Neurological Assessment Flashcards
What are the 2 main types of nervous systems?
Central and Peripheral (Peripheral is further split into somatic and autonomic).
What are the main structures of the CNS?
Cerebral Cortex, Basal Ganglia, Thalamus, Hypothalamus, Cerebellum, Brainstem, Spinal Cord.
What is crossed representation?
Feature of the nerve tracts where the left cerebral cortex receives sensory info from and controls the right cerebral cortex, and vice versa.
What is the spinothalamic tract?
Contains sensory fibers that transmit the sensations of pain, temperature, and crude or light touch.
When asking patient history, what are some changes that are notable?
Change in A&O and memory Change in sensation Change in performing ADL's Change in appearance or symmetry Changes in dizziness, fainting, insomnia, nervousness, tremors, weakness, gait, and coordination.
What are important aspects when gathering patient’s FAMILY history?
Seizure, stroke, dementia, lightheadedness/vertigo, learning, retardation, neuromuscular disorders.
What are some important things to know about a patient’s PAST history?
Birth trauma, injury, speech/hearing problem, exposure to chemicals, alcohol, coffee, drugs, medications, and allergies.
What is some equipment you would need for a neurological exam?
Flashlight, tongue blade, tuning fork, reflex hammer, sensory testing equipment.
What is the order of the neurological exam?
- Mental status
- Cranial Nerves 1-12
- Motor function
- Sensory
- Cerebellar
- Reflexes
Mental status
A person’s emotion and cognitive functioning. This cannot be scrutinized directly like skin or heart sounds. Its functioning is inferred through assessment of the individual’s behaviors.
Mental disorder
Significant behavioral or psychological pattern associated with distress, a painful symptom, disability, impaired functioning, or significant risk of pain, disability, death of loss of freedom.
Organic disorders
Due to brain disease of known specific organic cause (ex. delirium, dementia, alcohol/drug intoxication and withdrawal)
Psychiatric mental illness
Organic etiology has not yet been established (ex. anxiety disorder, schizophrenia)
What are some behaviors that can help you assess a person’s mental status?
LOC, language, mood, affect, orientation, attention, memory, abstract reasoning, thought process, thought content, perceptions.
What is the Glasgow coma scale (GCS)?
A standardized objective assessment that defines the LOC by giving it a numeric value. Divided into three areas: eye opening(4), verbal response(5), and motor response(6). Normal score is 15, 7 or less is a coma.
LOC
(Level of consciousness) Alert, awake, readily aroused
Lethargy
Responds appropriately once aroused
Obtunded
Transitional state between lethargy and stupor; difficult to arouse
Stupor
Semi-coma, arousal to stimuli(shake or pain) with simple motor or moaning responses
Coma
Completely unconscious; no pain response
What can grooming indicate?
Poor hygiene or lack of concern about appearance may indicate major depression, dementia, or psychiatric disturbance.
Facial expression should be consist with…
Emotional content of topic discussed.
What are some aspects of body language that may be observed?
Eye contact, posture, hyper vigilance
Affect
Describes emotional reaction
What are the four different intensities/ranges of affect?
- Congruents-with context and situation
- Constricted-a reduced range and intensity
- Blunted-more reduced
- Flat-no expression
Mood
Longer term emotion; sustained presentation
What are different words to describe a patient’s mood?
Euthynic-normal Depressed/Dysthymic Elevated Irritable, Anxious
What are some signs of a depressed mood?
- Verbalizes feeling sad, hopeless, helpless, worthless.
- A loss of interest
- Crying spells, hyperrsomnia, insomnia
- Appetite change
- Appears sad; cries easily
- Psychomotor retardation
Manic
- Elevated, expansive, euphoric
- Exaggerated feeling of well being
- Not justified by objective circumstances
- Reports feeling elated
- Appears happy, exhibits controlling and dominant behavior
Anxiety
- Unrealistic or excessive worry
- Apprehension about life
- May report dizziness, palpitations, nausea, vomiting, diarrhea
Irritable
Anger, animosity, contempt, belligerent, disdain for people.
What are some signs of possible cognitive impairment?
Impaired communication, inappropriate affect, getting lost in a familiar place, or at night, hazardous behavior, memory loss, agitated or suspiciousness, trouble performing ADLs.
What are some methods of cognitive testing?
Current events, insight/judgement(give a scenario), repetition of series of numbers, word listing.
What would you ask a patient in order to determine short term memory?
Ask for a 24 hour diet recall.
What questions would you ask to determine a persons long term history?
Ask person verifiable past events such a birthday, anniversary date, or relevant historical events.
What is MMSE?
Mini mental status exam; a simplified scored form of the cognitive functions of the mental status exam (takes 5-10 minutes, about 11 questions)
What are thought content abnormalities?
Delusions, paranoid ideation, ideas of reference, obsessions compulsions, phobias
Delusion
False beliefs firmly sustained in site of what everyone else believes, or evidence to the contrary
Paranoid Ideation
Not delusional but suspicious, feels harassed, persecuted or unfairly treated. Projects blame or accuses other of malicious intent.
Ideas of Reference
Less firm than delusion but believes events, objects or people have unusual meaning specifically to him/her
Obsessions
Recurrent, persistent senseless ideas or impulses that interfere with thought
Compulsion
Irresistible urges to engage in meaningless motor acts
Phobias
Strong, persistent irrational fear.
What is judgement and how do you assess it?
When a person can compare and evaluate alternatives in a situation and reach and appropriate course of action. We can assess it by noting if a person’s job and future plans are realistic.
Cranial Nerve I
Olfactory. Sensory-smell. Tested by choice of odors.
Cranial Nerve II
Optic. Sensory- central and peripheral vision, optic disc.
Cranial Nerve III
Oculomotor-mixed. Parasympathetic-PERRLA, Motor-EOMs, lids.
Cranial Nerve IV
Trochlear. Motor-EOMS
Cranial Nerve V
Trigeminal. Motor- muscles of mastication. Sensory-touch, sensation face, scalp, cornea, mucous membranes of mouth and nose.
Cranial Nerve VI
Abducense. Motor-lateral movement of eye (EOM)
Cranial Nerve VII
Facial-mixed. Sensory-taste on anterior ⅔ tongue. Parasympathetic- saliva and tear secretion.
Cranial Nerve VIII
Acoustic. Sensory-hearing and equilibrium.
Cranial Nerve IX
Glossopharyngeal-mixed. Motor- phonation “ash” and swallowing. Sensory- taste posterior ⅓ tongue, pharynx (gag reflex) Parasympathetic- parotid gland, carotid reflex.
Cranial Nerve X
Vagus-mixed. Motor-pharynx and larynx(talking and swallowing), Sensory-General sensation from carotid body and sinus, pharynx, viscera. Parasympathetic-carotid reflex.
Cranial Nerve XI
Spinal Accessory. Motor-sternomastoid and trapezius muscle movement; neck and shoulders resistance.
Cranial Nerve XII
Hypoglossal. Motor- tongue “light, tight, dynamite.”
When testing reflexes, where on the muscle would you strike the reflex hammer?
the insertion point of the muscle
What is the range of reflex reactions?
4+ very brisk, hyperactive with disease. 3+ Brisker than avg. Maybe disease. 2+ Average, normal. 1+ Diminished, low normal. 0+ No response.
