CLASS 3 - NEUROLOGICAL ASSESSMENT Flashcards
CNS COMPONENTS
- Brain
- Spinal cord
PNS COMPONENTS
- 12 cranial nerves
- 31 pairs of spinal nerves
BRAIN COMPONENTS
- Frontal lobe
- Temporal lobe
- Parietal lobe
- Occipital lobe
- Cerebellum
- Brain stem
FRONTAL LOBE ACTIONS
- Personality
- Behavior
- Intelligence
- Emotion
TEMPORAL LOBE ACTIONS
- Smell
- Taste
- Hearing
PARIETAL LOBE ACTIONS
- Sensation
OCCIPITAL LOBE ACTIONS
- Visual
CEREBELLUM ACTIONS
- Motor
- Balance
BRAIN STEM ACTIONS
- Autonomic nervous system
SPINAL CORD COMPONENTS
- Extends 1st cervical vertebrae to the 1st lumbar vertebrae
- Protected by the spinal vertebrae
- Facilitates communication between the brain and periphery
SPINAL NERVE COMPONENTS
- 31 pairs of spinal nerves
- 8 cervical
- 12 thoracic
- 5 lumbar
- 5 sacral
- 1 coccygeal
CRANIAL NERVE COMPONENTS
- Nerves that emerge directly from the brain - Divided based on specific functions
TYPES OF NEUROLOGIC ASSESSMENT
- Screening neurologic exam
- Complete neurologic exam
- Neurologic recheck exam
PAST MEDICAL HISTORY ASSESSMENT
- Hypertension
- Seizures
- Headaches
PERSONAL/SOCIAL HISTORY ASSESSMENT
- Environmental hazards
- Exposure to insecticides, lead, radiation
LIFESTYLE/HEALTH PRACTICES HISTORY ASSESSMENT
- Diet/exercise
- Smoking/alcohol or substance abuse
- Safety practices
FAMILY HISTORY ASSESSMENT
- Hypertension
- Stroke
- Cancer
- Cardiac/renal disease
- Bleeding disorders
- Seizure disorders
- Brain tumors
- Neurological disorders (Alzheimer’s, dementia, Parkinson’s, ALS)
REVIEW OF SYSTEMS ASSESSMENT
- Headaches, trauma, dizziness, fainting, loss of balance
- Weakness, numbness, tingling
- Visual disturbance, double vision photophobia
- Difficulty with swallowing/speaking
- Motor deficit, incontinence
- Memory, thought process, speech, mood, or personality changes
- Seizures, tremors
RISK FACTORS FOR NEUROLOGIC IMPAIRMENT
- Hypertension*
- Chronic atrial fibrillation and flutter
- Obesity*
- Sedentary life-style*
- Smoking tobacco products*
- Stress*
- Increased levels of serum cholesterol, lipoproteins, and triglycerides*
- Use of oral contraceptives in high-risk women*
- Family history of diabetes mellitus, CVD, hypertension, increased serum cholesterol levels
- Congenital cerebrovascular anomalies
- Modifiable risk factors - Health Promotion Opportunities
PHYSICAL EXAMINATION ASSESSMENT
- Mental status: LOC, speech, cognitive, orientation, memory function, emotional status
- Glasgow coma scale
T/F: Level of consciousness is the most sensitive indicator of neurologic deterioration
- True
ALERTNESS LOC EXAMINATION ASSESSMENT
- Speak to patient in a normal tone of voice
- Alert patient opens eyes, looks at you, responds fully and appropriately to stimuli
LETHARGY LOC EXAMINATION ASSESSMENT
- Speak to the patient in a loud voice
- Call the patient’s name or ask “how are you?”
- Patient appears drowsy but opens eyes and looks at you
- Responds to questions then falls asleep
OBTUNDATION LOC EXAMINATION ASSESSMENT
- Shake patient gently
- Patient opens eyes and looks at you
- Responds slowly and somewhat confused
- Alertness and interest are decreased
STUPOR LOC EXAMINATION ASSESSMENT
- Apply a painful stimulus (pinch tendon)
- Arouses from sleep only after painful stimuli
- Responses slow or absent
- Lapses into unresponsive state when stimulus ceases
- Minimal awareness
COMA LOC EXAMINATION ASSESSMENT
- Apply repeated painful stimuli
- Unarousable with eyes closed
- No evident response to inner need or external stimuli
GLASGOW COMA SCALE
- Objective assessment that defines level of consciousness by giving it a numeric value
- Divided into: eye opening, verbal response, motor response
- Monitors for trends of neurologic deterioration
- Minimum score = 3
- Maximum score = 15
- Coma = < 8
CRANIAL NERVE I ASSESSMENT ASSESSMENT
- OLFACTORY
- Occlude each nostril and test different smells
CRANIAL NERVE II ASSESSMENT
- OPTIC
- Test visual acuity with Snellen chart/card
- Inspect fundi
- Screen visual fields by confrontation
CRANIAL NERVE III, IV, VI ASSESSMENT
- OCULOMOTOR, TROCHLEAR, ABDUCENS
- Inspect pupils
- Test extra ocular movements in 6 directions of (EOM’s)
- Test convergence (corneal light reflex)
CRANIAL NERVE V ASSESSMENT
- TRIGEMINAL
- Palpate temporal and masseter muscles while patient is clenching
- Light touch on forehead, cheek and jaw
- Sharp and dull sensation on forehead, cheek and jaw
CRANIAL NERVE VII ASSESSMENT
- FACIAL
- Assess for asymmetry, tics, abnormal movements
- Raise eyebrows
- Frown
- Close eyes tightly
- Smile
- Grimace
- Puff both cheeks
CRANIAL NERVE VIII ASSESSMENT
- ACOUSTIC
- Test hearing by: whisper test, weber, and rinne test
CRANIAL NERVE IX & X ASSESSMENT
- GLOSSOPHARYNGEAL, VAGUS Assess if voice hoarse - Say "AH" - Gag reflex - Assess swallow
CRANIAL NERVE XI ASSESSMENT
- SPINAL
- Assess strength
- Patient shrugs shoulders up against your hands
- Contraction of opposite sternocleidomastoid muscle as patient forces head against your hand
CRANIAL NERVE XII ASSESSMENT
- HYPOGLOSSAL
- Assess for symmetry, atrophy
- Patient to protrude tongue and move side-to-side and up-and-down
SENSORY SHARP/DULL ASSESSMENT
- U/L & bi-lateral extremities able to distinguish sharp/light touch
- Eyes closed
- Start distally and prick area on both sides and ask if sensation is sharp or dull
SENSORY LIGHT TOUCH ASSESSMENT
- Light touch using cotton wisp and ask if patient feels touch
SENSORY VIBRATORY SENSE ASSESSMENT
- Tap 128 Hz tuning fork on the DIP joint of the patient’s finger
- “What do you feel?”
- “Tell me when it stops”
DISCRIMINATIVE SENSATION ASSESSMENT FACTORS
- Stereognosis
- Graphesthesia
- 2-Point discrimination
- Localization
- Extinction
STEROGNOSIS ASSESSMENT
- Place familiar object in patient’s hand and ask to identify object
GRAPHESTHESIA ASSESSMENT
- Outline a number in the patient’s palm and ask to identify number
TWO-POINT DISCRIMINATION ASSESSMENT
- Using two ends of an opened paper-clip, touch finger pad in two places simultaneously
- Ask the patient to identify 1 or 2 touches
LOCALIZATION ASSESSMENT
- Touch a point on the patient’s skin and ask the patient to point to that spot
EXTINCTION ASSESSMENT
- Touch 1 or 2 points on the patient’s skin and ask them to tell you where you pointed
MOTOR FUNCTION ASSESSMENT FACTORS
- Balance, gait, coordination
- Romberg test
- Pronator drift
- Rapid alternating movements (RAM)
- Finger-to-nose or finger-to-finger
- Heel-to-shin
BALANCE, GAIT, COORDINATION ASSESSMENT
- Have patient walk across room
- Walk heel-to-toe
- Walk on toes then on heels
- Hops in place
ROMBERG ASSESSMENT
- Have patient stand with feet together and arms at sides
- Close eyes and stand for 20-30 seconds
- Loss of balance = positive test
- Always be guarding in case patient starts to sway!
PRONATOR DRIFT ASSESSMENT
- Have patient stand with feet together and arms straight forward, palms up
- Close eyes for 20-30 seconds and examiner taps arms briskly downward
- Pronation and downward drift of the arm = positive test
RAPID ALTERNATIVE MOVEMENTS ASSESSMENT
- Patient turns hand rapidly over and back on thigh
- Taps tip of index finger rapidly on distal thumb
- Taps ball of foot rapidly on your hand
FINGER-TO-NOSE ASSESSMENT
- Patient touches nose then your index finger as you move it different positions
HEEL-TO-SHIN ASSESSMENT
- Patient moves heel from opposite knee down the shin to the big toe and back up
DEEP TENDON REFLEX ASSESSMENT FACTORS
- Biceps
- Triceps
- Brachioradialis
- Patellar
- Achilles
- Plantar Response (+/- Babinski)
- Assess for Clonus
- Graded 0 to 4+ scale
0 - 4+ DEEP TENDON GRADING SCALE
- 4+ : Very brisk, hyperactive, with clonus
- 3+ : Brisker than average, but not necessarily indicative of disease
- 2+ : Average; normal
- 1+ : Somewhat diminished; low normal
- 0 : No response
BICEPS TENDON ASSESSMENT
- Place thumb on palpated biceps tendon
- Strike thumb with a brisk, direct movement
TRICEPS TENDON ASSESSMENT
- Palpate triceps tendon and strike with a brisk, direct movement
BRACHIORADIALIS TENDON ASSESSMENT
- Hold thumb of hand you are planning to test (helps relax wrist)
- Strike right below the bony protrusion on the wrist
- Can feel the thumb vibrate
PATELLAR TENDON ASSESSMENT
- Strike the patellar tendon with a brisk, direct movement
ACHILLES TENDON ASSESSMENT
- Hold the foot in dorsiflexion and strike the achilles tendon directly
PLANTAR RESPONSE ASSESSMENT
- Drag of object in a j motion starting at the heel on the lateral side, ending at the big toe
Curling in of toes (normal) - Fanning out of toes (abnormal)
CLONUS
- Tested when the reflexes are hyperactive
- Rapid, rhythmic contractions of the calf muscle and movement of the foot
FURTHER NEUROLOGIC ASSESSMENT
- Mental status changes or change from baseline
- Known or suspected brain lesion (stroke, tumors, trauma)
- Memory deficits or confusion
- Vague behavioral complaints from friends or family
- Aphasia
- Irritability
- Motor or sensory deficits
