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Why does my neurologist do that?
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DUKE MEDICINE
Timothy Collins, MD posted:
One thing I've realized over the last few years---We (neurologists) do all these "things" during our examination of a patient, and we almost never explain what we are doing. So I though I would post some explanation of what we are going when we look in your eyes or "tickle" your feet.

Eye examination:
"watch my finger" is a test to look at how the eye muscles move the eye, and lets me evaluate how the nerves that move these muscles work (the cranial nerves 3, 4, and 6). We also look for abnormal eye movements that can be seen in some diseases.

We look at how the pupil works (another reflex) which is controlled by the brainstem. We also look into the eye--the retina at the back of the eye is living nerve tissue, and we can actually look at it and observe its health.

Face
We ask you to smile to watch how the facial muscles (controlled by the facial nerve, cranial nerve 7) work, and make sure both sides move the same way. Sometimes we ask patients to "close your eye" to look at the same nerve function. "Stick out your tongue and say ahh" lets us look at cranial nerve 12 (tongue muscles) and the muscles in the back of the throat. (Your family MD is often just looking for a sore throat)

Muscles
Neurologist do a lot of tests for muscle strength in the arms and legs. We are looking for any signs of weakness in the muscles. The pattern of which muscles are weak helps us tell how well the brain, spinal cord and nerves are working. For example---if the weakness is one arm and leg on the same side, we worry mostly about a brain problem like stroke. These is the part of the examination where we ask the patient to squeeze our hands, make a muscle, stand on there toes, etc.

balance:
We often ask patients to do some crazy sounding things while standing or walking, like "stand on one foot with your eyes closed" or "walk on your heels, now on your toes". These are all tests of balance and coordination, and help us understand how part of the brain is working. Some diseases of the brain mainly affect balance and coordination (and some things like alcohol do as well, which is why the police "borrowed" that part of the neurologic examination to use on the roadside)

Reflexes:
about half of my patients giggle when I tap their knee and make their leg twitch. This is a normal muscle reflex, and tells me a lot about the health of the nerves in the leg and the back. We can get the same reflex by tapping on the back of the ankle (achilles tendon) or the inside of the elbow (biceps tendon) or the back of the elbow (triceps tendon). The "tickling" of the foot is actually supposed to be scrapping something along the bottom of the foot. In normal people, not much happens (or the toes curl down). In n people with a brain problem, the first toe (Big toe) points up when we scrape on the sole of the foot. This is called Babinski's sign. Babies have a Babinski's sign because their spinal cord and brain are still maturing.

Hope this is helpful.
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Moxie1956 responded:
WOW! Dr. Collins! Even tho' I knew most of the info you offerred, except for "reflexes," I am just impressed and grateful you took the time to explain. Thanks for that consideration. I hope you post more info!

~~moxie1956
 
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RobbinB responded:
What is your thought on exercise that can improve balance? I suffered a TBI over 20 years ago, and although it is still improving, it is very slow. Along with balance problems, I do have coordination issues. Both of these issue are due to the left side of my brain being more damaged (I had a helmet on which saved me, but did not solve my problem completely). Some of the rest you wrote about it the Balance section I am able to do, but only on really left side. It is hit and miss on the right.
 
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vanieca responded:
dr. collins, thank you so much. this is very helpful,i have always wondered why my neurologist does all these things.i asked once and he only laughted.
 
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DUKE MEDICINE
Timothy Collins, MD replied to RobbinB's response:
RobbinB---I'm going to answer this in its own discussion topic, so check their
 
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khsouza replied to Timothy Collins, MD's response:
Thank you Dr. Collins! This was really helpful,and in very patient friendly terms. I do often wonder what you guys are doing:) Now my anxious self is worried b/c I'm pretty sure my big toe points upward when you guys scrape the bottom of my feet. Are CSF leaks/low pressure considered a "brain problem"??
 
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DUKE MEDICINE
Timothy Collins, MD replied to khsouza's response:
Almost everyone pulls their foot back when we do this, because it tickles or is irritating. If the only odd finding on a patients examination is the big to "goes up" we usually don't consider that a really huge problems.

As far as CSF leaks, this is usually considered a neurology or neuro-radiology problem. It can be hard to diagnose, and often takes a special test called a dynamic CT myelogram.


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