Neuro Assesment Flashcards
Health History Questions
12
HHDSTWINDDSE
Headache Head injury Dizziness / vertigo Seizures Tremors weakness incoordination Numbness or tingling Difficulty swallowing Difficulty speaking Significant past history Environmental / occupational hazards
Health History Questions
Headache Questions
PQRSTU
Ask if normal/changing
Health History Questions
Head injury
Have you had one?
Cause?
Loss of consciousness
Location
Health History Questions
Dizziness / Vertigo
Vertigo- sensation of rotational spinning (objective vs. subjective)
Syncope (fainting)- sudden loss of strength and temporary loss of consciousness
Health History Questions
Seizures questions
- what is aura
- what is postictal phase
Aura - subjective sensation that happens before (auditory, visual or motor)
how long how often medication new or different how long to regain what happens
Post Ictal Phase? (altered state when you wake up, 5-10 minutes (longer for bad seizures) [Drowsiness, confusion, nausea, hypertension, headache or migraine, disorientation
Health History Questions
Tremors
Shaking
involuntary movement
Health History Questions
Incoordination
Balance
Trouble walking
Health History Questions
Numbness or tingling
-what is paraesthesia
Paraesthesia- an abnormal burning or tingling sensation
Health History Questions
Difficulty swallowing
-what is dysphagia
Dysphagia - difficulty swallowing
Health History Questions
Difficulty Speaking
- what is Dysphasia
- what is dysarthria
Dysphasia- difficulty speaking
Dysarthria- difficulty articulating / forming words
Additional Health History Questions
Infants and children
Maternal health and neonatal period Reflexes Weakness and balance Seizures Physical and cognitive development Family history Environmental hazards
Additional Health History Questions
Older Adults 4
Risk for falls
Cognitive function
Tremor
Vision
Objective Data
3 Types of neurological Examinations
Screening neurological examination
-healthy individuals whose histories reveal no significant subjective findings
Complete Neurological examination
-Neurological concerns (headache, weakness, loss of coordination) or have signs of neurological dysfunction
[Cranial, motor, sensory, reflexes]
Neurological Recheck examination
- hospitalized patient
- periodic assessments on people with deficits
Physical Exam
Test Cranial Nerves and Palpate the Motor System
Assess Sensation
Test Reflexes
Physical Exam
Test Cranial Nerves
Test 12 Cranial Nerves
I = Olfactory = Oh II = Optic = Once III = Oculomotor = one IV = Trochlear = Takes V = Trigeminal = The VI = Abducens = Anatomy VII = Facial = Final VIII = Acoustic = A IX = Glossopharyngeal = Good X = Vagus = Vacation XI = Spinal Accessory = Seems XII = Hypoglossal = Heavenly
Olfactory = I
Function, Type, Assessment
Function: Smell (Olfaction) Type: Sensory Assessment: o Assess patency of nostrils o Assess smell of each nostril with opposite occluded & eyes closed o Possible smells: coffee, cloves, peppermint o Asnomia: decrease or loss of smell o Not routinely tested
Optic = II
Function, Type, Assessment
- Function: Vision
- Type: Sensory
- Assessment:
o Visual acuity (Snellen chart)
-The lower the denominator the worse your vision
o Test visual fields by confrontation
o Ophthalmoscope exam
III = Oculomotor
Function, Type, Assessment
PERRLA
Nystagmus
Ptosis
- Function:
o Motor: movement of eyeball (EOM) & upper eyelid
o Parasympathetic: pupil constriction, lens shape - Type: Mixed
- Assessment:
Pupils equal round react to light accommodation - Cardinal positions of gaze
o Nystagmus- back & forth oscillation of the eyes
o Ptosis- drooping of eyelids - Pupils = round, reactive to light and accommodation
*CNs III, IV & VI assessed together
IV = Trochlear
Function, Type, Assessment
- Function: movement of eyeball (down & inward)
- Type: Motor
- Assessment:
o Cardinal positions of gaze
o *CNs III, IV & IV assessed together
V = Trigeminal
Function, Type, Assessment
3 areas (FCC)
Corneal reflex
- Function:
o Motor: Mastication (chewing)
o Sensory: Sensations from face, scalp, cornea, nasal & oral mucosa - Type: Mixed
- Assessment:
o Motor:
Palpate muscles of mastication (temporal & masseter) while pt clenches teeth
Try to separate jaws by pushing on chin
o Sensory:
Test skin on 3 areas of face with cotton wisp (tests 3 divisions)
• Forehead (ophthalmic)
• Cheeks (maxillary)
• Chin (mandibular)
Corneal reflex- omit unless abnormalities present (Do you close eyes when wisp touches it)
VI = Abducens
Function, Type, Motor
- Function: movement of eyeball (lateral)
- Type: Motor
o Assessment:
Cardinal positions of gaze (6 lines, diagonal, and horizontal) - *CNs III, IV & VI assessed together
VII = Facial
Function, type, assessment
- Function: o Motor: Facial expression o Parasympathetic: Secretion of tears & saliva o Sensory: Taste (ant. 2/3 of tongue) - Type: Mixed - Assessment: o Motor: Note mobility & facial symmetry: • Have pt raise eyebrows, show teeth, smile, puff out cheeks • Press on puffed out cheeks (air escaping?) o Sensory: To test taste apply sugar, salt or lemon juice on tongue & ask pt to identify it o Not routinely tested
VIII = Acoustic
Function, type, assessment
- Function: Hearing and equilibrium
- Type: Sensory
- Assessment:
o Whispered voice test
o Tuning fork tests
o Romberg
IX = Glossopharyngeal
Function, type, assessment
- Function: o Motor: Assists with swallowing & phonation o Parasympathetic: Salvia secretion o Sensory: Taste (post. 1/3 of tongue); gag reflex - Type: Mixed - Assessment: o Motor: Inspect pharynx- “Ahh” Observe uvula, soft palate, & tonsillar pillars o Gag reflex o Voice - Sensory: o Too difficult to test
*CN IX & X are tested together
X = Vagus
Function, Type, Assessment
Carotid Relfex
- Functions: o Motor: Talking and swallowing o Sensory: Sensations from pharynx Monitors BP, O2 & CO2 levels (carotid sinus & carotid body) Sensations from thoracic & abdominal organs o Parasympathetic: Motility & secretion of GI organs Constrict lung passages Slows HR (carotid reflex) - Type: Mixed - Assessment: o Same as Glossopharyngeal (*CN IX & X are tested together)
XI = Spinal Accessory
Function Type Assessment
- Function: o Movement of head & shoulders (trapezius & sternomastoid muscles) - Type: Motor - Assessment: o Examine for equal size o Against resistance: o Rotate head o Shoulder shrug
XII = Hypoglossal
Function, type, assessment
- Function: o Movement of tongue - Type: Motor - Assessment o Inspect tongue o Have pt stick out tongue o Ask pt to say: “light, tight, dynamite”
Inspect and Palpate the Motor System
Muscles
Cerebellar Function
Coordinated and Skilled movements
Inspect and Palpate the Motor System
Muscles 4
Size, strength, tone, involuntary movements
Inspect and Palpate the Motor System
Cerebellar Function
Balance Test 4
- Gait
- Tandem walking (heal-to-toe)
- Romberg test (Eyes closed, do you sway? Positive sign indicates cerebral Ataxia)
- Shallow knee bend or hop in place
Inspect and Palpate the Motor System
Coordinated and Skilled movements 4
Rapid alternating movements (knee tapping or touch fingers together
Finger-to-Finger test (nose to my finger)
Finger-to-Nose test (eyes closed, arms stretched, touch your index finger to nose)
Heel-to-Shin test (move your shin to ankle)
Failure = Cerebellar dysfunction
Sensory System
o Ensure pt is alert, cooperative, comfortable, with adequate attention span
o Compare sensations bilaterally
o Avoid asking leading questions
Spinothalamic tract
Posterior column tract 3
(T is 5 tests)
Spinothalamic tract
Pain, temperature, light touch
Only assess temperature when pain is abnormal
Posterior column tract
Vibration
Position (kinesthesia)
Tactile discrimination
- Stereognosis (3d objects)
- Graphaesthesia (spelling letters in hand)
Two-point discrimination
o NR: 2-8 mm
• Extinction (touch two point on their body and say where it is)
• Point localization (touch them and say where it is)
Test Reflexes 3
Deep Tendon Reflexes
- Clonus
Superficial Reflexes
Test Reflexes
Graded on 5 point Scale (0-4)
4+: Very brisk, hyperactive with clonus, indicative of disease
3+: Brisker than average, may indicate disease
2+: Average, normal
1+: Diminished, low normal
0: No response
Test Reflexes
Deep tendon Reflexes (5)
And what parts of spine do they test (cervical, Thoracic, Lumbar, Sacrum)
Abnormal:
Hyperflexia
Hypoflexia
Clonus
Biceps (c5 to c6) (blow to thumb on bicep)
Triceps (c7 to c8)
Brachioradialisis (forearm C5 to C6)
Quadriceps (patellar) (knee jerk L2 to L4)
Achilles (L5 to S2) (should plantar flex)
Hyperreflexia- an exaggerated reflex
Hyporeflexia- a reduced reflex
Clonus- a set of rapid, rhythmic contractions of the same muscle
Test Reflexes
Superficial Reflexes 3
(normal/ abnormal for P)
Babinski Sign
Abdominal (Stroke upper[T8 to T10] and lower [T10 to T12], abs contract and belly button moves the way of stroke)
Cremasteric (L1 to L2, Stroke inner thigh, balls elevate)
Plantar (L4 to S2, Rub L from ankle up)
-Normal response
• = plantar flexion of the toes + inversion and flexion of the forefoot
Abnormal response
• = dorsiflexion of the big toe + fanning of all the toes (a positive Babinski sign)
o This is normal only in infancy
o Past infancy indicates upper motor disease of the corticospinal tract
Test Reflexes
Neurological Recheck (5 parts)
Deficit Patients
Level of consciousness (LOC)
• Person, place, time
• A change in LOC is the most important factor
• If pt difficult to rouse, use progressive stimuli
Motor function
• Check voluntary movement of each limb by giving specific commands
Pupillary response
• Size shape, symmetry, reaction to light
Vital signs
Glasgow Coma Scale
Glasgow Coma Scale
3 areas and scale
Mostly widely used scoring system for altered level of consciousness Divided into 3 areas: • Eye opening • Verbal response • Motor response Numbers added with total score reflecting brain’s functional level Issues: • Can be subjective • Patient that is non-verbal can not use this test Scoring: • 15 is normal • <7 = coma • <8 = intubate
Abnormal Postures
Decorticate Rigidity
Flaccid Quadriplegia
Decerebrate Rigidity
Opisthotonos
Decorticate Rigidity
-Hemispheric lesion of cerebral cortex
Flaccid Quadriplegia
-Complete loss of muscle tone and paralysis of 4 limbs
Non-functional Brain stem
Decerebrate Rigidity
- Lesion in brain stem at midbrain/upper pons
- Worse than decorticate rigidity
Opisthotonos
- Prolonged arching of back, with head and heels bent backward
- meningeal irritation
