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General Inspection
During the general inspection of the cranial nerves, we should look for whether the patient has any ptosis, abnormal eye movements and facial asymmetry. We should also inspect for whether there are any neuro-cutaneous features (for example in patients with tuberous sclerosis and neuro-fibromatosis), syndromal features etc.
Cranial Nerve I (Olfactory Nerve)
Cranial Nerve II (Optic Nerve)
Visual Acuity
Visual Fields
Inspection of the Pupils
Direct and Consensual Light Reflexes
The Swinging Torch Test
Accommodation Reflex
Cranial Nerves III (Oculomotor Nerve), IV (Trochlear Nerve) and VI (Abducens Nerve)
Cranial Nerve V (Trigeminal Nerve)
Cranial Nerve VII (Facial Nerve)
Cranial Nerve VIII (Vestibulocochlear Nerve)
Cranial Nerves IX (Glossopharyngeal Nerve) and X (Vagus Nerve)
Cerebral vascular malformations can be classified by histopathology into 4 major types: Arterio-venous malformations (AVMs) Venous angiomas (developmental venous anomalies) Capillary telangiectasias and Cavernous malformations Arterio-venous malformations (AVMs) are congenital vascular lesions due to dysregulated angiogenesis. They are most often solitary but rarely could be multiple, in which case an underlying syndrome (e.g. hereditary haemorrhagic telangiectasia,…
This is the non-contrast CT (Figure 1) of a patient with an acute right-sided epidural haematoma . The skull vault is a tight space and the haematoma is causing significant mass effect, resulting in mid-line shift (the right cerebral hemisphere is shifted to the left as it can be seen crossing the mid-line). The epidural space is a potential…
Intracranial calcifications are frequently seen in non-contrast CT scans. These are often due to age-related physiological changes of the brain but can occasionally be mistaken as an intra-cerebral hemorrhage. The most common sites of intracranial calcifications include the basal ganglia (often bilateral, Figure 1), pineal gland (Figure 1), choroid plexus (often bilateral, Figure 1), dentate…
In this contrast thoracic CT scan of a middle-aged woman with newly diagnosed seropositive generalized myasthenia gravis, an abnormal thymic lesion (present in the anterior mediastinal compartment) could be seen (Figure 1). The patient was referred to the Cardiothoracic Surgeons where she received a thymectomy via an open sternotomy. The thymic specimen was sent for histo-pathological…
Before touching the patient, it is important and good practice to stand back and spend some time in performing a thorough general examination of the patient. Unfortunately, students often rush into touching the patient, hence often neglecting crucial signs which may lead to the diagnosis. An approach to the general examination of a patient presenting…
The neurological examination is an important skill to acquire for all medical students. If performed correctly, it can help tremendously to narrow down the differential diagnoses which would subsequently guide investigations and management plan. One important aspect of the neurological examination is to help localise the lesion. For example, in patients presenting with unilateral limb…
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