Neuro Exam

Question 1

Level of alertness, attention and cooperation: Exam and Reporting Clinical Findings (Mental Status)

Answer 1

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?

Question 2

Level of alertness, attention and cooperation: Neuroanatomical Structure Involved

Answer 2

Impairment in level of consciousness:
Severe impairment
1. Brainstem reticular formation
2. Bilateral lesions of thalami or cerebral hemispheres

Question 3

Orientation: Exam and Reporting Clinical Findings

Answer 3

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.

Question 4

Orientation: Neuroanatomical Structure Involved

Answer 4

-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

Question 5

Recent Memory: Exam and Reporting Clinical Findings

Answer 5

Recall 3 items 3-5 minutes after being told

Question 6

Recent Memory: Neuroanatomical Structure Involved

Answer 6

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

Question 7

Remote Memory: Exam and Reporting Clinical Findings

Answer 7

Ask patient to recall verifiable information, such as names of 3 last presidents.

Question 8

Remote Memory: Neuroanatomical Structure Involved

Answer 8

Loss of storage, consolidation and retention of information that has passed through working memory. Includes ability to retrieve information.

Question 9

Spontaneous Speech (language): Exam and Reporting Clinical Findings

Answer 9

Note fluency, phrase length, abundance of spontaneous speech, paraphrasic disorders, neologisms or errors in grammar

Question 10

Spontaneous Speech (language): Neuroanatomical Structure Involved

Answer 10

Language abnormalities:
Frontal lobe: L Broca’s (Fluent, expressive or motor ) aphasia
-Difficulty speaking

Question 11

Comprehension (language): Exam and Reporting Clinical Findings

Answer 11

Can pt. understand simple questions and commands?

Question 12

Comprehension (language): Neuroanatomical Structure Involved

Answer 12

Wernicke’s aphasia L temporal and parietal lobes (difficulty comprehending speech)

Question 13

Naming (language): Exam and Reporting Clinical Findings

Answer 13

Name simple objects and more difficult to name objects

Question 14

Naming (language): Neuroanatomical Structure Involved

Answer 14

Anomia: loss of ability to name objects or retrieve names of people

Question 15

Repetition (language): Exam and Reporting Clinical Findings

Answer 15

Can pt. repeat simple phrases, “no ifs, and or buts”?

Question 16

Reading (language): Exam and Reporting Clinical Findings

Answer 16

Ask patient to read simple words or a passage. Check comprehension.

Question 17

Reading (language): Neuroanatomical Structure Involved

Answer 17

Inability to read: Dyslexia

Question 18

Writing (language): Exam and Reporting Clinical Findings

Answer 18

Ask patient to write their name and write a sentence

Question 19

Writing (language): Neuroanatomical Structure Involved

Answer 19

Inability to write: agraphia

Question 20

Right-Left Confusion (calculations): Exam and Reporting Clinical Findings

Answer 20

Can the pt. do simple addition? (Calculations)

ID of R/L body parts

Question 21

Right-Left Confusion, Finger Agnosia, Agraphia (calculations): Neuroanatomical Structure Involved

Answer 21

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

Question 22

Finger Agnosia (calculations): Exam and Reporting Clinical Findings

Answer 22

Can the pt. name and identify each digit?

Question 23

Agraphia (calculations): Exam and Reporting Clinical Findings

Answer 23

Can the pt. write their name?

Question 24

Apraxia: Exam and Reporting Clinical Findings

Answer 24

Can the patient demonstrate action such as “combing their hair”?

Question 25

Apraxia: Neuroanatomical Structure Involved

Answer 25

Diffuse lesions of the cortex or more focal lesions affecting the frontal or L parietal lobe.
-Deficit in higher order planning

Question 26

Neglect and Construction: Exam and Reporting Clinical Findings

Answer 26

-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

Question 27

Neglect and Construction: Neuroanatomical Structure Involved

Answer 27

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

Question 28

Sequencing tasks and frontal release signs: Exam and Reporting Clinical Findings

Answer 28

Presence of primitive reflexes beyond developmental norms (2-3month age) (grasp, root, suck)
Written alternating sequencing. Check for perseveration.

Question 29

Sequencing tasks and frontal release signs: Neuroanatomical Structure Involved

Answer 29

Associated most frequently with lesions to the frontal lobes.

Question 30

Logic and Abstraction: Exam and Reporting Clinical Findings

Answer 30

Can the patient solve simple problems?

Question 31

Logic and Abstraction: Neuroanatomical Structure Involved

Answer 31

Difficulties can often be associated with higher order association cortex

Question 32

Delusions and Hallucinations: Exam and Reporting Clinical Findings

Answer 32

• Does the patient report seeing, hearing, smelling stimuli that is not there (hallucination)?
• Does the pt. report having special powers (delusions)?

Question 33

Delusions and Hallucinations: Neuroanatomical Structure Involved

Answer 33

• 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.

Question 34

Mood: Exam and Reporting Clinical Findings

Answer 34

Does the pt. have signs of anxiety, depression, mania? Are there patterns of loss of sleep, loss of initiation, poor concentration, etc.

Question 35

Mood: Neuroanatomical Structure Involved

Answer 35

This may be psychiatric, related to neurotransmitter imbalance. This can also be seen in focal brain lesions, thyroid or metabolic disorders.