Clinical Assessment of the Neurosurgical Patient’ Flashcards
What is the point in doing a history/exam?
- Anatomical Localisation……where is the lesion?
- Causative Pathology…..what is the problem?
- Effect on Daily Life…..how it effects the patient day to day?
WHat should be found when assessing a patient?
- Pick up on cues
- Explore anatomically adjacent areas
- Probe inconsistencies
- Don’t finish the encounter with a story that doesn’t make sense to you
What questions should you ask yourself in regards to a patients management?
- Are special tests required?
- Which ones?
- What can I do to help this patient?
- How quickly do we need to act?
Who would you get a histroy from when dealling with a unconscious patient (A+E/roadside) and what tests would be done?
History from paramedics/bystanders
GCS, pupils
Who would you get a histroy from when dealling with a patient who is confused/dysphasic/preverbal patient (ward) and what tests would you need to carry out?
History from family/notes
Posture, neglect, mini-mental
Who would you get a histroy from when dealling with an awake and alert patient (ward/clinic)and what tests would you need to carry out?
History from patient
Focused neuro-exam
WHat tests are done for unconscious patients and what may be the cause?
ABC
GCS
Pupils
Cerebral perfusion/metabolic
Cerebral herniation
Why may the pupils dilate in herniation?
Brain can be pushed under the falx cerebri and the brain can so be pushed below the tentorium cerebelli and if it herniates over the tent then it presses on the 3rd nerve resulting in dilation
What tests do you do in a non communicative Patient?
Observation – posturing, focal lack of movement, neglect, eye movements
Assess speech
Mini-mental score
What do you need to think about when dealling with a communicating Patient?
Cranial - which lobe, cerebellar, CN?
Spinal - which level, myelopathy, radiculopathy,
Peripheral nerve
Is cerebral localisation important?
yes
What are the functions of the forntal lobe?
Voluntary control of movement - precentral gyrus
Speech – pars opercularis, pars triangularis
Higher order - Restraint, Initiative, and Order (RIO)
What are the higer order functions of the frontal lobe?
Restraint, Initiative, and Order (RIO)
Restraint - Mediates empathic, civil and socially appropriate behaviour
What is involved in an examination of the frontal lobe?
• Inspection
- Decorticate posture
- Altered behaviour
- Abulia
• Pyramidal weakness
- UMN signs – weakness, increased tone, brisk reflexes, up-going plantar
- Pronator drift
• Speech
What are the 2 speech areas of the brain?
inferior frontal gyrus, area known as brocas area which is responsible for motor and expressive point of speech. IT is involved in the expressive aspects of spoken and written language (production of sentences constrained by the rules of grammar and syntax)
Wernicke’s area is the region of the brain that is important for language development. It is located in the temporal lobe on the left side of the brain and is responsible for the comprehension of speech, while Broca’s area is related to the production of speech