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Neuro Assess Basics

Cranial nerves, parts of brain, neuro exam, patho;HA (NEUROLOGIC) QL

neurologic functions physiological functions, ADLs, function in society; indepent status
CNS brain, spinal cord
PNS cranial nerve / spinal nerve
cerebrum lobes frontal, parietal, occipital, temporal (speech, sensation, vision, hearing)
frontal lobe "SPEECH"; voluntary movement, emotions, intellect, conscious activities
frontspeak j
parietal lobe "SENSATION"; temperature, pain, tactile, shape/object discrimination
paired-senses k
occipital lobe "VISUAL"; recieves & interprets visual stimuli from retina
occipital (oh see!) k
temporal lobe "HEARING; SMELL"; recives auditory impulses from cochlear nerve; interprets smell from olfactory
temporary hearing and smell f
CNS: diencephalon thalamus, hypothalamus, epithalamus
thalamus "traffic control tower"; all motor AND sensory signals processed
hypothalamus autonomic control center; regulating involuntary activities
hypothalamus regulates: BP, HR, force of heart contraction, digestion, RR /depth, temp, food intake (satiety), water balance, sleep cycle, pain, pleasure, fear
epithalamus mood, sleep control, CSF fluid formation
cerebellum muscle coordination,smooth movement, tone, equilibrium (balance)
CNS: lower brain area brainstem: midbrain, pons, medulla oblongata
brainstem regulates BP, RR, Resp. depth, Resp. rhythm, coughing, sneezing, hiccuping, swallowing, and vomiting
spinal cord extension of brain stem; transmits impulses to brain; simple reflex activity
spinal cord protection: meninges, CSF, vertebrae
CN originating in brain: 1,2 (anterior); 3,7 (brainstem)
cranial nerves olfactory, optic, oculomotor, trochlear, trigeminal, abducens, facial, vestibulocular, glossopharyngeal, vagus, spinal accessory, hypoglossal
some say money matters but my brother says big brains matter more sensory, sensory, motor, motor, both, motor, both, sensory, both, both, motor, motor
olfactory smell (unilateral/bilateral anosmia)
optic vision (optic atrophy, papilledema, amblyopia, field defect)
oculomotor extrinsic eye movement (diplopia, ptosis of lid, dilated pupil, inability to focus close objects)
trochlear eye muscle movement (convergent strabismus, diplopia)
trigeminal TOUCH ON FACE; opthalmic: (scalp, upper eyelid, nose, cornea, lacrimal gland); maxillary & mandibular (lower eyelid, nasal cavity, upper teeth / lip;;;; tongue, lower teeth, skin of chin, lower lip); MOTOR: teeth clenching; mandibular movement (tic, loss
abducens extrinsic eye movement (strabismus, diplopia)
facial taste; facial movements (smiling, closing eyes, frowning); tear production; salivary stimulation (Bell's palsy, inability to distinguish taste)
vestibulocochlear vestibular (balance, coordination); cochlear (hearing); (tinnitus, vertigo, deafness)
glossopharyngeal gag/swallow reflexes; taste (posterior 3rd of tongue); (loss of gag reflex, taste, swallowing)
vagus muscles of throat, mouth (swallowing, talking); (loss of voice, impaired voice, unable to swallow)
spinal accessory moves trapezius, SCM muscles, larynx, pharynx, soft palate (difficulty shrugging shoulders, unable to turn head R/L)
hypoglossal moves tongue (swallowing, movement of food (during chewing), speech); (difficulty speech, swallowing, protruding tongue)
spinal nerves all have sensory & motor properties
dermatome area of body that each spinal nerve innervates
neuro exam head to toe; distal to proximal
slow, deliberate movement frontal
slurred speech parietal
smiling facial
hearing vestibulocochlear
voluntary skeletal muscle movement frontal
neuro techniques inspection, palpation, sensory / motor func. tests, percussion (relex hammer)
neuro exam assesses: mental status, CN function, motor function, sensory function, simple reflex
Broca's aphasia (expressive aphasia); know what to say but can't get words out; FRONTAL LESION
Wernicke's aphasia (receptive aphasia); difficulty forming cohesive sentences; can say words but sound like nonsense; TEMPORAL/PARIETAL LESION
degrees of consciousness lethargy, obtunded, stupor, coma
LETHARGY client opens eyes, answers questions, and falls back to sleep(common: light sleep)
OBTUNDED opens eyes to LOUD voice, responds slowly w/ confusion, unaware of environment. (common: deep sleep, narcotic use)
STUPOR awakens to painful stimuli, but quickly returns to unresponsive sleep. (common: drug overdose, general anesthesia).
COMA least responsive; graded on the GLASCOW COMA SCALE w/ best eye opening response, best motor response, best verbal response. 3 = deep unresponsive , coma; (common: brain trauma/disease).
glasgow coma scale 15 highest possible score—all of us now should be at 14 or higher. 3 = deep unresponsive , coma. (Brain trauma/disease being one of most common).
short-term memory current data
long-term memory easy past history; ABNORMAL: inability to recall: (cerebral cortex damage, Alzheimer's disease)
memory that declines w/ aging short-term
problem solving addition/subtraction; ABNORMAL: organic brain disease, nervousness, lack of education
abstract thinking similar / different about objects?; common sayings; ABNORMAL: organic brain damage, mental deficiencies, language/education difference
mood / emotional state ABNORMAL: depression, neuro problems (parkinson's); emotional disturbances, psychiatric issues (schizo, bipolar)
thought processes / judgement / decision-making ABNORMAL: psychiatric disease, emotional dist., neuro disorder (Alzheimer),
olfactory (S); identify smell; ABNORMAL: cold; CN I dysfunction, genetic, zinc deficiency Unilateral problem? Brain tumor?
optic test near/far/color vision; opthalmoscope ID optic disc; ABNORMAL: CN 2 dysfunction; chronic disease like HTN, DM. Tumors, Intracranial Hemorrhage.
CN 3,4,6 (eye muscle movement) (M); follow finger 6 card. points of gaze (hor, vert, diag); shine light to observe constrict; both eyelids lifted (ptosis)
CN 3 eye muscle movement, pupillary const., eyelid lifting
ptosis eyelid drooping (CN 3)
trigeminal (S + M); SENSORY: perceive TOUCH ON FACE by blink reflex, cotton ball; MOTOR: clench / move temporalis, masseter muscles
facial (S+M): SENSORY: test taste on anterior 2/3 tongue w/ food samples; MOTOR: manipulate muscles of face (smile, close eyes tightly); identify "blink" (corneal) reflex; tear,saliva production (onion)
vestibuloscochlear (S): hearing (whisper test); vestibular (Romberg test); + Romberg = unable to maintain balance
glossopharyngeal (S+M): SENSORY: gag reflex (tongue depressor), taste (posterior 3rd); MOTOR: say "AHH" (uvula rises midline symmetrically at soft palate); swallow
vagus (S+M): SENSORY: normal digestive response; MOTOR: vocal cord function (hoarseness = CN X lesion); swallowing (tongue depressor)
spinal accessory (M): manipulate SCM, trapezius muscles (shrug shoulders, rotate neck w & w/o resistance)
hypoglossal (M): tongue movement (R+L, U+D, smooth, easy movements); tongue strength (equal resistance both sides)
cerebellum, posterior spinal tract neurons test smooth, coordinated movement (gait, balance, walk heel to toe); client unable to walk (shin to heel test: slide heel one foot along shin of other = motion should be smooth / heel should NOT fall off shin
upper extremity coordination (finger-nose) finger to nose test; ABNORMAL: cerebellar disease (overshoot and miss nose)
upper extremity coordination (rapid alternating movements of hands test) RAMHT test: supinate/pronate hands (movement equal b/w hands; smooth)
parietal lobe / (sensory) spinal tract / peripheral spinal nerves *test most distal areas first; TOUCH tests (touch over all extremeties while eyes closed); dull/shap; hot/cold; vibration (tuning fork)
other sensory function tests: stereognosis (closes eyes, IDs object); graphesthesia (closes eyes, IDs number)
Two-Point Discrimination test sensory func.; gradually move qtips apart; peripheral nerves, parietal cortex intactness;
Sense of Joint Movement Test (Sense of positions) closes eyes, tells whether moving toe/finger up, down, etc.; ABNORMAL: parietal cortex, sensory spinal tract, or peripheral nerve damage (tracts are not intact or otherwise damaged in some way)
reflex tests? spinal nerve / cord
reflex hammer 0 = Absent reflex; 1+ = Hypoactive reflex 2+ = Normal reflex.
3+ = Brisk (above normal BUT NOT indicative of disease).
4+ = Hyperactive,hyperreflexive= ABNORMAL:Increased CNS excitability: assoc w/ Clonus—rapid succession of muscular contraction and relaxation when foot dorsiflexed.
Clonus hyperreflexive; rapid succession of muscular contraction/relaxation when foot dorsiflexed
other reflex tests biceps reflex: strike tendon w/ hammer = biceps contract; triceps reflex (same), patellar reflex, ankle reflex (elicits plantarflex); plantar reflex,
Babinski's reflex (plantar) ABNORMAL: toes fan out, extend (normal < 2yo)
Abdominal reflexes stroke w/ handle side of hammer along abdomen (ab muscles contract)
Neuro check (abb.) Level of Consciousness
Pupillary constriction (direct/consensual).
Strength and movement of extremities (hand grips, range of motion).
Sensation in extremities
Vital Signs
common neuro abnormalities: motor function, gait, and movement.
dysfunction of cranial nerves.
spinal cord injury.
degenerative disorders.
fasciculation twitch = motor neuron disease
tic habit; psychogenic; involuntary spasmodic muscle movement; common: face, neck, shoulders
tremor rhythmic, alternating involuntary movement (contraction of opposing muscle groups); Parkinson's, MS, uremia, alcohol intoxication
seizures / epilepsy rapid, excessive firing of synapses in the brain
-clonus, tonic-clonic seizures severely attacking entire body for minutes to a brief, simple staring state lasting less than a second.
-brain injury at birth, high fever in childhood, trauma, infections, HTN syndrome, stroke, environmental toxins, drug O.D., withdrawal from alcohol, sedatives.
--EPILEPSY: chronic seizure disorder
spinal cord injuries --(cervical, thoracic, lumbar, sacral areas); higher the level of injury of spinal cord = more neurological deficiencies. Cervical injury most severe leading to quadriplegia or death.
--Causes: Accidents (MVA), sports, diving, gunshots, stab wounds
most sever spinal injury cervical
neuro infections Meningitis: inflammation and bacterial/ viral infection of meninges or membranes of brain + spinal cord; high fever, nuchal (neck) rigidity, inability to flex neck greater than 45 degrees without pain, severe headache. When neck flexed, hips and knees fle
encephalitis neuro infection spread into brain tissue (often deadly or with permanent brain damage); high fever, nuchal (neck) rigidity, inability to flex neck greater than 45 degrees without pain, severe headache. When neck flexed, hips and knees flex (Brudzinski's s
Brudzinski's sign when neck flexed, hips and knees flex (encephalitis, meningitis)
lyme disease deer-borne tick disease; (flu-like symptoms, followed by arthritis symptoms (joint stiffness) and papular erythemic rash at bite site) Simple antibiotic tx—but without can lead to permanent and severe neurological complications
Alzheimer's Disease degenerative neuro disease: progressive deterioration of cerebral cortex functioning (common over 65 yo; can begin in middle adult years); loss of memory (noticeable by self and others), shorter attention span, then confusion and disorientation, hallucina
MS degenerative neuro disease: deterioration of the myelin sheath or protective coating protecting the nerve tracts in the brain and spinal cord; first signs: 20 - 40 yo - numbness, tingling of one side of the body; progressive but ranges in severity; may le
Parkinson's Disease Attacks "white matter" nerve cell bodies of the brain responsible for initiating and stopping smooth flowing voluntary movements.
;uncontrolled voluntary movements (fasciculations and tremors of hands when write or eat, shuffle feet when walking, bob head when moving or rotating, speak with tremor in voice); moves very slowly; "mask face." ;respond to you, but slowly. You MUST be pa
Etiology unknown—perhaps toxins. Can also be genetic.
dev. cons: geriatric Changes in neurologic function (steady, slow decline) already begin at 40 .
Senses change (All deteriorate over time—smell, taste, vision, hearing, touch).
Gait slows. Posture more flexed, not as erect. Takes longer to perform tasks.
Decreased reaction time. Be patient and don't talk for them!! Recent memory in particular more difficult to recall.
Deep tendon reflexes diminish. Coordination there but slowed.
Tire faster. If need to complete full neurological exam—give rest breaks
psychosocial Inability to control movements—So Frustrating!!!
Changes in speech and elimination patterns (want to communicate but find it difficult or impossible).
Inability to carry out certain activities of daily living/others seem to take forever and more tiring.
Diminished self-esteem—I just can't do as much any more.
Social isolation—U.S. culture values youth
cultural / environmental Genetics: Alzheimer's, Multiple Sclerosis, Parkinson's.
Environmental toxins: neurological disorders like Parkinson's, neuro deficits, neoplasms (cancerous tumors).
Alzheimer's: more common in blacks
HP 2010: Alzheimer's & head trauma s
HP 2010: alzheimer's Increase numbers of persons seen in primary healthcare who receive mental health assessment, particularly middle, older adults with family history of Alzheimer's; increase the numbers of adults w/ mental disorders who receive treatment. More adult daycare
HP 2010: head trauma Reduce hospitalization for nonfatal head injuries (safety courses; equipment free or low cost).
Reduce deaths caused by motor vehicle crashes (safety courses).
Increase the use of safety belts (random police checks).
Increase the use of helmets by cyclists (law requirement in motorcycles; should we enforce it with bicycles?)
Reduce deaths by falls (home safety programs for older clients).
Created by: hezasan