By Schwartzman R.J.
A advisor to varied features of the neurological examination which reemphasizes the usefulness of the examination in localizing lesions within the vital and peripheral fearful method from which differential diagnoses are derived. It reintroduces using drifts, the arm roll and parietal replica to medical neurology.
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Extra info for Neurologic Examination
Most often it is a golden-brown ring inside the limbus of the cornea that may form a complete circle or just a crescent at the upper and lower margins. It is difﬁcult to see in dark eyes. Slitlamp evaluation reveals copper deposition in Desçemet’s membrane. After treatment with penicillamine it becomes a dull mottled brown. Behçet’s, Kawasaki’s and Stevens–Johnson syndrome can all produce conjunctival ulcers as do all severe collagen vascular diseases. The eyelids The position of the lids in relation to the iris and the width of the palpebral ﬁssure are noted in primary gaze and with forced eye opening.
A severely compromised midbrain may cause maximally dilated 6 mm pupils. An elliptical pupil (“cat’s eye pupil”) is often seen after midbrain damage from head trauma. An oval pupil may be seen with third nerve damage anywhere in its course. It is also seen in partial peripheral third nerve damage from compression or infarction. 5 mm in diameter but constrict to light. A Horner’s pupil is usually 1 mm and light reactive. Pupils are small in early infancy, old age, during sleep and in bright light.
The pupils are normal to clinical examination. In the ocular myopathies (dystrophic, congenital and mitochondrial) the ptosis is ﬁxed and the head is often extended to look out under the drooping lids. The ptosis tends to be symmetric in these entities. ru peripheral conditions. The lid should follow the globe in up and down gaze in a yoked fashion. If the sclerae is seen above the iris on down gaze, there is pathologic lid retraction. This occurs on a peripheral basis most commonly with hyperthyroidism, but may also be noted with excess anticholinesterase medication, hypokalemic periodic paralysis and in any state that results in a high concentration of circulating norepinephrine such as metastatic liver disease (norepinephrine cannot be metabolized).
Neurologic Examination by Schwartzman R.J.