Sensory Examination - General Principles

SENSORY EXAMINATION There are two types of sensory: Exteroceptip Tactile pain, Hot/cold, Tactile, Vibration, Tactile graphesthesia, Tekture, Stereographic, Sensory attention, Barognosis Proprioceptip • Joint movement • Muscle tension General principles of tessensation • Comfortable position • Description of test procedures • The patient does not see the area being examined • Sign of trouble area • The normal area is used as a standard • The tools used are not interchangeable • Be careful in interpretation EXAMINATION TECHNIQUES Proprioceptip Tendon reflex • Attention : • The patient must relax • Able to pay attention to the hammer reflex • Correct execution technique Degree of reflex • 0 no response. • 1+ minimal response. • 2+ normal response. • 3+ fast response, strong muscle contractions, clear joint movements. hyperactivity, very • 4+ strong contractions, strong movements to the point of clonus. Replex tendons are frequently checked • biceps reflex • bracio radialis reflex • triceps reflex • quadriceps reflex • Achilles reflex Replex disorders • Value 0 ---- LMN lesion • Grade 4+ ---- UMN lesion • Asymmetry ---- other neurological disorders • Proximal to distal changes ---- peripheral nerve lesions • Pendular ---- cerebral lesions Movement test • Method: the patient is not looking at the member who is asked to feel. LOCATION OF NEUROLOGICAL LESIONS • Peripheral nerve --- loss of all sensation. • Nerve root --- loss of dermatum sensation. • Spinal cord --- bilateral loss of sensation. • Brain stem --- loss of sensation on the contralateral side. • Cerebral cortex - Stereographic. - Graphisthesia. - Sensory attention. HEADACHE Arises: stimulation of extra cranial structures of the head and neck (those sensitive to pain) Skin Periosteum Muscles: frontalis m. Meninges (artery-sinus venosus) Basal – cerebral arteries Veins – brain Nerves: n.trigeminus, n.facialis, n. Glossopharyngeus, n.vagus, cervical roots 2.3 Which are not sensitive to stimuli • Brain parenchyma • Ventricular epidyma • Choroid plexus • Skull TL Extra cranial N. Trigeminus →ant.head Cervical radix 2.3 → nape & post'or head N. Obtalmicus→face-eyes-2/3 front covered by hair N. Maxillary → ant cheeks, mouth, eyes, nose N. Mandibularis→lower lip and chin, nasal mucosa TENSION HEADACHE Due to contraction of the muscles of the head and nape of the splenius capitis m. temporalis, m. masseter, m. trapezius m. sternokleido mastoideus, m. cervicalis post'or, m. levator scap Primary: Chronic anxiety, depression, direct stimulation Secondary: Disorders of the eyes, neck, ENT, teeth, mouth. Clinical symptoms: Severe KPL, aches, like being tied, throbbing pain, nausea, vomiting, vertigo, lethargy, difficulty sleeping, palpitations, nightmares IDIOPATHIC TRRIGEMINUS NEURALGIA • Paroxysmal and recurrent headaches in: mandibular, maxillary and ophthalmic cabs • Symptom : • Sharp, burning and stabbing facial pain • It happened suddenly • Kdg2 repeats • There are no motor deficits • Attacks occur due to stimulation of the zone, for example: when chewing food, brushing teeth, yawning CEPHALGIA CLUSTER Vascular KPL pain – also called Horton/histamine KPL pain, Bing syndrome, neuralgia migrainosa Symptoms: • Stabbing pain in half of the head • Behind or in the eyeball • Cheeks, nostrils, palate, gums • Spreads via frontal, temporal, occiput • Typical symptoms of red side of the eye Average attack 15mt-5h Usually attack before morning Men: pr 5:1 ---20-40 yrs Trigger: food/alcoholic drinks TEMPORAL ARTERITIS (giant cell arteritis) Older women > 50 years old • Sudden temporo-parietal pain • Unilateral / bilateral • Throbbing pain in temporo parietal – slrh kpl • Very painful in a. temporalis (temple) • 10-40% can cause blindness • If it lasts a long time KU↓ • Lab, LED↑ 60-120mm/hr ATYPICAL FACIAL PAIN Like idiopathic trigeminal pain • Chronic, dull, burning, cramping pain • Not paroxysmal • Pain in the cheeks, jaw, teeth → other parts of the neck, shoulders • Can't get it: trigger zone, mtrk/sensrk deficit • Women > men • Depression, anxiety, cramps MIGRAINE • Recurring headache attacks with long frequency, varying degrees of pain, one-sided attacks, usually don't like eating, nausea and vomiting (Ad Hok Committee on Classification of Headache) • Often preceded by sensory and motor disorders, psychiatric disorders • There are hereditary factors • According to Blau • Recurrent vaginal pain lasting 2-72 hours is related to visual or gastro intestinal disturbances. Migraine classification (Headache classification Committee of the international Headache Society) • Ordinary migraine • Classic migraine • Migraine with eye muscle paralysis • Migraine with blind onset <1 hour Clinical symptoms Preceded by focal neurological symptoms for a moment • Sparkling view ( scintallating scotoma) • The feeling is like being pricked by a needle starting from fingers, arms, face, nose – mouth • Kpl pain on one side, nausea Ordinary migraine • Kpl pain on one side • Pulsating, moderate to intense intensity • Nausea, afraid of light • Pain increases with physical activity Migraine Pathophysiology Suppression of the spreading & expanding activity of brain neuron cells (Leao 1944). Local stimulation of the cerebral cortex will cause suppression of spontaneous brain neuron cell activity which will then spread and occur quickly. 2.Vascular Trigemino System – The brain's nerve fibers contain: • Substance P (SP) • Neurokinin – A (HKA) • Calcitonin gene related peptide (CGRP) – From ganglion n, trigeminus SP,NKA,CERP → arterial vasodilation Migraine – plasma serotonin↑→stimulates influence on all 3 elements→headache Vasocontraction of cerebral vessels – vaso dilation outside the brain 3. Nervous nuclei of the brain Rafe and Locus Ceruleus have a connection with serotonin and noradrenaline - affect vessels from the brain - vasocontraction of blood vessels from the brain - vaso dilation of blood vessels outside the brain