Neurological Assessment

    Cards (66)

    • Nervous System
      A complex network of nerves and cells that carry messages to and from the brain and spinal cord to various parts of the body
    • Divisions of the Nervous System
      • Central Nervous System
      • Peripheral Nervous System
    • Central Nervous System

      • Brain
      • Spinal Cord
    • Parts of the Brain
      • Cerebrum
      • Cerebellum
      • Diencephalon
      • Midbrain
      • Pons
      • Medulla Oblungata
    • Cerebrum
      • Frontal Lobe - controls emotional expression, memory
      • Parietal lobe - sensation and perception and integration
      • Occipital lobe - visual processing
      • Temporal Lobe - primary auditory perception
    • Spinal Cord
      Long, thin, tubular structure made up of nervous tissue, which extends from the medulla oblongata in the brainstem to the lumbar region of the vertebral column. Functions primarily in the transmission of nerve signals from the motor cortex to the body.
    • Peripheral Nervous System
      Parts of the nervous system outside the brain and spinal cord. Includes the cranial nerves, spinal nerves and their roots and branches, peripheral nerves, and neuromuscular junctions.
    • Common Symptoms
      • Headache
      • Mental Status Change
      • Dizziness, Vertigo, & Syncope
      • Numbness Or Loss Of Sensation
      • Deficits Of The Five Senses
    • Headache
      Most common. Pain may be mild or severe, acute or chronic, localized or generalized. 90% of HA - benign in nature (muscle contraction or vascular). 10% - pathology. May be a symptom of a serious medical problem.
    • Mental Status Change
      Early indication of a change in neurologic status. Begin slowly as forgetfulness, a memory loss or inability to concentrate → rapidly proceed to unconsciousness. Causes: neurologic problems, fluid & electrolyte imbalance, hypoxia, low perfusion state, nutritional deficiencies, infections, renal & liver disease, hyper or hypothermia, trauma, medications, & drug & alcohol abuse.
    • Dizziness
      Fainting sensation
    • Vertigo
      1. Objective vertigo – sensation that the surroundings are spinning around. 2. Subjective vertigo - the person is spinning around. Accompanied by nausea & vomiting, nystagmus & tinnitus.
    • Syncope
      Temporary loss of consciousness. "Blacked out" or "had a spell".
    • Numbness or Loss of Sensation
      Paresthesia – numbness or tingling sensation. Causes: diabetes, neurologic, metabolic, CV, renal, inflammatory.
    • Deficits of the Five Senses
      • Smell - CN I (olfactory)
      • Visual acuity, pupillary constriction, extraocular movement (EOM) - CN II (optic); III (oculomotor); IV (trochlear); VI (abducens)
      • Taste - VII (facial); IX (glossopharyngeal)
      • Hearing - VIII (acoustic)
      • Touch - V (trigeminal)
    • Neuro-Sensory System Assessment

      Examination of the Neurological System: 1. Level of Functioning, 2. Mental Status, 3. Cranial Nerves, 4. Motor Function, 5. Cerebral Function, 6. Reflexes
    • Level of Functioning - Level of Consciousness
      • Alert - follows commands in a timely fashion
      • Lethargic - appears drowsy, may drift off to sleep during examination
      • Stuporous - requires vigorous stimulation (shaking, shouting) for a response
      • Comatose - does not respond appropriately to either verbal or painful stimuli
    • Glasgow Coma Scale

      • Abnormal position of the arms with legs extended & internally rotated & feet plantar flexed - ominous sign (poor prognosis)
      • Decorticate (flexion posturing) - Arms are flexed chest & hands are clenched & internally rotated
      • Decerebrate (extension posturing) - Arms are extended & the hands are clenched & hyperpronated
    • Assessing Orientation
      • Time - Ask date, including the year & the day of the week
      • Place - Ask to state where he is. (identify environmental cues)
      • Person - Ask patient to state his name. Self-identity usually remains intact the longest. Orientation to person an ominous sign.
    • Memory
      • Immediate Memory - Repeat a series of numbers
      • Recent Memory - What the patient had for breakfast, name 3 objects (pen, tree, ball) & recall again
      • Remote Memory - Ask dates of major historical events, ask birthdates or anniversary date (validate)
    • Mental Status
      Check for: Known brain lesion, Suspected brain lesion, Memory deficits, Confusion, Vague Behavioral complaints, Aphasia, Irritability, Emotional lability
    • Sensation
      • Exteroceptive sensations - Light touch, superficial pain and temperature
      • Proprioceptive sensations - Motion and position
      • Cortical Sensations - Stereognosis, Graphestesia, Two-point Discrimination, Extinction
    • Cranial Nerves
      Anatomically, the cranial nerves travel through distinct locations in the brain, and because of this assessing them can sometimes give us early and detailed information about brain injury.
    • Motor Function
      Assessing for muscle size, muscle strength, muscle tone, muscle co-ordination, gait & movement.
    • Cerebral Function
      The cerebellar examination is performed in patients with neurological signs or symptoms of cerebellar pathology, for example: dizziness, loss of balance, or poor co-ordination.
    • Reflexes
      Reflex tests are performed as part of a neurological exam, either a mini-exam done to quickly confirm integrity of the spinal cord or a more complete exam performed to diagnose the presence and location of spinal cord injury or neuromuscular disease.
    • Common Neurologic Problems
      • Agnosia - inability to recognize object
      • Akinesia - complete or partial loss of voluntary muscle movement
      • Aphasia - absence or impairment of ability to communicate through speech, writing, or signs
      • Expressive (motor) aphasia - inability to express language even though person knows what he wants to say
      • Fluent aphasia - words can be spoken but are used incorrectly
      • Nonfluent aphasia - slow deliberate speech, few words
      • Receptive (sensory) aphasia - inability to comprehend spoken or written words
      • Apraxia - inability to carry out learned sequential movements or commands
      • Circumlocution - inability to name object verbally, so patient talks around object or uses gesture to define it
      • Dysarthria - defective speech
    • Agnosia
      Inability to recognize object
    • Types of Agnosia
      • Sight (visual agnosia)
      • Touch (tactile agnosia)
      • Hearing (auditory agnosia)
    • Akinesia
      Complete or partial loss of voluntary muscle movement
    • Aphasia
      Absence or impairment of ability to communicate through speech, writing, or signs
    • Expressive (motor) aphasia
      Inability to express language even though person knows what he wants to say
    • Expressive (motor) aphasia
      Also known as Broca's or motor aphasia; Frontal lobe affected
    • Fluent aphasia
      Words can be spoken but are used incorrectly
    • Nonfluent aphasia
      Slow deliberate speech, few words
    • Receptive (sensory) aphasia
      Inability to comprehend spoken or written words (also known as Wernicke's or sensory aphasia)
    • Apraxia
      Inability to carry out learned sequential movements or commands
    • Circumlocution
      Inability to name object verbally, so patient talks around object or uses gesture to define it
    • Dysarthria
      Defective speech; inability to articulate words; impairment of tongue & other muscles needed for speech
    • Dysphasia
      Impaired or difficult speech