Mental Status Examination- Alert and oriented means:o Opens eyes spontaneouslyo Converses appropriatelyo Follows commandso Is oriented to person, place and time- Mini Mental Status Examination is used usually for people with dementiaTESTING CRANIAL NERVESThe Olfactory Nerveso Test with odorous things one nostril at a timeo Dysfunction to Cranial Nerve I is caused usually by trauma to cribiform plate, frontal lobe mass or strokeo Nasal problems that could be allergic or viralCranial Nerve II: Optic Nerveo Test with field of vision and visual acuityo Dysfunction to Cranial Nerve II is caused usually by eye disease or injury, diabetic retinopathy and glaucoma, occipital lobe mass or stroke (both eyes loss of visual field), pituitary tumorsCranial Nerve III, IV, and VI: Oculomotor, Trochlear and Abducens Nerveso Test three nerves with extraocular movements and pupil function. Askpatient if they have double vision during extraocular movementso CNS Syphilis produces Argyll Robertson pupil: loss of pupil response to light but still responds to accommodation. o Dysfunction caused by brainstem injury or compression and diabetic neuropathy.Cranial Nerve V: Trigeminal Nerveo Screen this nerve with facial sensation and strength of the masseter muscles. o Dysfunction usually caused by stroke in contralateral sensory cortex. Cranial Nerve VII: The Facial Nerveo Test with facial movements to raise eyebrows, show teeth, smile, puff out cheeks and whistle. o Injuries to facial strength central to the nucleus are often caused by a stroke and cause weakness of the lower face.o Injuries to the facial nerve cause weakness of the entire side of the face, including the forehead. Cranial Nerve VIII: The Acoustic Nerveo Test the acoustic nerve with hearing test. o Dysfunction usually caused by age, noise exposure, tumors, acoustic neuroma, middle ear disease. Cranial Nerve IX and X: Glossopharyngeal and Vagus Nerveso Test with gag reflex and ask patient to phonate to watch for uvula movement. o Dysfunction usually caused by large stroke and uvula retracts to the normal side. Cranial Nerve XI: The Accessory Nerveo Ask patient to shrug shoulders or turn head against resistanceo Dysfunction usually caused by neck injuryCranial Nerve XII: The Hypoglossal Nerveo Ask patient to protrude tongue and move it from side to side. o Dysfunction usually caused by stroke, tongue points toward weak side.SENSORY EXAMo Touch: Test light touch and abnormality may manifest as extinction: eyes closed and patient touched on both sides only feels it on normal side.o Sharp: Ask patient with eyes closed which object is sharp and dullo Vibration: Test with tuning forko Proprioception: Patient distinguishes whether finger and toe are moved up or down to test posterior column functiono Stereognosis: Patient identifies what is placed in hand to test parietal sensorycortex and posterior columnso Graphesthesia: Patient identifies numbers written on palmo Strength: Rated from no motion to full strength against resistance.o Subtle central weakness can be tested through pronator drift. In mild cortical weakness, patient’s hand on weak side pronates and drifts down.DEEP TENDON REFLEXESo Biceps reflex test, brachioradialis reflex test, triceps test, knee jerk test and ankle jerk test. o Babinski’s Sign: Stroke sole of foot with back of hammer normal is great toe goes down, normal great toe goes UP and toes fan up and ankle may dorsiflex.Babinski abnormal test is a sing of upper motor neuron disease. ABRORMAL GAITSo Spastic Hemiplegia: Foot is inverted, leg too straight and swung out, arm flexed and held close to chest (a sign of stroke or old cortical injury)o Parkinsonian Gait: shuffling gait, rapid small steps, little arm swing, turning en bloc. o Antalgic Gait: pain avoiding, not due to neurologic illness, minimal time on painful leg. o Ataxic Gait: Wide-based, irregular gait, sign of cerebellar diseaseOTHER TESTS OF COORDINATIONo Finger to noseo Patient touches nose and then examiner’s finger. Cerebellar disease causes abnormality. o Heel to shino Patient moves one heel down to the other shin. Abnormal jerky motion is in cerebellar disease. o Rapid alternating movementso Rapidly pronate and supinate hands. Dysdiadochokinesia in patients with cerebellar disease. o Fine motoro Patient rapidly touches thumb to each finger of the same hand. Abnormal with cortical lesions. o Romberg’s signo Patient stands with feet together and closes eyes. Patient sways and can’t hold position with eyes