the two, make sure the eyes work
consensually and they do. Now, I'm going to check
some motions of your eyes, so if you can follow my
finger with your eyes here. I'm going to move
across this way up through here, down here. I'm watching both eyes, making sure that
they're moving equally. Up here again and
down through there, and then back to the middle. Now, can you look wait
off to the distance, and now look at my
finger again here, make sure it reacts. I see your pupils coming together and your pupils
reacting a little bit to that. That was cranial nerve III, IV, and VI is what I
checked there together. Now, the next nerve that
I'm going to check is cranial nerve V and it's
feeling on the face. If you can close
your eyes for me, you'll feel me touch, tell
me where you feel me touch. Forehead. All right. Does
that feel about the same on both sides there? Yes. Okay. And here, where you feel me touch there. Cheek. Okay. And does that
feel about the same? Yes, it does. And down here, same thing? Chin. Yeah. And how does that feel? The same. All
right. Now, if you can open your eyes again, clench your jaw very tightly. I'm checking these muscles
here and open your mouth here. Okay. Good. Checking
to make sure your jaw sits in about the same spot.
All right. That's good. The next nerve is
cranial nerve VII, I'm going to start with some
of the muscles of your face. First, can you look up towards the ceiling, wrinkle eyebrow? Now, close your eyes tightly. Don't let me open them. Good. If you can smile, show me your teeth, good. Now puff out your
cheeks, like that. Great. Excellent. That's
cranial nerve VII, and that all looks very good. I'm going to check hearing
a little bit here. If you can close your eyes and tell me when you
hear a noise here. Now. What ear is that by? Left. Okay. Now, again, close your eyes, tell me
when you hear a noise. Now. All right. And what
side was that on? Right. All
right. I'm going to take a look in the back
of your throat here. So if you can open your
mouth and say ah. All right. I'm watching for the
palette to rise. And now, if you can stick
out your tongue towards me, move it from side to side. Excellent. Okay. That
was cranial nerve XII, the moving to side to side. Now I'm going to check some muscle strength in
your neck here. If you can turn your head
towards the left side and now try to straighten it
while my hand is here. Now turn to the right.
Now try to straighten it. Now, lastly, if you can lift your shoulders
just like that, hold them up there,
I'm going to push down. Good strength there. That checks out the
nerves of the face and the head and everything
checks out just fine. For the next part of
the neurologic exam, I'll move to the
upper extremities. Now, Frank, could
you tie your gown and lower it so it's
sitting just at your waist here. Thank you. Now, first, I'll start
with looking at muscles. I'm looking for the
circulations or movement of your muscles here comparing one side to another. Also looking for any loss
of muscle such as atrophy, and everything looks okay there. I'm going to check tone of the muscles. You
just relax your arm. I'm going to move the arm
back and forth a little bit. I'm going to check it on this
side here too. All right. That's all normal. Next, I'm going to check for your arms to see whether
they move or not. Can you put your arms
out just like this? Now, close your
eyes. I'm going to watch your arms and hands
for about 20 seconds. This is pronator drift. Now you can rest
your arms again. Next, I'll check strength. Can you put your
arms up like this? I'm going to press down. You keep your arms
up just like that. Good. Now you can
rest your arms again. I'm going to check first the
right arm here, the elbow. Can you push out against me? And I'll pull back
in towards you. Elbow flexion and extension
now on this side, push out against me and
pull in towards you. Elbow flexion and
extension there. Now, extend your
fingers like this. I want you to keep
your fingers apart. I'm going to try and
press them together, keep them spread
apart. Very good. Now, rest your arms
just like this and take this thumb and touch the
little finger on that thumb. There you go. Now, I'm going to try and pull the thumb open. You keep it close there. Good. Now on this side, bring your thumbs together. I want to try and pull apart.
You keep them together. Good strength on both sides. The next part will be
checking sensation. I'm going to use some Q
tips here and I'm going to touch one side then the other and you tell me whether
you can feel it, whether it feels the
same on both sides. Okay. All right. If you
can close your eyes. Right side. Left side. Does that feel
about the same? Yes, it does. All right. Right side. Left side. Same? Yes. Okay. Left side. Right
side. That's the same. Okay. Left side. Right side, the same. Right side. Left side, it's the same. Right side. And left
side, it's the same. All right. Now, I'm
going to do the same thing, but with a little sharper end to the other side of the Q tip. So I'll touch your
finger so you know what that feels like
there. All right. I broke off the end of this
Q tip and I'll use that. All right. And close
your eyes again. Left, right. Is that the same? Yes. Okay. Right, left. That's the same. Left, right, same. Right, left, same, right,
left, that's the same. Left, right. That's the same. All right. Very good. You can open your eyes again. Now, the next part of this
is checking vibratory sense. Again, I want you
to close your eyes, and I'm going to touch
your finger here. You tell me what does
that feel like there? It feels like it's vibrating. Okay. I want you to
tell me when it stops. Now. All right. Now
I'm going to check on the other side here too. Same thing. Tell me
what it feels like. Vibration. And then tell me
when it stops here. Now. All right.
That's comparing both sides vibratory sense. Now the last part of this particular exam is
joint position sense. Again, close your eyes and I'm going to either
lift up your finger, which will feel like this or lower your finger, which
will feel like that. But I'm going to do it a little more subtly than that here. All right. So tell me whether
I'm lifting up or lowering. Lower. Okay. And again? Up. Now I'm going to check
it on the right side here. Up. All right. Now, that's the end of the
sensory exam here. The next part I'm going
to check is coordination. It's how quickly you can move
your hands back and forth. I want you first to
take your left hand on your lap and slap it back
and forth like this. And go as fast as you can there. Good. Now, you can rest that hand and do it
on the other side. I'm going to compare how
fast that one can go. Very good. Then I'm going to check on your left
hand first here. I want you to do this.
Touch first, second, third fourth, fourth,
second, third, go back and forth like that. And do this on the
other side too. Are you left or right handed? Ambidextrous. Ambidextrous.
Okay, so you have equal ability to do
that on both sides. That goes along with
your ambidexterity. Last thing is finger
to nose test. I want you to take
the first finger of your right hand and touch
your nose and then touch my finger and go
back and forth to your nose and my finger and
your nose and my finger. Now you can rest that
hand and do it with the left hand. Okay. Very good. Next, I'm going to check
some reflexes here. I'm going to check all the reflexes on the
right side here first. I'm going to start
first with bicep, so you can just
rest your arm here. I'm going to press right over the tendon and then
tap the tendon. Then I'm going to check
on your forearm here. I'm going to tap right
on your forearm. And lastly, I'm going to
bring your arm out like this, let the arm hang free. I'm going to tap the
triceps right here. Now I'm going to move and check the same thing on the
left side here too. First, I'll start with checking biceps right in the elbow. I'm going to check on
the fore arm here. Then lastly, triceps,
let your arm relax here, and I'll check right
across through here. You can rest your arms there. And that concludes the
upper extremity part of the neurologic exam. I'm going to check the
same type of things on your legs that I did
with your arms, Frank. First, I'm just looking at the skin here,
looking at muscles, looking for any spots where
muscles are twitching or not moving the
way they should. I'm going to take my hand
just behind your knee. I'm going to move your
leg back and forth, just let me move the
leg back and forth. Checking for a tone, making sure there's no
increased tone there. I'll do the same
thing on this side, my hand right behind your knee. Move it back and forth
just a little bit. I'm going to next
check strength. I'll start with the upper part of your legs and move down. Can you lift this leg up and hold it there
and I'll press down. Same thing here,
lift this leg up and hold it. I'll press down. Good. That's equal
on both sides. Press this leg out towards me. And then press this
leg out towards me. That part of the leg is good. I'm going to now check toes, so lift your toes up
against my fingers on both sides and press down. Okay. Strength is good. The next part of the exam
is the sensory exam. I'm going to take these Q tips. I'm going to touch your leg
on one side, then the other. I want you to let me know if they're about the
same on both sides. Tell me which side I'm checking and whether
it's the same. If you can close your eyes here. So tell me left or right. Left. Okay. Right. They're the same. All right. Right. Left, same. Left. Right, it's the same. Right. Left. It's the same. Left. Right. That's the same. Now, I'll do the
same thing with the other ends of the Q tip, the sharper end here. I'm going to touch
your finger so I can show you what
that feels like here. It's just a little sharper. Same thing, I'll have you close your eyes and then
tell me which side you feel that on and whether
it's the same on both sides. Left, sharp and
right then the same. Okay. Left, right. That's the same. Right, left, it's the same. Left. Right and it's just the same. Right. Left, same. All right. The next part
is checking vibration. So I'm going to touch your
toe with this tuning fork, close your eyes, and tell
me what it feels like. Vibration. And then tell
me when it stops. Now. I'll check on the other side. Same thing. Tell me what
that feels like there. Vibration. And tell me when it stops. Now. Okay. Then another aspect of this is for me to check whether you can
tell where your toe is, whether it's up or down. I'll demonstrate that for you if I lift the toe up like this, that's up, and I press the
toe down, that's down. And if you can
close your eyes and then tell me which way it feels
like I'm moving your toe. Down. And again? Down. And then check on this
right side here too. Up, down. Okay. So that checks
out just fine as well. The next part is to
check coordination. So if you can take the
heel of your right foot and run that up and down
the shin of your left foot. Yeah, just like
that. Good. Go back and forth several times. Then now go to the other side, run the left shin or left
heel up and down the shin. Very good. That's perfect. Now, the next part,
I'll check reflexes. I'm going to check.
There's two reflexes on the left leg and
two on the right leg. I'll check those on the
left leg first here, so you can just relax your
muscles. I check there. Now I'll check this reflex, the Achilles tendon reflex. Now I'm going to move
over to the right side. I'll check this
patellar reflex here. And I'll check the
Achilles tendon reflex right back there.
Those are fine. You don't have much in
the way of reflexes, but they're equal on both
sides, so that's normal. Now I'm going to next check the planter
reflex that's called. What I'm going to do
is take your foot. And I'm going to take the
bottom of this reflex hammer. I'm going to run it
across the bottom of your foot and across
the top like this. I'll start in the back
and go right around here and I'm watching your
toes as you're doing that. Okay. Now I'll check on this
side here too, same thing. Okay. And so normal
response since your big toe drops down
as I'm checking that. The next part will
be for me to check your gait or your ability
to walk and stand. Frank, can you walk
towards me normally? For purposes of this video, we'll conduct this
in the hallway. And now turn around
and walk on your toes. And turn around again, walk
on your heels this time. Turn around one last time, walk as though you're
walking on a tight rope, one foot in front of the other. That's good. Thank you, Frank. Another part of the neurologic
exam is the Romberg. What I'm going to have
you do is stand with your feet together,
arms at your side, and I'm going to hold my hands here and I want you to close your eyes and I'm
holding my hands. I'm going to watch and
just make sure that you can stand in one
place like this. That's good. You can stand
wherever you're comfortable.