Neuro assessment

Question 1

Coma Scale Assessment

Answer 1

• Full Name: Confirm patient’s full name.
• Orientation Questions: Assess for awareness:
  o Where are we?
  o Date of birth?
  o Time and day of the week?
  o If correct, document as “alert to person, place, and time.”
• Commands to Assess Response:
  o Motor Response: “Can you raise your arms?”
  o Eye Opening: “Can you open your eyes?”

Question 2

Reflexes

Answer 2

• Deep Tendon Reflexes (DTRs):
  o Assess sensory, motor neurons, and spinal cord reflex arcs.
  o Knee Jerk (Patellar Reflex): Taps patellar tendon to test L2-L4.
  o Bicep Reflex: Tests C5-C6.
  o Tricep Reflex: Tests C6-C7.
  o Achilles Reflex: Tests S1-S2.
  o Findings:
   Hyporeflexia: Indicates peripheral nerve or spinal cord damage.
   Hyperreflexia: Suggests central nervous system involvement.
• • Primitive Reflexes:
    o Babinski Sign: Drag reflex hammer along the sole:
     Normal (negative): Toes curve inward.
     Abnormal (positive): Toes fan out (normal in infants).

Question 3

Cranial Nerves (I, V, VII)

Answer 3

• CN I (Olfactory):
  o Test with distinct scents (e.g., cinnamon or coffee) on each nostril.
  o Patient identifies the smell.
• CN V (Trigeminal):
  o Sensory: Test light touch (cotton swab) across forehead, cheek, and jaw. Ask if sensation feels the same on both sides.
  o Motor: Ask the patient to clench their jaw and resist opening against force.
• CN VII (Facial):
  o Motor: Raise eyebrows, close eyes tightly, puff cheeks, show teeth. Check for asymmetry or weakness.
  o Corneal Reflex: Gently touch cornea (blinking indicates normal response).
  o Sensory: Test taste using flavored liquids on various parts of the tongue.

Question 4

Balance and Cerebellar Function

Answer 4

Rapid alternating movements
 performs test: finger to thumb OR patting knees

Romberg test
 Patient stands upright and asked to close eyes
 A loss of balance is interpreted as a positive Romberg sign

Finger to nose test or finger to finger test
 for finger to nose test: has patient close eyes and touches nose with alternating hands OR
 for finger to finger test: has patient touch nose then touch examiner’s finger (examiner’s finger
should move to different locations)

General gait
Heel-to-toe (tandem walk)

Question 5

Cranial Nerves (II, III, IV, VI)

Answer 5

• CN II (Optic):
  o Test visual acuity using the Snellen chart (one eye at a time).
  o Confrontation test for visual field deficits (hemianopsia or quadrantanopsia).
• CN III (Oculomotor), IV (Trochlear), VI (Abducens):
  o Test eye movements:
   Follow a finger in an H-shape.
   Test accommodation by moving finger toward the nose (eyes cross, pupils constrict).
   Test pupillary light reflex with a flashlight (both pupils should constrict).

Question 6

Sensory and Motor Function

Answer 6

Sharp&dull (doneonmultiplespots,upperandlowerbody)
 Applies sharp or dull sensation on multiple locations, must be done at least once each leg and
arm

Two-pointdiscrimination
a. Performs test on finger –left & right hand and states value (normal 2mm-8mm)
b. Performs test on forearm –left & right arm and states value (normal 4cm-7.5cm)

Graphesthesia (drawing number on hand)  done on each hand

Stereognosis (identifying familiar object)  done on each hand
Motor

Muscularstrength/resistance(bilateralcomparisonofupper&lowerlimbs)
 Each arm and leg tested against resistance
 comparing bilaterally

Pronator drift
 has patient lift arms out, palms facing upwards
 has patient hold position for appropriate length of time (aprox. 10 sec)
 Patient’s eyes must be closed

Question 7

Cranial Nerves (VIII, IX, X, XI, XII)

Answer 7

• CN VIII (Vestibulocochlear):
  o Rub fingers near ears; ask if the sound is equal bilaterally.
  o Perform Weber Test (tuning fork on forehead) and Rinne Test (bone vs. air conduction).
• CN IX (Glossopharyngeal) & X (Vagus):
  o Assess uvula movement and gag reflex by asking the patient to say “Ahh.”
  o Uvula deviates away from the weak side.
• CN XI (Accessory):
  o Ask the patient to shrug shoulders and turn head against resistance.
• CN XII (Hypoglossal):
  o Stick out tongue and move side to side; tongue deviates toward weakness.

Question 8

Neurological Functions

Answer 8

• Frontal Lobe: Controls personality, emotions, and movement.
• Parietal Lobe: Primary sensory center.
• Occipital Lobe: Visual processing.
• Temporal Lobe: Auditory reception and language comprehension (Wernicke’s and Broca’s areas).
• Cerebellum: Coordinates voluntary movement and balance.
• Brain Stem:
  o Midbrain: Motor pathways.
  o Pons: Fiber tracts.
  o Medulla: Autonomic centers (respiratory, cardiac).
• Spinal Cord:
  o Transmits sensory (afferent) and motor (efferent) signals.
  o Reflex arc involves sensory nerve, spinal cord synapse, and motor nerve.

Question 9

Reflex Arc

Answer 9

• Deep Tendon Reflexes:
  o 5 components: intact afferent, synapse, efferent, neuromuscular junction, and competent muscle.
  o Spinal nerve involvement:
   C5-C6: Bicep Reflex
   L2-L4: Patellar Reflex
   S1-S2: Achilles Reflex

Question 10

Geriatric Considerations

Answer 10

• Normal Aging Changes:
  o Loss of muscle bulk and reflexes (e.g., Achilles reflex).
  o Decreased coordination, reaction time, and vibratory sense.
  o Slower movements and increased risk of falls.

Question 11

Quick Bedside Neurological Assessment

Answer 11

1. Vital Signs: Monitor for changes.
2. Level of Consciousness: Use Glasgow Coma Scale.
3. Cranial Nerves: Check pupils, eye movements, speech.
4. Motor Strength: Assess for limb drift or weakness.
5. Reflexes: Test deep tendon and superficial reflexes.