UNIT 5I - NEUROLOGIC

• Structural Components and Subdivision of the Nervous System

  • Central Nervous System
  • Peripheral Nervous System
• Subdivisions of the Central Nervous System

  • Cerebrum
  • Diencephalon
  • Brainstem
  • Cerebellum
• Subdivisions of the Cerebrum

  • Frontal
  • Parietal
  • Temporal
  • Occipital
• Subdivisions of the Diencephalon

  • Thalamus
  • Epithalamus
  • Hypothalamus
• Subdivisions of the Brainstem

  • Midbrain
  • Medulla Oblongata
  • Pons
• Components of the Peripheral Nervous System

  • Cranial Nerves (12 pairs)
  • Spinal Nerves (31 pairs)
• Cranial Nerves


  12 pairs of nerves that emerge directly from the brain
• Spinal Nerves


  31 pairs of nerves that emerge from the spinal cord (8 cervical, 12 thoracic, 5 lumbar, 5 sacral and 1 coccygeal)
• Cranial Nerves


  • I (olfactory)
  • II (optic)
  • III (oculomotor)
  • IV (trochlear)
  • V (trigeminal)
  • VI (abducens)
  • VII (facial)
  • VIII (acoustic)
  • IX (glossopharyngeal)
  • X (vagus)
  • XI (spinal accessory)
  • XII (hypoglossal)
• Type


  • Sensory
  • Motor
  • Mixed
• Function


  • Sense of smell
  • Visual acuity and visual fields
  • Muscles that move the eye and lid, pupillary constriction, lens accommodation
  • Muscles that move the eye
  • Facial sensation, corneal reflex, mastication
  • Muscles that move the eye
  • Facial expression and muscle movement, salivation and tearing, taste, sensation in the ear
  • Hearing and equilibrium
  • Taste, sensation in pharynx and tongue, pharyngeal muscles, swallowing
  • Muscles of pharynx, larynx and soft palate; sensation in external ear, pharynx, larynx, thoracic and abdominal viscera; parasympathetic innervations of thoracic and abdominal organs
  • Sternocleidomastoid and trapezius muscle
  • Movement of the tongue
• Related Disorders


  • Anosmia
  • Papilledema; blurred vision; blindness
  • Anisocoria; pinpoint pupils; fixed, dilated pupils
  • Nystagmus
  • Trigeminal neuralgia (Tic douloureux)
  • Diplopia; ptosis of the eyelid
  • Bell's palsy; ageusia on the anterior 2/3 of the tongue
  • Tinnitus; vertigo
  • Loss of gag reflex, drooling of saliva, dysphagia, dysphonia, posterior third ageusia
  • Loss of gag reflex, drooling of saliva, dysphagia, dysarthria, bradycardia, increased HCl secretion
  • Inability to rotate the head and move shoulders
  • Protrusion of the tongue, deviation of the tongue to one side of the mouth
• Aspects of Neurologic Assessment

  • Health History and Clinical Manifestations
  • Physical and Neurologic Examination
• Health History and Clinical Manifestations

  • Pain
  • Seizures
  • Dizziness and vertigo
  • Visual disturbances
  • Muscle weakness
  • Abnormal sensation (Paresthesia, loss of sensation)
• Components of Physical and Neurologic Examination

  • Mental Status
  • Intellectual Function
  • Emotional Status
  • Perception
  • Motor Ability and Muscle Strength
  • Language ability
  • Balance and coordination
  • Level of Consciousness
  • Examining Reflexes
• Mental Status


  • Orientation to time, place and person
  • Memory: immediate recall, recent recall, remote recall
• Intellectual Function


  IQ test
• Perception


  Agnosia – inability to interpret or recognize objects seen through the special senses
• Motor Ability and Muscle Strength

  • Muscle power: weakness (-paresis), paralysis (-plegia)
  • Muscle tone: flaccidity (hypotonicity), rigidity (hypertonicity)
• Language ability


  Speech centers – Broca's area (located in the left frontal lobe) and Wernicke's area (located in the temporal lobe)
• Balance and coordination


  • Reflected as the function of the cerebellum
  • Assessed by FTNT (finger-to-nose test)
• Level of Consciousness


  • The most sensitive indicator of the changes in neurologic status of the client
  • Glasgow Coma Scale (GCS) – assessment tool for LOC which comes in 3 areas: eye opening, motor response, and verbal response
• Types of Reflexes


  • Superficial Reflexes
  • Deep Tendon Reflex
  • Reflexes to assess meningeal irritation
• Superficial Reflexes


  • Pupillary Reflexes
  • Corneal Reflex
  • Abdominal Reflex
  • Cremasteric Reflex
  • Anal Reflex
  • Babinski Reflex
• Pupillary Reflexes


  Represented by PERRLA (pupils equal, round, reactive to light, accommodation)
• Deep Tendon Reflex


  • Ankle jerk
  • Knee jerk (patellar reflex)
• Reflexes to assess meningeal irritation

  • Kernig's sign
  • Brudzinski's reflex
• Kernig's sign


  In a supine position, flex the knee, attempt to extend the leg. (+) pain is experienced.
• Brudzinski's reflex


  In a supine position, passively flex the neck. (+) result when spontaneous flexion of the hips occurs with complaint of pain. More accurate indicator than Kernig's sign
• Frontal Lobe


  Problem solving, emotional traits, reasoning (judgment), speaking, voluntary motor
• Parietal Lobe


  Knowing right from left, sensation, reading and body orientation
• Temporal Lobe


  Understanding language, behavior, memory and hearing
• Occipital Lobe


  Vision and color perception
• Cerebellum


  Balance, coordination and control of voluntary movement, fine muscle control
• Brain Stem


  Breathing, body temperature, digestion, alertness/sleep, swallowing
• The cranial nerve is I (Olfactory) - Type is Sensory - Function is Sense of Smell - , Related disorders is Anosmia
• The cranial nerve is III (oculomotor)- Type is Motor - Function is Muscles that move the eye and lid, pupillary constriction, lens accommodation - Related disorders is Anisocoria; pinpoint pupils; fixed, dilated pupils.
• The cranial nerve is II (optic) - Type is Sensory - Function is Visual acuity and visual fields - Related disorders is Papilledema; blurred vision; blindness.
• The cranial nerve is IV (trochlear) - Type is Motor - Function is muscles that moves the eye - Related disorders is Nystagmus.
• The cranial nerve is V (trigeminal) - Type is Mixed - Facial sensation, corneal reflex, mastication- Related disorders is Trigeminal neuralgia (Tic douloureux)