Assessment Of The Neurological System Flashcards
A complex network of nerves and cells that carry messages to and from the brain and spinal cord, to various parts of the body
Nervous System
Center of the nervous system
Brain
6 parts of the brain
- Cerebrum
- Cerebellum
- Diencephalon
- Midbrain
- Pons
- Medulla Oblungata
Superior part of the brain
Cerebrum
Coordinating voluntary movements
Cerebellum
Primary relay and processing center for sensory information
Diencephalon
Associated with vision, hearing, and others
Midbrain
Bridge between parts of the nervous system
Pons
Control center for heart and lungs
Medulla Oblungata
Lobe that controls emotional expression, memory
Frontal lobe
Lobe responsible for sensation, perception, and integration
Parietal lobe
Lobe responsible for visual processing
Occipital lobe
Lobe responsible for primary auditory perception
Temporal lobe
Long thin tubular structure made up of nervous tissue which extends from the medulla oblungata to the lumbar region of the vertebral column
Spinal cord
Functions primarily in the transmission of nerve signals from the motor cortex to the body
Spinal cord
Parts of the nervous system outside the brain and spinal cord
Peripheral nervous system
The 12 cranial nerves
- Olfactory
- Optic
- Oculomotor
- Trochlear
- Trigeminal
- Abducens
- Facial
- Vestibulocochlear
- Glossopharyngeal
- Vagus
- Accessory
- Hypoglossal
- most common neurologic symptom
- pain may be mild or sever, acute or chronic, localized or generalized
- 90% benign 10% pathology
Headache
Maybe a symptom of a serious medical problem
Headache
Early indication of a change in neurologic status
Mental status change
May begin slowly as forgetfulness, memory loss, and inability to concentrate to loss of consciousness
Mental status change
Fainting sensation
Dizziness
Sensation that the surroundings are spinning around
Objective vertigo
Sensation that the person is spinning around; accompanied by nausea, vomiting, nystagmus, and tinnitus
Subjective vertigo
- can be a result of dizziness
- temporary loss of consciousness
- blacked out or had a spell
Syncope
Numbness or tingling sensation
Paresthesia
5 causes of paresthesia
- Diabetes
- Metabolic
- Neurologic
- CV Renal
- Inflammatory
Smell
CN I Olfactory
Visual acuity, pupillary constrictions, extraocular movements
CN II (optic), CN III (oculomotor), CN IV (trochlear), CN VI (Abducens)
Taste
CN VII (facial, CN XI (Glossopharyngeal)
Hearing
CN III (Acoustic)
Touch
CN V (Trigeminal)
(6) Examination of the Neurological System
- Level of Functioning
- Mental Status
- Cranial Nerves
- Cerebral Function
- Motor Function
- Reflexes
(4) Terms used to describe the level of consciousness
Alert, Lethargic, Stuporous, Comatose
Follows command in a timely fashion
Alert
Appears drowsy, may drift off to sleep during examination
Lethargic
Requires vigorous stimulation (shaking, shouting) for a response
Stuporous
Does not respond appropriately to either verbal or painful stimuli
Comatose
Provides a more objective way to assess the patient’s LOC. Decrease score indicates impending neuro crisis
Glasgow Coma Scale
Lower level response and indicates that the patient pulls away from painful stimuli
Flexes and Withdraws
Ominous sign (indicates poor prognosis)
Abnormal position of the arms with legs extended and internally rotated, and feet plantar flexed
- flexion posturing
- arms are flexed, chest and hands are clenched and internally rotated
Decorticate
- extension posturing
- arms are extended, hands are clenched and hyper pronated
Decerebrate
Result of lesion and or above the brainstem in the cerebral cortex
Decorticate
Midbrain lesion
Decerebrate
What do you ask when assessing orientation?
Time, Place, and Person
Ask the date including the year and the day of the week
Time
- ask to state where he is
- identify environmental cues
Place
Usually remains intact the longest
Self-identity
- ask patient to state his name
- orientation to a person is an omnious sign
Person
Fourth area of orientation
Purpose
Three types of memory
Immediate, recent, remote memory
Repeat a series of numbers
Immediate memory
- what the patient had for breakfast
- name 3 objects and recall them later
Recent memory
- ask dates of major historical events
- ask birthdates or anniversary date
Remote memory
Inability to communicate
Aphasia
Rapid exaggerated changes in the mood
Emotional lability
- done in an interview
- must check for the following: known brain lesions, suspected brain lesions, memory deficits, confusion, vague behavioral complaints, aphasia, irritability, emotional lability
Mental status
Three types of sensation
- Exteroceptive
- Proprioceptive
- Cortical
Superficial sensations that originate in the skin and mucous membranes
- examples. Light tough, temperature, and superficial pain
Exteroceptive senstations
- deep sensations with memory receptors on muscles, tendons, joints, and ligaments
- tested within the modalities of motion and position
Proprioceptive sensation
Those that require cerebral integrative and discriminative abilities
Cortical Sensations
(4) Examples of Cortical Sensations
- Stereognosis
- Graphestesia
- Two-point discrimination
- Extinction
Recognition of movements drawn on the skin
Stereognosis
Recognition of solid objects through touch
Graphestesia
Ability to discern that two points touching the skin are two different objects
Two-point Discrimination
Individual ability to perceive two simultaneous light touches
Extinction
They travel through distinct locations in the brain and because of this, assessing them can sometimes give us early and detailed information about an injury
Cranial nerves
Involves assessment of the muscle size, muscle strength, muscle tone, muscle coordination, gait, and movement
Motor function
Inspect all major muscle groups bilaterally for symmetry, hypertrophy, and atrophy
Muscle size
- Assess the power in major muscle groups against resistance
- use 5 point scale in all extremities, comparing one side to the other
Muscle strength
Performed in patients with neurological signs or symptoms of cerebral pathology (ex. Dizziness, loss of balance, poor coordination)
Cerebral Function
Performed as part of a neurologic 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
Reflex test
Inability to recognize object
Agnosia
Complete or partial loss of voluntary muscle movement
Akinesia
Absence or impairment of ability to communicate through speech, writing, or signs
Aphasia
Inability to express language even though person knows what he wants to say; also known as Broca’s or motor aphasia
Expressive aphasia
Words can be spoken but are used incorrectly
Fluent aphasia
Slow, deliberate speech, few words
Nonfluent Aphasia
Inability to comprehend spoken or written words; also known as Wernicke’s or sensory aphasia
Receptive aphasia
Inability to carry our learned sequencial movements or commands
Apraxia
Inability to name object verbally, so patients talks around object or uses gesture to define it
Circumlocution
Lobe affected in auditory receptive
Temporal lobe
Lobe affected in visual receptive
Parieto-occipital nerve
Defective speech; inability to articulate words; impairment of tongue and other muscles needed for speech
Dysarthria
Impaired or difficult speech
Dysphasia
Difficulty with quality of voice; hoarseness
Dysphonia
Made-up, nonsense, meaningless words
Neologism
(4) common neurological disorders
ADHD, MIGRAINE, ALZHEIMER’S, PARKINSON’S
