Lecture 8: Neurological Assessment Flashcards
What does the CNS consist of? What is it important for?
Brain and spinal cord
- control and coordination of the body
Brain - what does the cerebrum consist of? What does the cerebral cortex consist of (all lobes/areas)?
Cerebrum - Left and Right hemispheres
Cerebral cortex:
- frontal lobe
- parietal lobe
- temporal lobes
- occipital lobe
- Wernicke’s are (temporal)
- Broca’s area (frontal)
Name the other areas of the brain? BTHCAFMB
- basal ganglia
- thalamus
- hypothalamus
- cerebellum
- amygdala
- forebrain
- midbrain
- brainstem (pons and medulla)
What does the peripheral nervous system consist of (PNS)
- cranial, spinal, and peripheral nerves
they connect the CNS to the rest of the body
How many pairs of nerves enter/exit the brain? Where do these nerve pairs come from?
- 12 pairs enter and exit the brain
CN 1 & 2 come from the cerebral cortex
The remaining 10 pairs come from the brainstem, the cerebellum has no CNs associated to it
What is the function of CNs?
CNs relay info from the brain to the body, mostly the head and neck
What function does each CN have (sensory, motor, both)
say both the acronyms for CN function and names of CNs
CN 1: S
CN 2: S
CN 3: M
CN 4: M
CN 5: B
CN 6: M
CN 7: B
CN 8: S
CN 9: B
CN 10: B
CN 11: M
CN 12: M
some say marry money but my brother says big brains matter more
on old Olympus’ towering top a fin and German viewed some hops
How many spinal nerves are there? How many are cervical, thoracic, lumbar, sacrum, coccygeal?
There are 31 spinal nerves:
- 8 cervical
- 12 thoracic
- 5 lumbar
- 5 sacrum
- 1 coccygeal
What does the autonomic nervous system (ANS) do? What are the two parts that make it up and their functions?
It maintains involuntary functions of cardiac and smooth muscle
1. Sympathetic:
- “fight or flight” produces body-to-action during periods of physiologic and psychologic stress (adrenaline)
2. Parasympathetic:
- “rest & digest” to conserve body resources and day-to-day functions (acetylcholine)
What are the components of the neurological assessment?
- Vital signs
- Level of consciousness (LOC) using GCS (Glasgow coma scale)
- Cranial nerves 1-12 (concentrate on 2, 3, 7, 9, 10)
- Speech
- Strength testing
- Cerebellar function
- Sensation testing
- Reflexes (advanced)
What is the Glasgow Coma Scale (GCS) purpose? What are its three components? What is the score range? What does a score of less than 8 mean?
- system for assessing extent of consciousness impairment (numeral score, low bad high good)
3 components:
- eye opening, verbal response, and motor response
Score range: lowest score you can get is 3, highest is 15.
less than 8 - profound impairment and cannot protect own airway
How does the GCS work (max points per component, what is the min amount of points)
- Eye opening
- none = 1 point
- max 4 - Verbal response
- none = 1 point
- max 5 - Motor response
- none = 1 point
- max = 6
What does verbal response consist of?
Orientation is made of the person, place, and time
- all 3 must be intact for the patient to be considered oriented
- usually documented as A & O x 3
What does motor response consist of?
Patient’s ability to receive the simple command and produce the action
- ex. “wiggle your thumb”
ability reflects LOC not motor impairment
Severely impaired LOC - decorticate & decerebrate postures
Decorticate posture is flexion (arms adducted/flexed to chest, legs fully extended)
Decerebrate posture is extension (arms adducted/extended, legs fully extended)
What are the components of the pupillary assessment (4 things), what nerves are responsible for them?
CN 2 optic and CN 3 oculomotor
1. Pupil size, equality and shape
2. Direct light reflex
3. Consensual light reflex
4. Accommodation
How do you test for the facial nerve, what number CN is it? What is the nerve’s function?
CN 7 is the facial nerve
- its function is facial expression
tests for motor:
- raise eyebrows
- frown
- show teeth
- smile
What are the glossopharyngeal and vagus nerves responsible for? What number nerves are they and how do you test for them?
They are responsible for swallowing and taste
- CN 9 is glossopharyngeal
- CN 10 is vagus
tests for motor:
- “aah” - uvula and palate rise
- gag reflex
What are the Broca’s area and Wernicke’s area responsible for? Where are they located? What is damage to the Broca’s area called? What is damage to the Wernicke’s area called?
Broca’s area is located in the frontal lobe
- forming words/language
Wernicke’s area is located in the temporal lobe
- understanding words/language
Damage to the Broca’s area is called expressive aphasia
Damage to the Wernicke’s area is called receptive aphasia
Explain the assessment of pronator drift
sit patient up, close eyes
- hold arms straight out in front, palms up, shoulder height
- hold for 20 sec
- if present, arm on one side will be weak and fall/drift across body
- hand will pronate
what is the Romberg test?
ask patient to stand still, if patient sways somethings wrong
ask patient to walk heel to toe, if patient unbalanced something might be wrong
Babinski Reflex
stroking lateral aspect of the sole (foot), normally, toes flex.
in positive babinski’s reflex, big toe dorsiflexes and other toes fan out
Gross extremity assessment: what are the most commonly tested muscles (both upper and lower body)
upper: biceps, triceps, deltoid
lower: hamstrings, quadriceps
