Clinical assessment of neurosurgical patient Flashcards
what three things do you need to check in an unconcious patient?
ABC
GCS
Pupils
what is GCS suggestive of?
Cerebral perfusion/metabolic
what is pupillary response suugestive of?
Cerebral herniation
what is cerebral perfusion pressure equal to?
CPP = MAP - ICP
what are the functions of the frontal lobe?
Voluntary control of movement - precentral gyrus
Speech
Higher order
Restraint, Initiative, and Order (RIO)
Gait – periventricular
Saccadic eye movements - frontal eye field
Bladder control – paracentral lobule
on inspection what would suggest lesion of frontal lobe?
Inspection
Decorticate posture
Altered behaviour
‘Magnetic gait’
Urinary catheter
Pyramidal weakness
UMN signs – weakness, increased tone, brisk reflexes, up-going plantar
Pronator drift (useful for subtle UMNL)
Speech
Saccadic eye movement
Primitive reflexes
how can you test the neuropsychology of the frontal lobe, Orbitofrontal cortex (Restraint)?
Mediates empathic, civil and socially appropriate behaviour
Is speech and behaviour socially appropriate?
Stroop test
what is the stroop test?
The Stroop Color and Word Test (SCWT) is a neuropsychological test extensively used to assess the ability to inhibit cognitive interference that occurs when the processing of a specific stimulus feature impedes the simultaneous processing of a second stimulus attribute, well-known as the Stroop Effect
how can you test the neuropsychology of the frontal lobe, Supplementary motor cortex/anterior cingulate (Initiative)?
Lack of motivation, apathy, depression
how can you test the neuropsychology of the frontal lobe, Dorsolateral prefrontal cortex (Order)?
Executive function
Ability to make an appointment and keep to time
Ability to give coherent account of history
Spell WORLD backwards
how can you examine language?
Ensure hearing is intact and patient’s first language is English
Handedness
Fluency – Broca’s
Nominal aphasia
Repetition – arcuate fasciculus
3 step command – Wernicke’s
‘Baby hippopotamus’ – cerebellar speech
Orofacial movement – ppp, ttt, mmm
Reading
Writing
functions of the parietal lobe?
Primary somatosensory area - Body image representation
Visuospatial coordination
Language
Numeracy
how can you determine involvement of the parietal lobe/examination?
Cortical Sensory Syndromes
Sensory inattention
Astereoagnosia
Dysgraphasthesia
Two point discrimination
what is symptomatic of the dominant side parietal lobe indicated?
Dyscalculia, finger anomia, left/right disorientation, agraphia
what is symptomatic of the non dominant side parietal lobe indicated?
Hemineglect
Constructional apraxia
Ideomotor apraxia - ‘How to do’ – light a match
Ideational apraxia - ‘What to do’ – loss of understanding of the purpose of objects – what is a comb for?
Dressing apraxia
Loss of spatial awareness
