1Department of Ophthalmology, Massachusetts Eye and Ear, 2JoVE Content Production
Source:Tracey A. Milligan, MD; Tamara B. Kaplan, MD; Neurology, Brigham and Women's/Massachusetts General Hospital, Boston, Massachusetts, USA
During each section of the neurological testing, the examiner uses the powers of observation to assess the patient. In some cases, cranial nerve dysfunction is readily apparent: a patient might mention a characteristic chief complaint (such as loss of smell or diplopia), or a visually evident physical sign of cranial nerve involvement, such as in facial nerve palsy. However, in many cases a patient's history doesn't directly suggest cranial nerve pathologies, as some of them (such as sixth nerve palsy) may have subtle manifestations and can only be uncovered by a careful neurological exam. Importantly, a variety of pathological conditions that are associated with alterations in mental status (such as some neurodegenerative disorders or brain lesions) can also cause cranial nerve dysfunction; therefore, any abnormal findings during a mental status exam should prompt a careful and complete neurological exam.
The cranial nerve examination is applied neuroanatomy. The cranial nerves are symmetrical; therefore, while performing the examination, the examiner should compare each side to the other. A physician should approach the examination in a …
Physical Examinations III
Source: Richard Glickman-Simon, MD, Assistant Professor, Department of Public Health and Community Medicine, Tufts University School of Medicine, MA
Proper evaluation of the eyes in a general practice setting involves vision testing, orbit inspection, and ophthalmoscopic examination. Before beginning the exam, it is crucial to be familiar with the anatomy and physiology of the eye. The upper eyelid should be slightly over the iris, but it shouldn't cover the pupil when open; the lower lid lies below the iris. The sclera normally appears white or slightly buff in color. The appearance of conjunctiva, a transparent membrane covering the anterior sclera and the inner eyelids, is a sensitive indicator of ocular disorders, such as infections and inflammation. The tear-producing lacrimal gland lies above and lateral to the eyeball. Tears spread down and across the eye to drain medially into two lacrimal puncta before passing into the lacrimal sac and nasolacrimal duct to the nose.
The iris divides the anterior from the posterior chamber. Muscles of the iris control the size of the pupil, and muscles of the ciliary body behind it control the focal length of the lens. The ciliary body also produces aqueous humor, which largely determines intraocular pressure (Figure 1). Cranial nerve…
Physical Examinations II
Source: Laboratories of Jonas T. Kaplan and Sarah I. Gimbel—University of Southern California
The study of how damage to the brain affects cognitive functioning has historically been one of the most important tools for cognitive neuroscience. While the brain is one of the most well protected parts of the body, there are many events that can affect the functioning of the brain. Vascular issues, tumors, degenerative diseases, infections, blunt force traumas, and neurosurgery are just some of the underlying causes of brain damage, all of which may produce different patterns of tissue damage that affect brain functioning in different ways.
The history of neuropsychology is marked by several well-known cases that led to advances in the understanding of the brain. For instance, in 1861 Paul Broca observed how damage to the left frontal lobe resulted in aphasia, an acquired language disorder. As another example, a great deal about memory has been learned from patients with amnesia, such as the famous case of Henry Molaison, known for many years in the neuropsychology literature as "H.M.," whose temporal lobe surgery led to a profound deficit in forming certain kinds of new memories.
While the observation and testing of patients with focal brain damage has provi…
Source: Laboratory of Jonathan Flombaum—Johns Hopkins University
In the back of everyone's eye is a small piece of neural tissue called the retina. The retina has photosensitive cells that respond to stimulation by light. The responses of these cells are sent into the brain through the optic nerve, a bundle of neural fibers. In each retina there is a place somewhere in the periphery where the outputs from retinal cells collect and the bundled optic nerve exits to the brain. At that location, there is no photosensitivity-whatever light reflects from the world and lands in that position does not produce a signal in the brain. As a result, humans have a blind spot, a place in the visual field for which they don't process incoming stimuli.
However, people are not aware that they have blind spots; there is not an empty hole in the visual images in front of the eyes. So what do people see in their blind spots? The brain actually fills-in missing input based on the surroundings.
This video demonstrates how to find a person's blind spot, and how to investigate the mechanisms of perceptual filling-in.…
Sensation and Perception