Module 11 - Neurological Assessment Flashcards
Structure of the Neurological System
- CNS
- PNS
- Meninges
- Cerebrospinal Fluid
Central Nervous system Structure
- Cerebral Cortex
- Frontal lobe
- Parietal lobe
- Occipital lobe
- Temporal lobe
Function of Neurological System
- Sensory
- Motor
- Integration
Function of Thalamus
Main relay station for the nervous system
Hypothalamus
- Major control centre
- Controls temperature, heart rate and blood pressure
- Regulates sleep
- Endocrine function from anterior/posterior pituitary
- Co-ordination of autonomic activity and emotions
Cerebellum
- Balance
- Equilibrium
- Coordination
- Muscle tone
Midbrain
Motor neurons
Pons
Relay station containing ascending and descending tracts
Medulla Oblongata
- Respiratory
- Cardiac
- GI
- Nuclei for cranial nerves VIII through XII
What is a dermatome?
A circumscribed skin area that is supplied mainly from one spinal cord segment through a spinal nerve
- Overlap if one nerve is severed most sensations will continue
Dermatome Landmarks
- Thumb, middle finger and fifth finger are connected to C6, C7 and C8
- The axilla is at level T1
- The nipple is at T4
- The umbilicus is at T10
- The groin is at L1
- The knee is at L4
Health History Questions
1) Headaches
2) Head Injury
3) Dizziness/Injury
4) Seizures
5) Tremors
6) Weakness
7) In-coordination
8) Numbness
9) Dysphagia
10) Difficulty speaking
11) Significant past history
12) Environmental and Occupational hazards
Components of the Glasgow coma scale
- Assessment of comatose patients and is important in critical care
- Used to assess functional state of the brain
- Standard assessment that defines LOC
Scoring areas of Glasgow Coma Scale
1) Best Eye opening response
2) Best Verbal responses
3) Best Motor responses
- 15 points is best response
- 8 or less is comatose
- 3 is totally unresponsive
Assessment of Gait
- Observe the client walking 3-6 m and then turn and return to starting point
- Smooth gait
- Rhythmic
- Effortless
- Equal arm coordination
- Turns are smooth
- Client should be walking in a straight line
Gait - Abormalities
- Stiff immobile posture
- Lack of arm swing or rigid arms
- Unequal rhythm of steps
- Crooked line
- Widening base
- Staggering balance
- Muscle weakness
- Swaying, falling
- Positive Romberg
- Loss of proprioception
- Loss of vestibular function
Romberg Assessement
- Test for balance/equilibrium
- A positive test is loss of balance
1) Ask patient to stand up with feet together and arms at the sides and to close their eyes and hold the position
2) Wait 20 seconds
3) Some swaying will occur - normal
4) Perform a shallow knee bend or hop in place - both legs
What are the neuro vital signs?
- All vitals (BP, HR, Temp) Co-ordination/Skilled Movements: - Grip strength - Finger to Finger - Finger to nose - Heel to shin
Cranial 1 – Olfactory Nerve
- Normal sense of smell
- Test one nostril at a time
Cranial 1 – Olfactory Nerve - Abnormalities
- Blocked passages
- Anosmia
- Neurogenic Anosmia (nasal disease)
Cranial Nerve II – Optic
- Test vision and visual fields
Cranial Nerve II – Optic
Vision lost
Cranial III, IV and VI – Oculomotor, Trochlear and Abducens
PERRLA:
- Pupils’ size
- Regulatory
- Equality
- Direct and consensual light reactions
- Accommodation
- Position of gaze
- Movement
Cranial III, IV and VI – Oculomotor, Trochlear and Abducens - Abnormal
- Myasthenia gravis
- Dysfunction of the nerves
- Intracranial pressure causes unilateral dilation and non-reactivity of the pupil
- Limited movement
- Disease
- Poor accomodation
- Stigma
Cranial Nerve V – Trigeminal Nerve - Motor
- Equally strong bilaterally
- Clenching teeth
Cranial Nerve V – Trigeminal Nerve - Motor Abnormal
- Decreased strength on one or both sides
- Asymmetry
- Pain
Cranial Nerve V – Trigeminal Nerve - Sensory
- Sensation is felt using cotton bud
- Test 3 division: ophthalmic, maxillary and mandibular
Cranial Nerve V – Trigeminal Nerve - Sensory Abnormalities
Decreased sensation
Cranial Nerve V – Trigeminal Nerve - Corneal Reflex
Test blinking reflex
Cranial Nerve V – Trigeminal Nerve - Corneal Reflex Abnormalities
No blinking occurs
Cranial Nerve VII: Facial Nerve
- Smiling
- Frown
- Lift eyebrows
- Shows teeth
- Puffs cheek
Cranial Nerve VII: Facial Nerve Abnormalities
- Muscle weakness
- Loss of movement
- Asymmetry
Cranial Nerve VIII: Acoustic Nerve
- Hearing
- Identifying sounds
Cranial Nerve IX and X: Glossopharyngeal and Vagus Nerve
Phalageal movement
Cranial Nerve IX and X: Glossopharyngeal and Vagus Nerve - Abnormalities
- Absence or asymmetry
- Deviation
- Asymmetry of tonsillar pillar
- Hoarseness or brassy voice
Cranial Nerve XI: Spinal Accessory
- Resistance is equal
- Equal movement
- Shrug against resistance
- Side to side resistance
Cranial Nerve XI: Spinal Accessory Abnormalities
- Atrophy
- Muscle weakness
- Paralysis
Cranial Nerve XII: Hypoglossal Nerve
- Speech
- Smooth/even tone tongue
Cranial Nerve XII: Hypoglossal Nerve Abnormalities
- Atrophy
- Tongue deviation
- Paralysis
Hypoalgesia
Decreased pain sensation
Analgesia
Absence of pain sensation
Hyperglesia
Increased pain sensation
Assessment of Sensory System
- Testing intactness of the spinal nerve, sensory tracts and higher cortical discrimination
- Do not need to test entire skin surface
- Detect localized pain, numbness and tingling
- Note decreases sensation areas
Hypoesthesia
Decreased touch sensation
Anaesthesia
Absent of touch sensation
Hyperasthesia
Increased touch sensation
Clonus
Rapid rhythmic contractions
Hyper-reflexes
Exaggerated reflexes
- Motor lesions
Hyporeflexia
Reduced function of reflex
Paralysis
Decrease in motor power caused by a problem with motor nerve or motor fibre
- Trauma
- Spinal Cord injury
- CVA
- MS
- Muscular Dystrophy
Fasciculation
Rapid continuous twitching of resting muscle
- Atrophy
- Fatigue
Tic
Involuntary compulsive repetitive twitching of muscle group
- Neurological issue (Tourettes)
Myoclonus
Rapid sudden jerk or short series of jerks at regular intervals
- Tonic Clonic Seizures
Rest Tremor
- Coarse and slow
- Disappearing voluntary movement
Intention tremor
Rate varies but worsens with voluntary movement
-Seen in MS and alcoholism
Chorea
- Sudden rapid jerky and purposeful movement involving the limbs, trunk or face
- Accentuated voluntary acts
- No rhythm or repetitive movement
- Disappears with sleep
Athetosis
Slow, twisting, writhing continuous movement resembling a snake or a worm
- Cerebral palsy
Spastic Hemiparesis
Arm is immobile against the body
- CVA
- Trauma
Cerebellar Ataxia
Patient is staggering, wide based gait
- Alcoholism
Parkinsonian (Festinating)
- Posture is stooped, trunk forward
- Elbow, hips and knees are flexed
- Hesitant to start walking
Scissors
Knees cross or are in contact
Steppage or Foot drop
Appears if patient is walking up stairs where there are no stairs
Waddling
- Weak hip muscles
- Opposite hip drop
Short Leg
Leg length discrepancy
Diseases of Motor System
1) Cerebral Palsy - Damage to cerebral cortex - developmental defect
2) Muscular Dystrophy - Wasting of skeletal muscle structures
3) Hemiplegia - Lower muscle paralysis
4) Parkinson Disease - Destruction of neurons producing dopamine
5) Cerebellar - A lesion in one hemisphere (will affect opposite side)
6) Paraplegia - Spinal injury - no movement below the lesion
7) Multiple Sclerosis - Destruction of Myelin of the neurons - both sensory/motor dysfunction
Sensory - Peripheral Neuropathy
Loss of sensation involves all modalities
- Diabetes
Sensory - Individual Nerves or Roots
Decrease in or loss of all sensory
Sensory - Spinal cord Hemisection
Loss of pain and temperature sensation starting one to two segments below the level of the lesion
Sensory - Complete Transection of the Spinal Cord
Complete loss of ALL sensory modalities below the level of the lesion
Sensory Loss - Thalamus
Loss of ALL sensory modalities
Sensory Loss - Cortex
Loss of discrimination of sensation
- Lesions
