EXAMINATION OF THE

CENTRAL NERVOUS
SYSTEM(CNS)

MOTOR NERVOUS SYSTEM

 CNS EXAMINATION
• Higher Mental Functions (HMF)
• Examination of the Unconscious Patient
• Cranial Nerves Examination
• Examination of the Motor Nervous System
• Examination of the Sensory Nervous System
 CNS EXAM
• The nervous system is broadly divided into the
central and peripheral nervous systems

• The CNS consists of the Brain & Spinal cord

• The Peripheral nervous system consists of the

peripheral nerves
BRAIN
SPINAL CORD
 MOTOR SYSTEM EXAM
• To determine if there are any abnormalities

• To determine the location of such abnormalities

• To determine the degree of such abnormalities

• i.e. to make a diagnosis, determine the site of

the lesion and formulate a management plan
 MOTOR SYSTEM EXAM
1. Bulk
2. Power
3. Tone
4. Deep Tendon Reflexes (DTRs)
5. Abdominal & Plantar reflexes
6. Coordination
7. Gait
 MOTOR SYSTEM EXAM
• BULK

• Increased

• Normal

• Decreased
 MOTOR SYSTEM EXAM
• TONE
• Hypertonia (increased tone): lead pipe/clasp
knife
• Normal tone
• Hypotonia (flaccidity)
 MOTOR SYSTEM EXAM
• POWER (graded 0 to V)
• 0 = absent power
• I = movement when gravity is eliminated
• II = movement against gravity but not against
the resistance of the examiner
• III = movement against mild resistance
• IV = movement against moderate resistance
• V = full power
 MOTOR SYSTEM EXAM
• DEEP TENDON REFLEXES (DTRs)
• Hypereflexia (+++)
• Normoreflexia (++)
• Hyporeflexia (+)
• Areflexia (absent reflex)
 MOTOR SYSTEM EXAM
• PLANTAR REFLEX
• Elicited by stroking the sole of foot
• A normal response involves flexion
(downward movement) of the great toe
• Abnormal response involves extension
(upward movement of the great toe) +/-
fanning out of the other toes (Babinski sign)
• Abnormal response seen in UMN lesions
 MOTOR SYSTEM EXAM
• ABDOMINAL REFLEX:
• Elicited by stroking the abdominal wall from
laterally towards the umbilicus in 4
quadrants.
1. Absent in UMN lesion

2. Decreased in LMN lesion

 MOTOR SYSTEM EXAM
• UPPER MOTOR NEURON LESIONS
• Seen in lesions (disorders) of Brain & Spinal cord:
1. Weakness
2. Wasting (mild)
3. Hypertonia (clasp knife)
4. Hypereflexia
5. Babinski sign
6. Clonus
 MOTOR SYSTEM EXAM
• LOWER MOTOR LESIONS
• Seen in lesions of the peripheral nerves:
1. Loss of power
2. Marked muscle wasting (decreased bulk)
3. Hypotonia
4. Areflexia
5. Fasciculations
 MOTOR SYSTEM EXAM
• Nerve Root Values (Upper Limb Power):
1. Shoulder abduction (C5,6)
2. Shoulder adduction (C5,6,7)
3. Elbow flexion (C5,6)
4. Elbow extension (C7,8)
5. Wrist flexion (C6,7,8,T1)
6. Wrist extension (C6,7,8)
7. Finger abduction & adduction (C8, T1)
 Upper Limbs
Deltoid C5/6 Biceps:C5/6
Shoulder Axillary Nerve
Elbow Musculocutaneous
abduction flexion nerve

Pectoralis major C6/7 Triceps C7/8

Shoulder Lattisimus dorsi C7
Elbow Radial nerve
adduction extension
Extensor carpi radialis Finger flexion/ Radial/Ulnar/Median
Wrist longus nerves C8/T1
Abduction/
extension Extensor carpi ulnaris
Adduction/
C6/7/8
Thumb
movements
 MOTOR SYSTEM EXAM
• DTRs Root Values (Upper Limb)
1. Biceps - C5,6
2. Supinator - C5,6
3. Triceps – C6, 7
 MOTOR SYSTEM EXAM
• Nerve Root Values (Lower Limb Power):
• Hip flexion (L1/2)
• Hip extension (L5,S1)
• Hip abduction (L4,5,S1)
• Hip adduction (L2,3,4)
• Knee flexion (L5,S1,2)
• Knee extension (L2,3,4)
• Ankle (plantar) flexion (S1,2)
• Ankle extension – dorsiflexion (L4,5)
• Inversion (L4,5)
• Eversion (L5, S1)
 Lower Limbs
Hip flexion Iliopsoas Hip Glutei
L2/3 extension L4/5/S1
Femoral Gluteal
nerve nerves

Hip Glutei + Tensor Hip Adductors

fascia lata L4/5 L2/3/4
abduction S1 adduction
Obturator nerve
 Lower Limbs
Knee Hamstrings Knee Quadriceps
L5/S1 L3/4
flexion extension
Sciatic nerve Femoral nerve

Ankle Tibialis anterior Ankle Gastrocnemius,

Extensor hallucis Tibialis posterior
dorsiflexion longus
plantar
S1
L4/5 flexion Tibial div. of
Peronial div. of sciatic nerve
sciatic nerve
 MOTOR SYSTEM EXAM
• DTRs Root value (lower limb)

1. Knee jerk – L2,3,4

2. Ankle jerk - L5,S1

 MOTOR SYSTEM EXAM
• Coordination:

1. Finger-Nose test

2. Heel-Shin test

3. Rapid alternating movements

 MOTOR SYSTEM EXAM
• EXAMINATION OF GAIT
1. Station
2. Turning
3. Tandem
4. Heel walking
5. Toe walking
6. Rhombergs