Neuro assessment

Question 1

Focused Health History Questions for Neuro Assessment

Answer 1

• Have you ever had any head or spine injury?
• Have you ever had a stroke or an infection affecting parts of your brain?
• Do you experience headaches?
• Do you ever feel lightheaded or faint?
• Have you ever had a seizure?
• Do you have any shakes or tremors in the hands or face?
• Do you have any weakness or problem moving any body part?
• Do you have any problems with coordination or balance? Any episodes of falling?
• Do you have any numbness or tingling in any body part?
• Do you have any difficulty swallowing?
• Do you have any difficulty speaking?

Question 2

Glasgow Coma Scale

Answer 2

• 3 areas: Eye opening (out of 4), motor response (out of 6), verbal response (out of 5)
• Verbal response: Oriented x3 = 5
• Motor response: Able to obey verbal command = 6
• Eye opening response: Spontaneous = 4

Question 3

How to test olfactory (#1)?

Answer 3

• Smell
• Close each nostril separately and ask the patient to sniff as you wave something underneath their nose (Ex. alcohol wipe)
• Patient should be able to identify the odor through both sides of the nose

Question 4

How to test Optic (#2), Oculomotor (#3), Trochlear (#4), Abducens (#6)?

Answer 4

-Vision and eye movements

• Test for vision (using chart)
• Test pupil size, regularity, equality
• Use light pen to test for direct and consensual light reactions and accommodation
• Extraocular movements: Cardinal positions of gaze

Question 5

How to test trigeminal nerve?

Answer 5

• # 5 = Jaw, mastication and facial sensation
• Palpate the temporal and masseter muscles of the patient as they clench their teeth
• Muscles should feel equally strong on both sides
• With the patient’s eyes closed, brush a cotton wisp on patient’s forehead, cheeks and chin; Have patient say “now” every time they feel a touch

Question 6

How to test facial nerve (#7)

Answer 6

-Testing facial muscles

• Ask patient to make various facial expressions, noting mobility and facial symmetry
  
  • Smile
  • Frown
  • Close eyes tightly
  • Lift eyebrows
  • Puff cheeks

Question 7

How to test acoustic nerve (#8)?

Answer 7

• Hearing acuity

- Whisper a word in each ear and ask patient to repeat what you said

Question 8

How to test glossopharyngeal (#9) and vagus (#10)?

Answer 8

• Testing tongue/palate movement and gage reflex
• Cannot test due to mask; Just verbalize
• Press down the tongue with a tongue blade and ask patient to say “ahhh”
  
  • Note pharyngeal movement (uvula should rise in the midline)

Question 9

How to test spinal accessory nerve (#11)

Answer 9

-Testing strength of sternomastoid and trapezius muscles

• Ask patient to rotate the head while you apply resistance to the chin
  
  • Examine sternomastoid and trapezius muscles for equal size
• Ask patient to shrug the shoulders as you apply resistance
  
  • Movement should feel equally strong on both sides

Question 10

How to test hypoglossal nerve (#12)

Answer 10

• Check tongue position and movement
• Examine tongue for wasting and tremors
• Ask patient to say “light, tight, dynamite”

Question 11

Inspection and palpation of muscles

Answer 11

• Inspect and palpate the large muscle groups in arms and legs
• Note changes in size and tone, comparing right and left side
• Muscle groups should be within normal size limits for age and should be symmetric bilaterally
• Note tone (degree of tension in relaxed muscles)

Question 12

Cerebellar Assessment

Answer 12

• Observe gait and coordination
• Ask patient to walk 3-6m, turn and walk back
• Gait should be smooth, rhythmic and effortless