Assessment Flashcards
Four types of glial cells
Microglia-microphages
Astrocytes-structure, blood brain barrier
Oligodendrocytes-produce myelin
Ependymal cells-line ventricles and help make CSF
What are nodes of Ranvier?
Gaps in myelin sheath that allows transmission to jump nodes and go faster
Excitatory neurotransmitters
Epi
Norepi
Glutamate
Inhibitory NTs
Serotonin
Dopamine
GABA
What are dermatomes?
Area of the skin innervated by the sensory fibers of a single dorsal root on the spinal nerve
It is mapped in layers of body from neck down and allows us to pinpoint the location in spine of sensory dysfunction
What are myotomes?
Muscle group innervated by the motor neurons of a single ventral root. Can pinpoint location in spine of motor dysfunction
Location on spine for lumbar puncture
Between 3rd and 4th lumbar vertebrae
What is the only space the brain can swell into?
Foramen Magnum
This is the hole at base of skull that allows spinal cord to enter at brain stem
What are the effects of aging on the nervous system?
Brain weigh decreases
Loss of neurons
CSF production declines
Brain blood flow decreases
Loss of myelin sheath
All of this decreases muscle/sensory/motor/cognitive function.
Orthostatic hypotension
Loss of senses and balance
Can’t regulate temp as well
What are the 6 categories of a standard neuro assessment?
Mental status
Cranial nerve function
Motor function
Sensory function
Cerebellar function
Reflexes
What is involved in mental status assessment?
General appearance and behavior:
LOC, motor, posture, dress and hygiene, expression, speech
Cognition: Orientation x 4
Mood and affect
Many times use Glasgow Coma Scale for this
What is the difference between decorticate and decerebrate posture in GCS?
Decorticate=Arms drawn and rotated to core
Decerebrate=Arms at side with fists clenched and rotated in
If pupils abnormal, what cranial nerve may be involved?
What other s/sx may present with oculomotor damage?
Oculomotor
#3
Drooping eyelid (ptosis)
Mnemonic for Cranial nerves
On
Old
Olympus
Towering
Top
A
Finn
And
German
Viewed
Some
Hops
First 3 Cranial nerves
Sensory or motor
Functions
Test
- Olfactory=Sensory=Smell
- Optic=Sensory=Vision
Snellen chart - Oculomotor=Motor=Movement of eye muscles
6 point gaze
Cranial nerves 4, 5, 6
Sensory or Motor
Functions
Test?
- Trochlear=Motor=eye movement
6 point gaze - Trigeminal=Sensory and Motor
Sensory=face touch
Motor=chewing
Close eyes>touch face lightly>can you feel that? - Abducens=Motor=eye movement
6 point gaze
Which 3 cranial nerves are tested together with eye movements?
Occulomotor (3)
Trochlear (4)
Abducens (6)
6 pt gaze
Acronym-OAT
Cranial nerves 7, 8, 9?
Sensory or motor?
Function?
Test?
- Facial=Sensory and motor
Sensory=taste anterior 2/3 of tongue
Motor=movement of face muscles
Smile/Frown - Auditory or Vestibulocochlear
Sensory=hearing, balance
Obviously working if they can hear - Glossopharyngeal=Sensory and motor
Sensory=Back of tongue taste
Motor=Pharyngeal muscle movement
Tongue depressor>say ah>watch symmetrical movement
Usually tested with Vagus nerve (10) because they both control muscles in throat
Cranial nerves 10, 11, 12
Sensory or motor
Functions
Tests
- Vagus=Sensory, motor and parasympathetic
Sensory=Viscera of thorax/abdomen
Motor=Muscles of throat
Tongue depressor>say ah>watch for symmetrical movement of throat muscles - Spinal accessory=Motor
Sternocleidomastoid and trapezius movement
Have them shrug shoulders, turn head - Hypoglossal=motor
Tongue muscles
Stick out tongue, move side to side
What is involved in assessment of motor system?
Strength, tone, coordination, symmetry of major muscle groups
Push/Pull against resistance in all 4 extremities
Pronator drift test (tests arm strength and cerebral edema)
How is a pronator drift test performed?
Close eyes
Pretend like they are holding a pizza box.
Hold for 30 seconds
Downward drift indicates opposite motor cortex issue.
How is sensory assessment done?
Keep their eyes closed
Touch them with various things in various places and have them indicate what it feels like and where
Proprioception-Move their fingers/toes up and down. Have them indicate the direction you are moving them
If the patient can feel pain what can they also feel?
Temperature sensation
They run along the same sensory pathways
What is anisocoria?
Unequal pupil size
What is ataxia?
Uncoordinated muscle movements
What is dyskinesia?
Can’t move voluntarily
What is hemiplegia?
Paraplegia?
Tetraplegia?
Hemi=half (right or left)
Para=2 (lower half)
Tetra=4 (upper and lower)
What is cerebral angiography?
X ray of blood vessels in CNS
Femoral catheter inserted and contrast injected
—No iodine/shellfish allergies–
What is CT angiography?
Noninvasive CT of CNS blood vessels
What is a myelogram?
Instructions before and after?
Xray of Spinal cord and vertebral column after injection of contrast
Before: empty bladder, sedate
After: Lie flat 1-2 hours to prevent spinal headache
What is PET?
Instructions before?
Measure metabolic activity in brain
Uses radioactive material to light and color areas
No sedatives, empty bladder, 2 IV access
What is SPECT?
Similar to PET but uses different substances injected
Assesses blood flow, O2 and glucose metabolism in brain
Same instructions as PET:
No sedatives, empty bladder, 2 IV access
What is carotid artery duplex scan?
Combo of ultrasound and doppler
Assesses stenosis of carotid arteries
What is transcranial doppler?
Evaluates blood flow in intracranial vessels by placing probes on the skull
What is EEG?
(Electroencephalography)
Evaluates electrical brain activity with probes placed on skin
What is EMG?
(Electromyography)
Recording of electrical activity in skeletal muscles
Needle electrodes inserted in muscles
What is electroneurography?
Also called nerve conduction studies
Measures nerve conduction speed
Allows to find damaged nerves
What is evoked potentials?
(this is a diagnostic study)
Assesses electrical activity in nerve conduction along a sensory pathway.
Electrodes placed and skin and scalp
Allows to find damaged nerves
Shampoo hair before test
What is echoencephalography?
–This is in peds not adults–
Ultrasound of surfaces of skull
Helps find abnormal structures
What are some differences in CNS of pediatric vs adult?
Peds=brain is 12% of body weight vs 2% in adult
Peds=have 50 ml of CSF vs 150 ml in adult
Peds=nerves aren’t completely myelinated so coordination and fine muscle movements aren’t there yet
GSC Eye evaluation in NB
Same as adult
4=Opens spontaneously
3=Opens to speech
2=Opens to pain
1=No response
GSC motor evaluation in NB
6=Spontaneous movement
5=Withdraws to touch
4=Withdraws to pain
3=Flexion (decorticate)
2=Extension (decerebrate)
1=No response or flaccid
GSC verbal evaluation in NB
5=Coos/babbles
4=Consolable cry
3=Inconsolable cry
2=Grunts, restless, agitated
1=No response
GSC motor eval in adult
6=Obeys commands
5=Localizes
4=Normal flexion
3=Abnormal flexion
2=Extension
1=Nothing
GSC Verbal evaluation in adult
5=Oriented
4=Confused
3=Inappropriate words
2=Sounds only
1=Nothing
What is receptive aphasia?
They can speak but don’t comprehend what you are saying
What is fluent aphasia?
Speak clearly but words make so sense and they don’t even realize it
What is global aphasia?
The most severe form
Can’t understand or express themselves
Four divisions of the cerebrum
Parietal=interprets spatial (location) info
Temporal=Integrates body, sight, hearing data
Occipital=Sight
Frontal=Memory, thinking, motor and eye movement and speech
