NEUROLOGICAL ASSESSMENT – Flashcards
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Neurological exam includes:
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mental status, cranial nerve, sensory, motor and reflexes
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three major functioning units
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spinal cord( lowest functional level, controls automatic motor responses), brain stem ( controls bp, respiration), corticol ( cognition)
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Central Nervous System
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receives it blood supply from 2 internal arteries and 2 vertebral arteries that join together form the basilar artery (** blood supply 15-25% of total cardiac output that goes into the brain) ** three major units: cerebrum, cerebellum, brainstem
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Cerebrum
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frontal lobe: personality, judgment, abstract thinking, social behavior parietal lobe: sensation and aware of bodys shape temporal: hearing occipital: vision
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cerebellum
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helps with movement and motor process, works with vestibular system (cranial nerve 8)- produce steady and precise movements
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brain stem
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breathing, heart rate, blood pressure, swallowing and coughing
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diencephalon
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hypothalamus: maintain body temp, emotions, hunger, thirst, circadian rhythm thalamus- sensory processes( pain, temperature control)
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Severe brain stem injury : decerebrate posture:
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flexed out
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severe brain stem injury: decorticate posture
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flexed inward toward core: WORSE
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CNS: spinal cord and tracts
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40-50 cm length, 2 tracts descending and ascending tract, common pathway
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Descending tract
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carries MOTOR impulse from the brain ( meter motor*)
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ascending
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carries SENSORY data to the brain (ahhhh, touch stove)
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ANS- sympathetic system
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fight or flight ( responds to stressor)
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ANS- parasympathetic
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rest or digest ( balancing and conservation)
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Dermatones
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2 point discrimination- (bigger ones on back, can't feel two points as you get closer)
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CN 1
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olfactory nerve: smell - make sure no inflammation
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CN2
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optic nerve - snellen chart - fundascopy - confrontation test
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CN 3, 4, 6`
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ocular motor never ( movement of eye) - look for nystagus ( jerking of movement - drooping of eyelip - lazy eye - D (distance, dilate) - C ( constrict, converge)
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CN 5
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Trigeminal ( motor- puff out cheeks, sensory- cotton wisp, mandibular- clench teeth together)
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CN 7
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facial nerve - raise eyebrowns and frown - show their teeth - whistle
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CN 8
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Ear - rhomberg test ( swaying) - whisper test -clock test - WEBER- tuning fork -rinne test ( on mastoid and then in front of ear)
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CN 9
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glossaphargeal- tongue - gag reflex before they eat
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CN 10
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vagus nerve (9+10 done together) ** rectal temp - rise of phaynx is equal ahhhh
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CN 11
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accessory - have patient turn head and resist -life shoulders and resist
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CN 12
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hypoglassal - tongue should be midline -can't say L, T, D, M resist their tongue ( push)
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Neurological assessment
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BE careful of expression, reactions and responses - look at baseline ** - look at genetics
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assess general appearance
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sloppy, not dressed right
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older the patient
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the longer the time for responses
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Assessment of mental status 1) and 2) and 3)
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patients posture, coordination, LOC ( level of consciousness)
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LOC ( level of consciousness) awake and alert
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follows comands
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LOC ( level of consciousness) lethargic
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drowsy- tap awake
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LOC ( level of consciousness) stuporous
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shake or shout to wake
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LOC ( level of consciousness)comatose
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does not respons to verbal or painful stimuli BAD
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Glasglowcoma scale
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neurological scale that aims to give a reliable, objective way of recording the conscious state of a person for initial as well as subsequent assessment.
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Unexpected gait pattern
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...
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orientation status
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person ( what is your name and address), place (tell me where you are) and time ( what is today, what month is it)
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Memory
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short term- immediate ( dementia patients have problem) recent- what did you have for breakfast remote- past occupations
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intellectual function
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abstracting thinking - give scenario ( give insight and judgment)
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mini mental status exam
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student can do - drop the face of clock tell me what 5:00 is
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testing cerebellar function
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FTN ( finger to nose testing) rapid alternating movement lay supine knee to ankle slide rhomberg coordination ( tandem/tip toe walking)
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Sensory function: anesthesia
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absent feeling
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Sensory function: hyperesthesia
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extreme sensitivity
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Sensory function: hypoesthesia
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weakness
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Sensory function: parathesia
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pins and needles
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Sensory function Light touch sensation
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wisp of cotton (side to side)
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Sensory function pain and temp sensation
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sharp & dull, hot & cold
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Sensory function vibration sensation
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using bony prominence (distal- proximal)
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Sensory function: stereogenesis
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pt close eyes, quarter in hand, identify it
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Sensory function:graphsthesia
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draw #3 in pt hand
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reflexes
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DTR( voluntary) biceps, triceps, brachioradialis, patellar knee jerks, Achilles tendon
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reflexes grade scale
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0 no response ( electrolyte imbalance ie. pregnant women) 1+ low normal 2+normal 3+ more brisk 4+ brisk, hyperactive clonus ** clonus- check in preg. women for preeclampsia ( take foot, push bottom foot in)
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primitive reflexes
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grasp sucking snout( kissing face) rooting ( stroke side of face, turn head) glabellar ( tap nose, blink) Babinski( make arch, and grasp)
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superficial reflexes
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plantar reflex (Babinski) anal reflex abdominal reflex ( abd muscles move)
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APHAGIA`
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speech disorder
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expressive aphagia
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unable to find words
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receptive aphagia
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difficulty understaind
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global aphagia
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both
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dyspagia
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difficulty swallowing
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aproxia
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inability to perform purposeful movements
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Agnosia
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inability to identify common objects
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Warnings of stroke
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- sudden weakness, numbness, paralysis of face, arm esp on one side - sudden trouble with vision - sudden confusion - sudden severe headache - sudden trouble walkin, loss of balance, falling
