1 / 25

Neurological Assessment

Neurological Assessment. Anatomy of Nervous System. Central Brain Spinal cord Peripheral Cranial Nerves Spinal Nerves. Brain. Cerebral cortex (“rind”) – gray matter Frontal Parietal Temporal Occipital Wernicke’s area – receptive aphasia Broca’s area – expressive aphasia. Brain.

hunter
Download Presentation

Neurological Assessment

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Neurological Assessment

  2. Anatomy of Nervous System • Central • Brain • Spinal cord • Peripheral • Cranial Nerves • Spinal Nerves

  3. Brain • Cerebral cortex (“rind”) – gray matter • Frontal • Parietal • Temporal • Occipital • Wernicke’s area – receptive aphasia • Broca’s area – expressive aphasia

  4. Brain • Basal ganglia: motor function • Thalamus: relay station • Hypothalamus: HR, BP, sleep, etc. • Cerebellum: motor coordination • Brain stem • Midbrain • Pons • Medulla: respiration, heart, GI function, CN 8 - 12

  5. Spinal Cord • Nerve cell bodies arranged in “horns” • Nerve pathways cross in the spinal cord • Eg. Sensation of the left side of the body enters the left dorsal horn, and crosses to the right ventral horn and travels to right hemisphere • Sensation • Spinothalamic tract: pain, temperature, crude and light touch • Posterior columms: does not cross sides; position, vibration, finely localized touch

  6. Spinal Cord • Motor pathways • Corticospinal (Pyramidal) tract: • All go through the medulla’s pyramid • Crossed • Uncrossed • Finer body movements • Extrapyramidal • Cruder movement (walking) • Upper vs Lower motor neurons

  7. Peripheral Nervous System • Reflex arc • Deep tendon reflexes: requires • Intact sensory nerve • Functional synapse • Motor Nerve • Competent Muscle • Superficial • corneal, abdominal • Visceral • Pupillary light, accommodation • Pathologic

  8. Cranial Nerves • Mnemonic: “Oh Oh Oh, To Taste And Feel Very Good Veal Simply Heaven”

  9. Spinal Nerves • Cervical 8 • Thoracic 12 • Lumbar 5 • Sacral 5 • 1 Coccygeal • Sensory in dorsal horns; motor in ventral • Dermatome

  10. Functional Divisions • Autonomic vs. Somatic Nervous System • Sympathetic vs. Parasympathetic • Primary sympathetic neurotransmitter is Norepinephrine, so sympathetic system is called “adrenergic” • Primary sympathetic neurotransmitter is Acetylycholine, so parasympathetic system is called “cholinergic”

  11. History • Headache • Head injury • Dizziness/Vertigo • Seizures • Tremors • Weakness • Incoordination

  12. History Cont • Numbness or tingling • Difficulty Swallowing • Difficulty Speaking • Environmental/occupational hazards • Past Medical History • Social History: smoking, drugs, alcohol • Medications

  13. Anticholinergic Symptoms • Mydriasis • Dry, flushed skin • Hallucinations • Agitation • Hyperthermia • Urinary retention • Delayed intestinal motility (constipation) • Tachycardia • Seizure

  14. Anticholinergic Mnemonic • Blind as a bat • Dry as a bone • Red as a beet • Mad as a hatter • Hot as a hare

  15. Phenobarbital Oxybutynin (20%) Isosorbide dinitrate Hydroxyzine Warfarin Dipyridamole Codeine Ranitidine (10%) Dyazide Furosemide (Lasix) Nortriptyline (3%) Drugs with Anticholinergic Effects • Atropine (100% of maximal anticholinergic effect) • Scopolamine • Tolterodine • Hyoscyamine • Cholinergic Parkinsonism agents • Prednisone (55%) • Diphenhydramine (Benadryl) • Amitriptyline (Elavil) • Digoxin • Nifedipine

  16. Physical Exam • Mental Status, Pyschiatric • Cranial Nerves • Sensory exam • Motor exam

  17. Level of Consciousness Speech Orientation Knowledge of Current events Judgment Abstraction Vocabulary Emotional responses Memory Calculation ability Object recognition Praxis Mental Status

  18. Cranial Nerves • 1. Olfactory – have patient identify smell • 2. Optic – Eye chart, visual fields, fundus • 3,4,6. Oculomotor, Trochlear, Abducens – PERRLA, positions of gaze, nystagmus • 5. Trigeminal Nerve: chewing muscles, facial sensation, corneal reflex • 7. Facial nerve: smile, frown, close eyes, puff cheeks

  19. Cranial Nerves • 8. Test hearing, Weber, Rinne tests • 9, 10. Glossopharyngeal and Vagus Nerves – Soft palate and uvula movement; gag reflex • 11. Spinal Accessory Nerve: head movement; shrug shoulders • 12. Hypoglossal – Tongue movement; “light, tight, dynamite”

  20. Sensation • Eyes closed • Avoid leading questions • In general, if distal is intact, proximal will also be intact • Spinothalamic tract • Pain: sharp or dull • Temperature • Light touch

  21. Sensation • Posterior Column Tract • Vibration sense • Position • Tactile discrimination • Stereognosis • Graphesthesia • Two point discrimination • Extinction • Point location

  22. Motor • Muscle • Size • Strength • Tone • Involuntary Movement • Cerebellar • Balance: • Gait, • Tandem walking • Romberg, • One legged squat

  23. Motor • Cerebellar • Coordination • Rapid alternating movement • Knee slapping • Finger to thumb • Finger to finger • Finger to nose • Heel to shin

  24. Deep Tendon Reflexes • Tests sensory and motor function • Biceps • Brachiradialis • Triceps • Quadriceps (patellar) • Achilles

  25. Additional Tests • Clonus • Superficial reflexes • Abdominal • Cremasteric • Plantar reflexes

More Related