Now, what we're going to do today is just a cranial nerve examination, and I'll start up at the top and move down, in terms of reflexes and strengths and coordination. The first thing I want you to do, first of all is just square yourself off, knees back on the edge of the table, back further, so your legs are dangling. Okay, good. Nice and square all the way so that you're looking straight at my nose. What I want you to do is just point with your hands to the fingers that you see wiggle, but keep staring at my nose the whole time. Okay, good, now watch my finger wherever it goes, holding your head still the whole time. Okay, good, now I'm going to touch your forehead. You tell me if you can feel it the same on both sides. Is it about the same? Equal? >> Yeah. Even in here, where that injury was before? >> Yeah. >> Or is it a little numb there? >> On this side here? >> Well, remember your second one you had that cut right in there. >> Oh, yeah, that's right. >> Can you feel there? >> Yeah. >> Oh, so that's all back to normal? >> It's good. >> Close your eyes real tight--real tight, like you've got soap in them. Don't let me open them up. Fight, fight, fight, fight, fight. Okay, good. Wrinkle up your forehead like that. Good. Show me your teeth like this. Okay, good. Open real wide and say "Ah." >> Ah. Okay, stick out your tongue. Okay, good. Clench your teeth. Again. Okay, that's good. I'm going to make soft noises next to your ears. Close your eyes and tell me left or right. >> Right. Left. Both. >> Okay, that's good. Shrug your shoulders like this. Okay. Turn your head as far as it will go to the left and hold it there. Okay, now and to the right. Good. Forward and back. Okay. No problems that way with that at all? Okay, good. With your hands, hold them out in front of you like this, stretched all the way out like you have a board. Now,close your eyes and hold them nice and steady. I'm going to tap your hands. Don't let them move. Keep your eyes closed and touch your nose with this finger. Okay, and now with this one. Okay, perfect. Just relax and open your eyes. With your right hand, do this like I'm doing here real fast--right on that knuckle. Very good, and left hand. Okay, very good. Now, do this. (slapping) And the other hand. (slapping) Very good. Now, here on this knee, do this. (slapping) Okay, and there. (slapping) Okay, good. Touch my finger with yours, and then touch your nose. Go back and forth wherever I move my finger. Very good, now, left hand. Okay, that's great. Hold your arms up like this and don't let me push them down. Fight real hard. Okay, good. Make muscles like this and don't let me pull them out. Fight. Okay, same idea, fight. Okay. Same position, this time push out. Okay. Okay, good. Now, stiff wrists back like this, and don't let me bend them. Okay. All right, very good. Grip my hands. Very good. Fingers spread apart and don't let me squeeze them together. Fight real hard. Fight real hard. Fingers back like this and don't let me push them down. Don't let me push them down. Okay, that's really good. Now, with one knee at a time, I'm going to have you lift it up and not let me push it down. So just pick this leg up. Fight. Okay, and this one. Okay, very good. Push knees out against my hands. Okay, and pull them in. Okay. Now, kick out. Kick out. Okay. And now pull back and don't let me pull it in. There you go. Pull it. Okay, very good. Now. feet up in the air like this and don't let me push down. Okay, and this one same thing. Okay, very good. Now. if we did that right, the doctor and the patient are supposed to get red in the face, but I suspect only I got red in the face this time. >> (laughing) (tapping) Okay. Scoot back just a little bit so your shoes aren't quite on that. There you go, perfect, just like that, nice and loose. (tapping) Okay, good. Now, stare at the edge of that picture and don't blink as I tap your forehead just with my finger. Keep staring there. Okay. Now, here, feel this first. It's a little bit--it's not sharp, but it's rough, right? I'm going to stroke your palm like that. Look at that. Don't pay any attention to what I'm doing. Same thing here. Same thing here. Okay, good. Now, I'm going to tap my finger. Just let your jaw hang. Just like that. ' Perfect, okay. Very good. Cool metal, yes, cool? >> Um-hmm. >> Same? >> Um-hmm. >> Here? And here? About the same? >> About the same. >> Here and here--about the same? >>Um-hmm. >> Here and here? About the same? >> Yeah. >> Okay, here and here? >> Um-hmm. Okay, and now what I'm going to do down here is I'm going to put this on your ankle and you can tell me what you feel now. >> Vibration. Okay, tell me when it's completely gone. Look away. >> Gone. >> Okay, and this one. The same idea. You feel it? >> Yeah. Gone. >> Okay, very good. Okay, the rest of what we would do, in terms of pin prick and and all of that, I'm not going to go through today because I know that's all been normal all along, and I wouldn't anticipate that to be a problem. I do want to look in your eyes. You still have just a little bit of a lin-lag on your left, since that blow to your brow. >> Yeah, remember when you first saw me, about the right side of my eye? I think that always was there, but you mean right here? >> It was your face. >> That was my right side wasn't it? >> Yeah, but it was down here, and then what we did is that you gave me that video tape of the pre-injury, that it was always--it was just the way your face has been all your life. >> That's just the way it is. >> What I want you to now is just stare again at that spot. Blink anytime you need to, but keep staring at one spot. I apologize for my sandwich breath here. (clicking) (walking) All right. It looks great. Any problems with your hearing? I surely didn't detect anything. >> No. >> Any problems with a wax buildup or anything I should look in there? >> No. Okay. But what I'm speaking of really has to do with the opening of this eye compared to this one. This one is still is down a little bit because of all of that injury right here from your last concussion. >> Yeah. That's where I had all the redness for the longest time. >> You sure did. It half closed your eye. >> For a long time. >> For the longest time. Now I think that the control of that lid is still impeded a little bit-- >> Really? --by the soft tissues that are coming down on it. It's just minimal. I don't think it's a neurological issue at all. >> It's just a cosmetic thing? >> Yeah, and well, it probably isn't noticeable to anybody other than those of us who examine you and look at these sorts of things. >> Yeah because I don't even notice it. No, it looks fine. Everything looks just like it has before. It's just perfectly fine, and no problems, no concerns.
Posted on BrainLine February 3, 2009.
James Kelly, MA, MD, FAAN, a neurologist, is one of America’s top experts on treating concussions. He currently serves as Executive Director of the Marcus Institute for Brain Health.
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