Lecture 36 Clinical Assessment of the Neurosurgical Patient Flashcards
How would you obtain a history from an unconscious patient
History from paramedics and bystanders
How would you assess an unconscious patient
GCS and Pupils- cerebral herniation
How would you be able to tell the patient was at the stage of decompensation
Pulse pressure increases
heart rate increases
respiratory rate increases
How would you obtain a history form a Confused/Dysphasic/Preverbal Patient (Ward)
History from family or notes
How would you assess a non-communicative patient
- Observation – posturing, focal lack of movement, neglect, eye movements
- Assess speech
- Mini-mental score
What type of imaging would you use
- Functional MRI
* Diffusion tensor imaging (tractography)- Cortex white matter tracts
Describe the functions of the frontal lobe
- Voluntary control of movement - precentral gyrus
- Speech – pars opercularis, pars triangularis
- Saccadic eye movements - frontal eye field
- Bladder control – paracentral lobule
- Gait – periventricular
- Higher order - Restraint, Initiative, and Order (RIO)
- Left hemisphere dominance- right handed, speech
What is usually a persons dominant hemisphere
Hemisphere opposite to dominant hand
How would you carry out a frontal lobe examination
• Inspection – Decorticate posture – ‘Magnetic gait’ – Urinary catheter – Abulia- absence of will power • Pyramidal weakness – UMN signs – weakness, increased tone, brisk reflexes, up-going plantar – Pronator drift • Saccadic eye movement • Primitive reflexes • Speech
How would 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- understanding
- ‘Baby hippopotamus’ – cerebellar speech
- Orofacial movement – ppp, ttt, mmm
- Reading
- Writing
What is the function of the Parietal Lobe
- Body image representation – primary somatosensory area
- Multimodality assimilation
- Visuospatial coordination
- Language
- Numeracy
How would you examine the parietal lobe
Assess whether it is a cortical sensory syndrome or a Gerstmann’s syndrome
What symptoms would suggest a cortical sensory syndrome
- Sensory inattention
- Astereoagnosia- inability to identify an object by active touch of the hands without other sensory input such as visual or sensory information
- Dysgraphasthesia- lack of ability to recognise writing on the skin purely by sensation of touch
- Two-point discrimination
What symptoms would suggest Gerstmann’s syndrome damage to dominant parietal lobe
agraphia (inability to communicate through writing), acalculia (inability to perform simple calculations), finger agnosia (inability to recognises sensation) and left-right disorientation.
How would examine non-dominant damage to parietals lobe
How to do?
‘What to do’ – loss of understanding of the purpose of objects – what is a comb for?
Apraxia
Loss of spatial awareness
