Clinical assessment of a neurosurgical patient Flashcards
3 different patients you may need to assess?
- Obtuded patient
- Confused/disphasic patient
- Awake patient
How to assess an obtuded patient
Via an independent witness -ABC -GCS Eye movement Verbal response Motor movement -Pupils - herniation (shown in image)
-Cerebral perfusion: CPP= MAP-ICP
Cerebral perfusion pressure= mean arterial pressure- intracranial pressure
-Cerebral herniation
How to assess a confused patient
History from a patient
- Observation: posturing, focal movement, eye movement
- Assess speech
- Mini mental score
How to assess an awake patient
From patient
- Assess CRANIUM
- Assess spinal cord
- Assess periphery
What are the functions of the frontal lobe
- Voluntary control of movement -
- Saccadic eye movement
- Bladder control
- Gait
- Speech
- Higher functions: RIO
What does RIO stand for?
Restraint, initiative, order
Examination of Frontal lobe
- Inspection
- Saccadic eye movements
- Problems with speech
- Problems with reflexes
- Pyrimidal signs
- Neurophysiology
What is looked out for during inspection of the frontal lobe
- Abulia : indecisiveness
- Urinary catheter
- Decordinate posture
- Magnetic gait
What are the pyrimidal signs looked out for in examination of the frontal lobe
UMN weakness, altered tone, altered reflexes
Pronator drift
Which are the cortexes examined In neurophysiology of the frontal cortex?
- Orbito-frontal cortex
- Anterior cingulate/ supplementary motor cortex
- Dorso-lateral pre-frontal cortex
What does the orbit-frontal cortex control?
How is it tested
- Controls restraint
- mediates empathetic, social and civil behaviour
- Can be tested via the troop test
- Can be tested via the GO/ NO-GO tests
What does the Dorso-lateral pre-frontal cortex control?
- Controls order
- Integrates sensory information with ordering of tasks in sequential order in response to a variety of environmental factors
What does the anterior cingulate cortex control?
Control initiative Lack motivation? Apathy? Abulia? Depression?
What is decordinate posture?
Stiff posture- extended legs, bent arms
What are the functions of the parietal lobe|?
Somatosensory area Multimodality Visuospatial co-ordination Language Numeracy
How to assess speech
- Ensure the patient can hear and that their first language is English
- Test fluency- reflected in Broca’s
- Normal aphasia
- Test repetition
- 3 step command to test Wernicke’s- assess comprehension of speech
- Baby hippopotamus- test cerebellar function
- Test orophacial movement: ppp, mmm,
- Test reading
- Test writing
What are cortical signs of parietal damage?
- Inability to distinguish between two distinct points
- Astereoagnosia
- Dysgraphethesia
- Sensory inattention
What is astereoagnosia?
Inability to recognise an item exclusively based on touch without other sensory information such as visual
What is dysgraphethesia
Inability to recognise writing just based on touch
Gertsman’s syndrome?
On dominant side Patient presents with: -Dyscalculia -Finger anomia : Inability to distinguish between numbers written on hand -Left and right disorientation -Agraphia
What are the temporal lobe functions
- Processing auditory information
- Language
- Emotion (amygdala)
- Declarative long-term memory
- Visual field
What are the symptoms to test for cerebellum damage
Dysdiacokinesia : inability to perform rapid movements
Ataxia
Nystagmus
Intention tremor
Slurred speech
Hypotonia
Past Pointing : patient asked to point at moving object with eyes open and then closed
Characters of radiculopathy
Damage to the nerve root
- unilateral
- myotome damage- weakness
- Dermatome damage- sensory pain
Characters of myelopathy
Damage to the spinal cord
- Bilateral
- Motor and sensory
- UMN below lesion
- At cervical/ thoracic level
- Long tract damage symptoms such as clonu, upgoing plantar, Hoffman sign
Diseases which affect the Spinal cord?
- Radiculopathy
- Myelopathy
- Peripheral neuropathy
- Peripheral nerve damage
- Damage to cerebellum/higher up..
