Neurological Assessment and Exam Deck 2 Flashcards
Peripheral nervous system is comprised of the
cranial and spinal nerves
PNS is broken into
ascending and descending pathway
PNS carries
information to and away from the nervous system
Stroke on right side of the brain will cause
a left sided defficit
Frontal lobe
motor skills, voluntary movements, fine movements, eye movement
parietal lobe
processing sensory data, pain, two point discriminations, vision, taste, smell, hearing sensations
temporal lobe
perception and interpretation, taste, smell, balance
occipital lobe
vision
hippocampus
memory
cerebellum
processes sensory information from ears, eyes, and touch receptors. Precision coordination and timing
Brainstem
involuntary functions and 12 cranial nerves
4 cranial nerves with mixed motor and sensory function
V, VII, IX, X
Conditions that cause tremor
hyperthyroidsim, familiar tremor, ETOH, liver or kidney disease, MS
Medications that cause tremor
cardiac arrhythmia medications, albuterol, corticosteroids, caffeine.
First two cranial nerves arise from the ___ the rest arise from the
cerebrum, brainstem
CN 2 distant and near vision is tested with the
Snellen test
pupils should be
2 to 4 mm in diameter
shine a light in one eye and both constrict this is known as
consensual response
absent red light reflex can result from
cataracts, a corneal scar, vitreous hemorrhage
accomidation
look in the distance then the tip of the nose. Pupils should constrict
six cardinal fields of gaze order
upwards to right, upwards to left, horizontal to the right, horizontal to the left, downward to the right, downward to the left
CN 4 eye movment
up and down
CN 6 eye movement
side to side
Check movement of eyes for presence or absence of __ gaze or CN 6 in patients with headache
lateral gaze. First nerve to loose function with increased pressure
CN XII inspection and early sign of
stick out tongue move side to side, inspect. Abnormal function is an early sign of ALS
proprioception test
touch finger to thumb or pat hands on legs front an back and increase in speed
accuracy of movement finger test procedure and findings
use right index finger and touch their nose then your index finger at 18 in away. then repeat with other hand. If they miss could indicate a cerebellar dysfunction
accuracy of movement other options
touch nose with one arm extended or move the heel of one foot up and down the shin of the other leg
Gait and balance are evaluated with
Romberg Test and Heel-Toe Walking
Romberg Test
stand with eyes close and gently push shoulders. If pt looses balance could indicate vestibular dysfunction
Heel toe walking
touch of toes of one foot to heel of the other. This will exaggerate difficulty with walking
testing for cortical sensory function options (3)
place a common object in the hand and ask them to identify it, use two points of a paperclip and put one or two points on the hand and ask to identify if it was one or two, draw a letter or number on the hand and ask them to identify it
Options to evaluate primary sensory functions
light stroke of touch to the skin with cotton. Then have patient tell you where they were touched. You can use sharp or dull touch, vibrating tuning fork touch. hold Move toe up or down and ask pt to tell you which direction the toe was moved.
Planter reflex
Use the end of the reflex hammer to stroke from the heel to the ball of the foot. Toes should al point away. If you see dorso flection or toward the leg/body this is Babinski sign
Babinski sign is present when there is
a lesion in the brain cortex
Abdominal reflex
stroke the quadrant of the abdomen with the end of teh relflex hammer to elicit the reflex slight movement. Umbilicus should move toward the stimulation. Absent sign could be a sign of cortospino tract lesion
Absent deep tendon reflex could indicate a
neuropathy or lower motor neuron disorder
Monofiliment testing sensation
Should be performed on all diabetic patients and patients with peripheral neuropathy. Eyes are closed and filiment is applied to multiple sites on planter side of foot and one point on the dorsal side of foot. Monofiliment should bend and be applied for 1.5 seconds. Loss of sensations indicates nueroapthy
Bell Palsy
acute paralyis or weakness of one side of the face that is affected by cranial nerve 7. Can occur at any age. Improves over weeks and complete recovery at 6 months. Cause unknown. Possible reaction to viral infection or rotting of nerve root
