- Temporal lobe - Language comprehension

- Frontal lobe - Speech production

Neurological Assessment Flashcards by Laura Matias

Number of spinal nerves

8C, 12T, 5L, 5S, 1C

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Function of the autonomous nervous system

Maintains involuntary functions of cardiac and smooth muscle of the viscera and glands

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Function of the sympathetic nervous system

Produces body to action during periods of physiologic and psychologic stress

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Function of the parasympathetic nervous system

Complements and counterbalances the SYN to conserve body resources and day-to-day functions

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SCAT

Sport Concussion Assessment Tool, a way to measure concussions, often used as a baseline

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Cranial nerves responsible for difficulty swallowing

9 (glossopharyngeal) and 10 (vagus)

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Important cranial nerves in neurological assessment

2, 3, 7, 9, 10

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Three indicators of the Glasgow Coma Scale

Eye opening
Verbal response
Motor response

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Range of the GCS

15 to 3

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Oriented x 3

Patient knows their name, the time, and their location

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GCS eye opening scores

4 - Spontaneously
3 - To speech
2 - To pain
1 - None

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GCS best verbal response scores

5 - Oriented
4 - Confused
3 - Inappropriate
2 - Incomprehensible
1 - None

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GCS best motor response scores

6 - Obeys commands
5 - Localizes
4 - Withdraws
3 - Flexion
2 - Extension
1 - None

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Widening pulse pressure

Emergency situation; could indicate increasing ICP

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Wernicke’s area

Temporal lobe

- Language comprehension

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Receptive aphasia

Issues with language comprehension. Speech and writing can be produced, but they do not understand what is being asked of them. They do not know there is a problem

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Broca’s area

Frontal lobe

- Speech production

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Expressive aphasia

The ability to understand language, but the inability to produce speech

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Central pressure points

Trapezius squeeze, supraorbital pressure

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Decerebrate posture

Damage to upper brain stem

- Arms adducted/extended, wrists pronated, fingers flexed, legs extended, feet plantarflexed

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Decorticate posture

Damage to corticospinal tract(s)

- Arms adducted/flexed, wrists/fingers flexed on chest, legs extended/internally rotated, feet plantarflexed

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20/40 vision

Must stand at 20 feet to see what an individual with 20/20 vision can see at 40 feet.

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PERRLA

Pupils equal, round, reactive to light, and accommodation.

How the oculomotor nerve is assessed

Pupillary response

Direct light reflex

Shine light in from temporal area 6 inches in front of the eye. Pupils should constrict briskly.

Consensual light reflex

Repeat above procedure on same eye but assess other eye for simultaneous constriction of pupil. Repeat light reflex assessments on other eye.

Accommodation

Ask client to focus on an object in the distance. Both pupils should dilate.

Pupillary response in an unconscious person

Should still be evident

Pupillary response in someone who cannot see out their eye

Should not be evident; without sensory input there will be no motor response

CN III lesion

Loss of consensual pupillary light reflex

CN II lesion

Loss of direct pupillary light reflex

Assessment of oculomotor, abducens, and trochlear nerves

Holding up a finger and having the patient follow the finger with their eyes without moving their head

Test for sensation in the facial nerve

Use the anterior 2/3 of the tongue

Test for motor function in the glossopharyngeal and vagus nerve

“Aah” uvula and palate rise, or test the gag reflex

Test for sensation in the glossopharyngeal and vagus nerve

Use the posterior 1/3 of the tongue

Spinal testing

Assesses movement and power of arms and legs and sensation on skin of arms and legs

Test for cerebellar function

Uses balance and proprioception, especially through gait

Tandem walking

Toe-to-heel walking where patients should not need to look at their feet or wobble significantly

Romberg’s test

Patients close their eyes and stand with their feet together. Wobbling may indicate cerebellar injury

Tests for coordination and skilled movements

Rapid alternating movements, finger-to-finger test, finger-to-nose test (proprioception), and heel-to-shin test

Decreased deep tendon reflexes

Indicate a peripheral problem

Exaggerated deep tendon reflexes

Indicate a central problem

Biceps reflex

- C5, C6 | - Depress biceps brachii tendon

Brachioradialis reflex

- C5, C6, C7 | - Strike brachioradialis tendon while arm is relaxed

Triceps reflex

- C6, C7, C8 | - Tap triceps tendon with sharp end of hammer while forearm is hanging loose at right angle to arm

Patellar reflex

- L2, L3, L4 | - Strike patellar tendon

Ankle jerk reflex

- S1 and S2 | - Achilles tendon is tapped while the foot is dorsiflexed

Cremasteric reflex

Lightly stroke superior and medial part of the thigh.

Cremasteric reflex

Lightly stroke superior and medial part of the thigh

Babinski reflex

- L4 to S2 - Sole of foot is stimulated with blunt instrument - CNS issues will fan toes in response unless they are under age of 2

Paralysis

Decreased or loss of motor nerve power due to problem with motor nerve or muscle fibres

Myoclonus

Rapid, sudden jerk at regular intervals (e.g. hiccups)

Tic

Involuntary, compulsive, repetitive twitching of a muscle group (e.g. wink, grimace, head movement, shoulder shrug)

Fasciculations

Rapid, continuous twitching of resting muscle that can be seen or palpated (fine or coarse)

Localization

Unable to follow commands but may move spontaneously or purposefully such as removing O2, IV lines, etc.