NEUROLOGICAL ASSESSMENT Flashcards
Nervous System is Divided into two regions:
–Central Nervous System (CNS)
–Peripheral Nervous System (PNS)
Control center of body and is covered and protected by scalp, skull, and meninges
CNS - Brain
parts of Cerebrum
right and left hemispheres
frontal
parietal
occipital
temporal lobes
part of the brain (thalamus and hypothalamus) responsible for body temperature and sleep
Diencephalon
part of the brain responsible for position sense, posture & equilibrium/balance
Cerebellum
part of the brain (medulla oblongata, pons & midbrain) responsible for respiration & cardiac regulation, sneezing
Brain Stem
4 Lobes of the Cerebrum
• Parietal
•Frontal
•Temporal
•Occipital
somatic sensory center
Parietal
higher intellect, speech production, personality, behavior, emotions, voluntary movement
Frontal
hearing, memory, speech perception and translation
Temporal
for vision
occipital
Extends from medulla to the level of the first lumbar vertebra; Cord protected by vertebra, meninges and cerebral spinal fluid
CNS – Spinal Cord
Spinal Roots
Cervical, thoracic, lumbar nerves
Posterior roots is for _____
sensory
Anterior roots is for _____
motor
Damage to posterior roots = loss of ____
loss of sensation
Damage to anterior roots = ______
flaccid paralysis
Rapid involuntary predictable motor response to a stimulus.
Reflex
Reflex ______ , is not dependent on the brain.
arc
2 types of reflex
• Somatic
• Autonomic
this type of reflex is for Skeletal muscle contraction
Somatic
This type of reflex is for Cardiac, smooth muscle and glands
Autonomic
Three basic types of neurologic examination
- Screening neurologic exam
- Complete neurologic exam
- Neurologic recheck exam
Assess Level of consciousness (LOC)/orientated, intact recent and remote memory by:
–Confusion/disorientation
–Lethargy
–Delirium
–Coma
–Glasgow Coma Scale
Assess Cognitive abilities and mentation by:
- Mini Mental State Examination
–Mental Status Exam
The Glasgow Coma Scale (GCS) is a calculated scale that determines a patient’s _______.
patient’s level of consciousness.
Medical professionals use Glasgow Coma Scale (GCS) to evaluate patients with:
•traumatic brain injury
•altered mental status
The Glasglow coma scale measures three categories:
•Eye opening (E)
• Motor response (M)
• Verbal response (V)
The GCS score is the sum of the score in each of the three categories, with a maximum score of ____ (normal) and a minimum score of _____ (deep unconsciousness),
maximum score of 15;
minimum score of 3
A normal GCS score is equal to _____, which indicates a person is fully conscious.
15
GCS Score of 13-15 indicates _____
Mild head injury
GCS Score of Score 9-12 indicates _____
Moderate head injury
GCS Score of Score of 8 or less indicates _____
Severe head injury
difficulty/discomfort in talking (laryngeal disease)
Aphonia/dysphonia
distorted speech sounds, may sound unintelligible, basic language intact
Cerebellar dysarthria
_____ is a language disorder that makes it hard for you to read, write, and say what you mean to say. Sometimes it makes it hard to understand what other people are saying, too.
Aphasia
Understands, but cannot speak
Broca’s (expressive)
severe form, absent/reduced speech, absent/reduced understanding; combination of broca’s and wrnicke’s
Global
Ability to express self, but cannot understand others
Wernicke’s (receptive)
Ask to repeat 3-4 unrelated words
Immediate memory (sec-min)
Ask who “I” am, last meal, last visitor
Recent memory (min-hrs)
Ask the birthday, anniversary, last President, favorite President
Remote memory (days-yrs)
Meaning of a proverb, simple math
Abstract reasoning skills
4 Comatose posturing
- Decorticate Rigidity (abnormal flexion)
- Decerebrate Rigidity (abnormal extension)
- Flaccid Quadriplegia (nonfunctional brain stem)
- Opisthotonos (meningeal irritation)
is a term for a group of disorders that affect coordination, balance and speech. Any part of the body can be affected, but people with ataxia often have difficulties with: balance, walking, speaking.
Ataxia
_____ is a neurological examination that is used to test for balance and coordination.
Romberg Test
This assesses the patient’s ability to stand with the feet parallel and together with the eyes open and then closed for 30 s.
Romberg Test
______ is a gait (method of walking or running) where the toes of the first foot touch the heel of the next one at each step. Neurologists sometimes ask patients to walk in a straight line using tandem gait as a test to help diagnose ataxia.
Tandem gait
stroke, immobile arm against body, stiff/extended leg, toe drag. It is a neuromuscular condition of spasticity that results in the muscles on one side of the body being in a constant state of contraction.
Spastic hemiparesis
loss of position sense, staggering, alcohol (barbiturate). It is a sudden, uncoordinated muscle movement due to disease or injury to the cerebellum.
Cerebellar ataxia
basal ganglia defects, stooped posture, trunk forward. It is a brain disorder that causes unintended or uncontrollable movements, such as shaking, stiffness, and difficulty with balance and coordination.
Parkinsonian
it is a type of spastic paraparetic gait in which the muscle tone in the adductors is marked. It is characterized by hypertonia and flexion in the legs, hips and pelvis accompanied by extreme adduction leading to the knees and thighs hitting, or sometimes even crossing, in a scissors-like movement.
Scissors
lower motor neuron defects the inability to lift the foot while walking due to the weakness of muscles that cause dorsiflexion of the ankle joint. Itis not a commonly seen condition.
Steppage/footdrop
weakness in your hip girdle and upper thigh muscles. To make up for the weakness, you sway from side to side and your hip drops with each step. It’s also called myopathic gait
Waddling
Occurs in a body part that is relaxed and completely supported against gravity and reduces activation of musculature.
Most commonly caused by parkinsonism, but may also occur in severe essential tremor
Resting
Occurs with voluntary contraction of muscle. Includes postural, isometric, and kinetic tremors
Action
Occurs when the body part is voluntarily maintained against gravity. Includes essential, physiologic, cerebellar, dystonic, and drug-induced tremors
Postural
Occurs as a result of muscle contraction against a rigid stationary object
Isometric
Occurs with any form of voluntary movement Includes classic cerebellar, dystonic, and drug-induced tremors; essential tremor can cross over to this category
Kinetic
Subtype of kinetic tremor amplified as the target is reached. Presence of this type of tremor implies that there is a disturbance of the cerebellum or its pathways
Intention
(also termed superficial sensation): receptors in skin and mucous membranes
Exteroceptive sensation
(also termed deep sensation): receptors located in muscles, tendons, ligaments and joints
Proprioceptive sensation
interpretative sensory functions that require analysis of individual sensory modalities by the parietal lobes to provide discrimination. Individual sensory modalities must be intact to measure _____
Cortical sensation
unable to identify object
Astereognosis
inability to identify figure
Agraphesthesia
Severe pain, spasms and resistance with gentle neck flexion
Nuchal rigidity
Thigh on abdomen, knee flexed to 90 degrees, resistance with pain
Kernig’s sign
Chin to chest - involuntary hip flexion and pain
Brudzinski’s sign
this reflex starts when the corner of the baby’s mouth is stroked or touched. The baby will turn his or her head and open his or her mouth to follow and root in the direction of the stroking.
Rooting
When something touches a baby’s palate, he or she starts to suck it.
Sucking
stroking the palm of a baby’s hand causes the baby to close his or her fingers in a grasp.
Palmar Grasp
it is a normal reflex for an infant when he or she is startled or feels like they are falling. The infant will have a startled look and the arms will fling out sideways with the palms up and the thumbs flexed.
Moro
Then a baby’s head is turned to one side, the arm on that side stretches out and the opposite arm bends up at the elbow.
Tonic Neck
occurs after the sole of the foot has been firmly stroked. The big toe then moves upward or toward the top surface of the foot.
Babinski
Abduction of the toes with dorsiflexion of the great toe
Babinski
