Neurological assessment

Question 1

What comprises the central nervous system (CNS) and the peripheral nervous system (PNS)?

Answer 1

CNS: Brain and spinal cord, carrying messages between the PNS and the brain

PNS: Nerves extending from the CNS to the periphery

Question 2

What fills our cranial space?

Answer 2

The brain (80%)
Cerebral blood volume (10%)
Cerebrospinal fluid (10%)

Question 3

What can cause an increase in intracranial pressure?

Answer 3

Brain bleeds
Aneurysm
Blood pooling
Brain tumors
Infection

Question 4

What can happen as a result of increasing intracranial pressure?

Answer 4

Altered/Decreasing the level of consciousness
Herniation of the brain through the foramen magnum
- Respiratory depressing
- Double vision
- Uneven pupils
- Nausea and vomiting
- Increased heart rate & blood pressure

Question 5

What is the ideal cerebral blood flow rate to maintain adequate perfusion to the brain?

At what cerebral blood flow rate does ischaemia begin to occur in the brain?

Answer 5

50-60ml/100g of brain weight/min

Ischaemia begins to occur below 18ml/100g of brain weight/min

Question 6

What are signs and symptoms of acute neurological deterioration?

Answer 6

Drop in their level of wakefulness/more drowsy

A sudden drop in Glasgow coma score

Hemiparesis - inability to move one side of the body

Sluggish pupil reactions

Confusion/disorientation/agitation

Systemic changes in BP, Pulse, RR

Cushing’s triad

Seizure

Question 7

What does Cushing’s triad indicate, and what are the vital signs that makeup Cushing’s triad?

Answer 7

A late sign of increased intracranial pressure

Hypertension (Widening blood pressure)
Bradycardia
Altered respiratory function

Question 8

What are the 12 pairs of cranial nerves?

Answer 8

Oh, Oh, Oh, to touch and feel good velvet: such heaven

Olfactory
Optic
Oculomotor
Trochlear
Trigeminal
Abducens
Facial
Glossopharyngeal
Vagus
Spinal accessory
Hypoglossal

Question 9

What is the olfactory nerve responsible for?

How do you assess its function?

Answer 9

The olfactory nerve is responsible for smell

Test it by Opening and closing each nostril and presenting a smell stimulus

Question 10

What is the optic nerve responsible for?

How do you assess its function?

Answer 10

The optic nerve is responsible for the visual fields and acuity

Test it by using a snellen’s letter chart

Question 11

What is the oculomotor nerve responsible for?

How do you assess its function?

Answer 11

The oculomotor nerve is responsible for eye movement and pupil reaction

Test it by getting the patient to follow your finger in an “H” shape and by shining a torch to assess pupil response

Question 12

What is the trochlear nerve responsible for?

How do you assess its function?

Answer 12

The trochlear nerve is responsible for inward and outward eye movements

Test it by having the patient follow your finger up and down, side to side and to their nose

Question 13

What is the trigeminal nerve responsible for?

How do you assess its function?

Answer 13

The trigeminal nerve is responsible for jaw opening and closing as well as touch sensation over the forehead, cheek and mandible

Test its function by touching the forehead, cheek and mandible with various sharp or dull objects and getting the patient to differentiate them, as well as having them open and close their jaw

Question 14

What is the abducens nerve responsible for?

How do you assess its function?

Answer 14

The abucens nerve is responsible for lateral eye movements

Ask the patient if they experience any double vision

Question 15

What is the facial nerve responsible for?

How do you assess its function?

Answer 15

The facial nerve is responsible for the sense of taste and facial movement and expression

Test it by getting the patient to wrinkle their forehead, puff out their cheeks and show their teeth

Question 16

What is the acoustic nerve responsible for?

How do you assess its function?

Answer 16

The acoustic nerve is responsible for the sense of hearing and for balance

Test it by rubbing fingers next to one ear at a time and getting the patient to tell you which ear your fingers are next to

Question 17

What is the glossopharyngeal nerve responsible for?

How do you assess its function?

Answer 17

The glossopharyngeal nerve is responsible for swallowing and sensations of the throat and the secretion of saliva

Test the patient’s gag reflex

Question 18

What is the vagus nerve responsible for?

How do you assess its function?

Answer 18

The vagus nerve is responsible for the sensation of the throat, larynx, thoracic and abdominal organs as well as swallowing and voice production. It also slows the heartbeat and accelerates peristalsis.

Test it by getting the patient to say “aghhhhhh” and look for elevation of the uvula

Question 19

What is the spinal accessory nerve responsible for?

How do you assess its function?

Answer 19

The spinal accessory nerve is responsible for shoulder movements and turning of the neck and head

Test it by getting the patient to shrug their shoulders and turn their head to resistance

Question 20

What is the hypoglossal nerve responsible for?

How do you assess its function?

Answer 20

The hypoglossal nerve is responsible for tongue movement

Test it by getting the patient to move their tongue up and down and side to side

Question 21

What are the components of a glasgow coma scale?

Answer 21

Eye Response
Verbal Response
Motor Response