Neuro Exam Flashcards
Level of alertness, attention and cooperation: Exam and Reporting Clinical Findings (Mental Status)
For a patient who is in a comatose state refer to the evaluation below this chart.
Glasgow Coma Scale often used by Paramedic, ER Physicians and OTs and PTs. Ranchos Los Amigos Scale used for pts. with TBI.
-Is patient able to attend and exert effort to communicate, and answer simple questions to test memory and thinking?
Level of alertness, attention and cooperation: Neuroanatomical Structure Involved
Impairment in level of consciousness:
Severe impairment
1. Brainstem reticular formation
2. Bilateral lesions of thalami or cerebral hemispheres
Orientation: Exam and Reporting Clinical Findings
Ask full name, location and date. If correct, pt. is “alert and oriented to person, place and time”, documented as A & O x3.
-If pt. is aware of reason why specifically they are receiving care, pt. is A & O x 4. Document specifically any areas missed.
Orientation: Neuroanatomical Structure Involved
-Mild impairment:
1. Unilateral cortical or thalamic lesions
2. Toxic or metabolic causes
-Generalized impairment in attention and cooperation:
1. Focal brain lesion
2.Dementia
3. Encepahalitis
4. Behavior, developmental or mood disorders
Recent Memory: Exam and Reporting Clinical Findings
Recall 3 items 3-5 minutes after being told
Recent Memory: Neuroanatomical Structure Involved
Impaired ability to register the three items can will present as impaired attention. Difficulty with recall after 1-5 minutes can be indicative of limbic system memory structures in medial temporal lobes and medial diencephalon.
-May see anterograde amnesia or retrograde amnesia or psychogenic amnesia
Remote Memory: Exam and Reporting Clinical Findings
Ask patient to recall verifiable information, such as names of 3 last presidents.
Remote Memory: Neuroanatomical Structure Involved
Loss of storage, consolidation and retention of information that has passed through working memory. Includes ability to retrieve information.
Spontaneous Speech (language): Exam and Reporting Clinical Findings
Note fluency, phrase length, abundance of spontaneous speech, paraphrasic disorders, neologisms or errors in grammar
Spontaneous Speech (language): Neuroanatomical Structure Involved
Language abnormalities:
Frontal lobe: L Broca’s (Fluent, expressive or motor ) aphasia
-Difficulty speaking
Comprehension (language): Exam and Reporting Clinical Findings
Can pt. understand simple questions and commands?
Comprehension (language): Neuroanatomical Structure Involved
Wernicke’s aphasia L temporal and parietal lobes (difficulty comprehending speech)
Naming (language): Exam and Reporting Clinical Findings
Name simple objects and more difficult to name objects
Naming (language): Neuroanatomical Structure Involved
Anomia: loss of ability to name objects or retrieve names of people
Repetition (language): Exam and Reporting Clinical Findings
Can pt. repeat simple phrases, “no ifs, and or buts”?
Reading (language): Exam and Reporting Clinical Findings
Ask patient to read simple words or a passage. Check comprehension.
Reading (language): Neuroanatomical Structure Involved
Inability to read: Dyslexia
Writing (language): Exam and Reporting Clinical Findings
Ask patient to write their name and write a sentence
Writing (language): Neuroanatomical Structure Involved
Inability to write: agraphia
Right-Left Confusion (calculations): Exam and Reporting Clinical Findings
Can the pt. do simple addition? (Calculations)
ID of R/L body parts
Right-Left Confusion, Finger Agnosia, Agraphia (calculations): Neuroanatomical Structure Involved
Impairment in all 4 is often referred to as Gerstmann’s Syndrome ( lesion in the L inf. Parietal lobe
Somatosognosia is a body scheme disorder that results in diminished awareness of body structure and function
Finger Agnosia (calculations): Exam and Reporting Clinical Findings
Can the pt. name and identify each digit?
Agraphia (calculations): Exam and Reporting Clinical Findings
Can the pt. write their name?
Apraxia: Exam and Reporting Clinical Findings
Can the patient demonstrate action such as “combing their hair”?
Apraxia: Neuroanatomical Structure Involved
Diffuse lesions of the cortex or more focal lesions affecting the frontal or L parietal lobe.
-Deficit in higher order planning
Neglect and Construction: Exam and Reporting Clinical Findings
-Observations to alertness or attention to stimuli presented to either side of a pt.s body.
-Neglect drawing tests such as draw a clock
-Construction tasks:
Drawing complex figures or manipulating blocks
Neglect and Construction: Neuroanatomical Structure Involved
Hemineglect in attention to one side of the universe not related to primary motor or sensory deficit. This abnormality can be caused by
R parietal lesions often cause neglect of the L side, due to distortion of perceived space. Other areas identified as potential locations for pathology include R frontal lesions, R thalamic or basal ganglia lesions.
-Anosgonosia: lack of awareness of a deficit
Sequencing tasks and frontal release signs: Exam and Reporting Clinical Findings
Presence of primitive reflexes beyond developmental norms (2-3month age) (grasp, root, suck)
Written alternating sequencing. Check for perseveration.
Sequencing tasks and frontal release signs: Neuroanatomical Structure Involved
Associated most frequently with lesions to the frontal lobes.
Logic and Abstraction: Exam and Reporting Clinical Findings
Can the patient solve simple problems?
Logic and Abstraction: Neuroanatomical Structure Involved
Difficulties can often be associated with higher order association cortex
Delusions and Hallucinations: Exam and Reporting Clinical Findings
- Does the patient report seeing, hearing, smelling stimuli that is not there (hallucination)?
- Does the pt. report having special powers (delusions)?
Delusions and Hallucinations: Neuroanatomical Structure Involved
- Concern for toxic or metabolic abnormalities, diffuse brain disorders, focal lesions, seizures in visual, somatosensory or auditory cortex.
- Thought disorders can be associated with disorders in association cortex and limbic system.
Mood: Exam and Reporting Clinical Findings
Does the pt. have signs of anxiety, depression, mania? Are there patterns of loss of sleep, loss of initiation, poor concentration, etc.
Mood: Neuroanatomical Structure Involved
This may be psychiatric, related to neurotransmitter imbalance. This can also be seen in focal brain lesions, thyroid or metabolic disorders.
