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An approach to the peripheral neuro exam - Coggle Diagram

- - - - Wheelchairs
      - Braces/orthotics
      - NIV machines
    - - Looks well?
      - Dysmorphism?
      - Supplemental O2?
      - Drooling?
      - Medications
      - Ptosis?
    - - Evidence of ataxia
        
        Romberg's
        
        Positive (sensory or vestibular)
        
        Congenital
        
        Friedrich's Ataxia
        
        Note that you can actually have cerebellar signs in this case, but the Romberg's will still be positive because of dorsal column involvement
        
        Eyes: Optic atrophy
        
        Endocrine: Diabetes
        
        Cardiac: HOCM
        
        Charcot Marie Tooth
        
        Spina Bifida
        
        Acquired
        
        Multiple sclerosis
        
        B12 deficiency
        
        Transverse myelitis
        
        Neurosyphillis
        
        Tumour
        
        Negative (cerebellar)
        
        VERY WORRYING TO SEE CEREBELLAR SIGNS IN CHILDREN
        
        Congenital
        
        Ataxia Telangiectasia
        
        Others
        
        Acquired
        
        Tumour
        
        Stroke
        
        Infective/post-infective AI
        
        Intoxication
        
        GO LOOKING FOR OTHER CEREBELLAR SIGNS
        
        DANISH
      - CLOSER INSPECTION OF THE AREA IN QUESTION
        
        Deformity
        
        Pes cavus
        
        F.A.
        
        CMT
        
        DMD
        
        CP
        
        Spina bifida
        
        Wasting/Hypertrophy
        
        Asymmetry
        
        Rashes/Neurocutaneous signs
        
        Fasciculations
        
        Scars/Skin
        
        Use the prompt of SCARS to remind me to take a look at the back/spine for any scars suggestive of spinal surgery, or for scoliosis
        
        ANd while looking at the spine, take a look behind the ears for a VP shunt
        
        TONE and Clonus("at each joint, comparing sides")
        
        Increased
        
        Globally (suggests cerebrum)
        
        CP
        
        Previous childhood stroke
        
        Neurometabolic/genetic conditions
        
        With a level
        
        Spinal cord
        
        Spina bifida (note can also be flaccid)
        
        Transverse myelitis (can also be flaccid)
        
        B12 deficiency
        
        Tumour (can also be flaccid)
        
        Decreased
        
        Globally (suggests LMN or muscular)
        
        Refer to gait and general inspection for clues as to whether likely myopathy
        
        Likely myopathy
        
        1 more item...
        
        Likely LMN
        
        4 more items...
        
        With a level
        
        POWER
        
        Pretty much always going to be reduced somewhere.
        
        Assess for global reduction of a level
        
        REFLEXES
        
        SENSATION
        
        Reduced touch and pin-prick - Spinothalamic
        
        Reduced vibration/proprioception - Dorsal columns
      - Unable to walk on tip-toes: Neuropathy
      - Unable to walk on heels: Myopathy
      - Gower's positive: Myopathy