Clinical assessment of the neurological patient Flashcards
who would you get a history from for the following patients respectively:
- obtunded patient (A+E/roadside)
- confused/dysphasic/preverbal patient (ward)
- awake and alert patient (ward/clinic)
- paramedics and bystanders
- family and notes
- patient themselves
what would you assess in an obtunded patent and why
ABC
GCS - cerebral perfusion/metabolic
pupils - cerebral herniation
how do you determine cerebral perfusion pressure
CPP = MAP - ICP
*mean arterial pressure
what would you assess in a non communicative patient
observation - postural, focal lack of movement, neglect, eye movement
assess speech
mini mental score
what would you be wanting to find out in the communicating patient and how
where the damage is:
cranial - which lobe, cerebellar, CN?
spinal - level, myelopathy, radiculopathy
peripheral nerve
MRI, CT
what are the functions of the frontal lobe
voluntary control of movement
speech
saccadic eye movements
bladder control
gait
higher order - restraint, initiative, order
how would you examine the frontal lobe
inspection
- decorticate posture
- magnetic gait
- urinary catheter
- abulia (lack of will/motivation)
pyramidal weakness
- UMN signs
- pronator drift
saccadic eye movements
primitive reflexes
speech
how can you examine the orbitofrontal cortex for restraint
is speech and behaviour socially acceptable?
go/no-go tests
stroop test
how can you examine the supplementary motor cortex/anterior cingulate for initiative
lack of motivation
apathy
abulia
depression
how can you examine the dorsolateral prefrontal cortex for order
Ability to make an appointment and keep to time
Ability to give coherent account of history
Spell WORLD backwards
Say as many words as possible with a particular letter
what must you ensure before examining language
ensure hearing is intact
ensure patients first language is english
how can you examine language
Fluency – Broca’s
Nominal aphasia
Repetition – arcuate fasciculus
3 step command – Wernicke’s
‘Baby hippopotamus’ – cerebellar speech
Orofacial movement – ppp, ttt, mmm
Reading
Writing
what are the functions of the parietal lobe
Body image representation
Multimodality assimilation
Visuospatial coordination
Language
Numeracy
what are cortical sensory syndromes to test for parietal function
Sensory inattention
Astereoagnosia - inability to identify an object by active touch of the hands alone
Dysgraphasthesia - inability to identify writing on the skin by touch alone
Two point discrimination
how can you examine the dominant side of the parietal lobe
Dyscalculia
Finger anomia
Left/right disorientation
Agraphia
