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Neuro Assessment

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NEUROLOGIC EXAMINATION Presented by: Reyna Paredes
HEALTH HISTORY ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
HEALTH HISTORY ,[object Object],[object Object],[object Object],[object Object]
HEALTH HISTORY INCLUDES: ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
HEALTH HISTORY ,[object Object],[object Object],[object Object]
PHYSICAL ASSESSMENT ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
PHYSICAL ASSESSMENT ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
PHYSICAL ASSESSMENT ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Clinical Manifestation ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Clinical Manifestations ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Clinical Manifestations ,[object Object],[object Object],[object Object],[object Object],[object Object]
Clinical Manifestations ,[object Object],[object Object],[object Object],[object Object],[object Object]
Clinical Manifestations ,[object Object],[object Object],[object Object],[object Object],[object Object]
Clinical Manifestations ,[object Object],[object Object],[object Object],[object Object]
Clinical Manifestations ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
PHYSICAL EXAMINATION ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Assessing Cerebral Function ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Assessing Cerebral Function ,[object Object],[object Object],[object Object],[object Object]
Assessing the Mental Status ,[object Object],[object Object],[object Object],[object Object],[object Object]
Intellectual Function ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Thought Content ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Emotional Status ,[object Object],[object Object],[object Object]
Perception ,[object Object],[object Object],[object Object],[object Object],[object Object]
Language Ability ,[object Object],[object Object],Posterior frontal area Expressive writing Inferior posterior frontal areas Expressive speaking Parietal-occipital lobe Visual-receptive Temporal Lobe Auditory-receptive Brain area involved Type of Aphasia
Motor Ability ,[object Object],[object Object],[object Object],[object Object],[object Object]
ASSESSING THE CRANIAL NERVES
CARNIAL NERVES On Old Olympus Towering Tops A Finn And German Viewed Some Hops Olfactory (I) Optic (II) Occulamotor (III) Trochlear (IV) Trigemenal (V) Abducens (VI) Facial (VII) Acoustic (VIII) Glossopharyngeal (IX) Vagus (X) Spinal Accessory (XI) Hypoglossal (XII) M S M M M/S M M/S S M/S M/S M M
Cranial Nerve I - Olfactory Nerve ,[object Object],[object Object],[object Object],[object Object],[object Object]
Cranial Nerve I - Olfactory ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Cranial Nerve II - Optic Nerve ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Cranial Nerves III, IV and VI ,[object Object],[object Object],[object Object],Testing eye movements Testing pupil accommodation
Normal: ■ Able to read without difficulty ■ Visual acuity intact 20/20, both eyes Hippus phenomenon: Brisk constriction of pupils in reaction to light, followed by dilation and constriction - may be normal or sign of early CN III compression. Abnormal: ■ CN II deficits - can occur with stroke or brain tumor. ■ Changes in pupillary reactions - can signal CN III deficits. ■ Increased ICP causes changes in pupillary reaction As pressure increases, response becomes more sluggish until pupils finally become fixed and dilated.
CN V - Trigeminal Nerve ,[object Object],[object Object]
CN V - Trigeminal Nerve ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Testing CN V – sensory function
Cranial Nerve V - Trigeminal Nerve ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Testing corneal reflex
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Cont. CN V
Cranial Nerve VII - Facial Nerve ,[object Object],[object Object],[object Object],[object Object],[object Object],Testing CN VII – motor function
Cranial Nerve VII - Facial Nerve ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Testing taste sensation
CN VII - Facial Nerve ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Cranial Nerve VIII - Acoustic Nerve ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Watch tick test
Cranial Nerve VIII - Acoustic Nerve ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Cranial Nerves IX and X Glossopharyngeal & Vagus Nerves ,[object Object],[object Object],[object Object],[object Object],[object Object],Testing CN IX and X – motor function
CN IX and X ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
CN IX and X ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
CN XI - Spinal Accessory Nerve ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Cranial Nerve XI ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
CN XII - Hypoglossal Nerve ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Testing CN XII – motor function
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Examining the Motor System ,[object Object],[object Object],[object Object],[object Object],[object Object]
MUSCLE STRENGTH ,[object Object],[object Object],[object Object],[object Object],[object Object],British Medical Council Method of Scoring
Balance and Coordination ,[object Object],[object Object],[object Object],[object Object]
Balance and Coordiantion a. Rapid Alternating Movements (RAM) Ask the person to pat the knees with both hands, lift up, turn hands over, and pat the knees with the backs of the hands. Then ask to do this faster. ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],The patient is asked to pronate and supinate the hands as rapid as possible
b. Finger-to-Finger test With the persons eyes open, ask that he or she use index finger to touch your finger, then his or her own nose. After a few times move your finger to a different spot. ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Balance and Coordination ,[object Object],[object Object],[object Object],[object Object],[object Object]
Balance and Coordination ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Perform Tandem Walking - ask the person to walk a straight line in a heel-to-toe fashion. - This decreases the base of support and will accentuate any problem with coordination. Normal: Person can walk straight & stay balanced ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Hopping in place, alternating knee bends ( some individuals cannot hop owing to aging or obesity)
Examining the Reflexes ,[object Object],[object Object],[object Object],[object Object]
Examining the Reflexes ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
REFLEXES ,[object Object],[object Object],Deep tendon reflex grades 0 absent + present but diminished + + normal + + + increased but not necessarily pathologic + + + + hyperactive or clonic (involuntary contraction and relaxation of skeletal muscle) Superficial reflex grades 0 absent + present
[object Object]
ASSESSING REFLEXES ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
ASSESSING REFLEXES ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
ASSESSING REFLEXES ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
ASSESSING REFLEXES ,[object Object],[object Object],[object Object],[object Object],[object Object]
ASSESSING REFLEXES ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
F. Superficial Reflexes Abdominal Reflex ■ Stroke patient’s abdomen diagonally from upper and lower quadrants toward umbilicus. ■ Contraction of rectus abdominis. Umbilicus moves toward stimulus.
Perianal Reflex ■ Gently stroke skin around anus with gloved finger. Normal: ■ Anus puckers. Cremasteric Reflex ■ Gently stroke inner aspect of a male’s thigh. Normal: ■ Testes rise. Bulbocavernosus Reflex ■ Gently apply pressure over bulbocavernous muscle on dorsal side of penis. Normal: ■ Bulbocavernosus muscle contracts.
ASSESSING REFLEXES ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
SENSORY EXAMINATION ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
SENSORY EXAMINATION Tactile Sensation or Light Touch - Brush a light stimulus such as a cotton wisp over patient’s skin in several locations, including torso and extremities. ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object]
Sensory Examination ,[object Object],[object Object],[object Object],[object Object]
Sensory Examination ,[object Object],[object Object],[object Object],[object Object],[object Object]
Stereognosis With patient’s eyes closed, place a familiar object, such as a coin or a button, in patient’s hand, and ask patient to identify it. ■ Test both hands using different objects. ,[object Object],[object Object],Abnormal: ■ Abnormal findings suggest a lesion or other disorder involving sensory cortex or a disorder affecting posterior column.
Sensory Extinction ■ Simultaneously touch both sides of patient’s body at same point. ■ Ask patient to point to where she or he was touched. ,[object Object],[object Object],[object Object],[object Object]
Assessing Level of Consciousness
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Glasgow Coma Scale ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Fully alert- 15, a score of 7 or less reflects coma. (Kozier p. 703-704)
ASSESSING LEVEL OF CONSCIOUSNESS ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Abnormal Findings Abnormalities in Muscle Movement ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Abnormal Findings Abnormalities in Muscle Movement ,[object Object],[object Object]
Abnormal Findings Abnormalities in Muscle Movement ,[object Object],[object Object]
Abnormal Findings Abnormalities in Muscle Movement ,[object Object],[object Object]
Abnormal Findings Abnormalities in Muscle Movement ,[object Object],[object Object],[object Object],[object Object]
Abnormal Findings Abnormalities in Muscle Movement ,[object Object],[object Object]
Abnormal Findings Abnormalities in Muscle Movement ,[object Object],[object Object]
Neurologic Exam: Meningeal signs Brudzinski’s sign - neck stiffness - involuntary flexion of hips and knees when flexing neck is positive sign for meningeal irritation
Neurologic Exam: Meningeal signs Positive Kernig’s sign -excessive pain in the lower back when examiner attempts to straighten knees with client supine and knees and hips flexed
Neurologic Exam: Meningeal ,[object Object],[object Object]
DIAGNOSTIC EVALUATION
Computed Tomography Scan ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
CT SCAN
Positron Emission Tomography (PET) ,[object Object],[object Object],[object Object],[object Object],[object Object]
Positron Emission Tomography (PET) ,[object Object],[object Object],[object Object]
PET Scan
Single Photon Emission Computed Tomography (SPECT) ,[object Object],[object Object],[object Object]
Single Photon Emission Computed Tomography (SPECT) ,[object Object],[object Object],[object Object],[object Object]
SPECT
Magnetic Resonance Imaging (MRI) ,[object Object],[object Object],[object Object]
 
 
Nursing Intervention: MRI ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Myelography ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Myelography
CEREBRAL ANGIOGRAPHY ,[object Object],[object Object],[object Object],[object Object],[object Object]
CEREBRAL ANGIOGRAM
 
Nursing Intervention: CEREBRAL ANGIOGRAPHY ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Non-invasive Carotid Flow Studies ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Transcranial Doppler ,[object Object],[object Object],[object Object],[object Object]
 
Electroencephalography (EEG) ,[object Object],[object Object],[object Object],[object Object]
 
Electroencephalography (EEG) ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Diagnostic Evaluation ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Lumbar Puncture and CSF examination ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Lumbar Puncture and CSF examination ,[object Object],[object Object],[object Object],[object Object]
Lumbar Puncture Guidelines ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
 
Queckenstendt’s Test ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
CSF Analysis ,[object Object],[object Object],[object Object]
Post Lumbar Headache ,[object Object],[object Object],[object Object],[object Object],[object Object]
sources ,[object Object],[object Object],[object Object],[object Object]
THANK YOU!!!

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Neuro Assessment

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  • 27. CARNIAL NERVES On Old Olympus Towering Tops A Finn And German Viewed Some Hops Olfactory (I) Optic (II) Occulamotor (III) Trochlear (IV) Trigemenal (V) Abducens (VI) Facial (VII) Acoustic (VIII) Glossopharyngeal (IX) Vagus (X) Spinal Accessory (XI) Hypoglossal (XII) M S M M M/S M M/S S M/S M/S M M
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  • 32. Normal: ■ Able to read without difficulty ■ Visual acuity intact 20/20, both eyes Hippus phenomenon: Brisk constriction of pupils in reaction to light, followed by dilation and constriction - may be normal or sign of early CN III compression. Abnormal: ■ CN II deficits - can occur with stroke or brain tumor. ■ Changes in pupillary reactions - can signal CN III deficits. ■ Increased ICP causes changes in pupillary reaction As pressure increases, response becomes more sluggish until pupils finally become fixed and dilated.
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  • 58. Hopping in place, alternating knee bends ( some individuals cannot hop owing to aging or obesity)
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  • 68. F. Superficial Reflexes Abdominal Reflex ■ Stroke patient’s abdomen diagonally from upper and lower quadrants toward umbilicus. ■ Contraction of rectus abdominis. Umbilicus moves toward stimulus.
  • 69. Perianal Reflex ■ Gently stroke skin around anus with gloved finger. Normal: ■ Anus puckers. Cremasteric Reflex ■ Gently stroke inner aspect of a male’s thigh. Normal: ■ Testes rise. Bulbocavernosus Reflex ■ Gently apply pressure over bulbocavernous muscle on dorsal side of penis. Normal: ■ Bulbocavernosus muscle contracts.
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  • 78. Assessing Level of Consciousness
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  • 81. Fully alert- 15, a score of 7 or less reflects coma. (Kozier p. 703-704)
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  • 90. Neurologic Exam: Meningeal signs Brudzinski’s sign - neck stiffness - involuntary flexion of hips and knees when flexing neck is positive sign for meningeal irritation
  • 91. Neurologic Exam: Meningeal signs Positive Kernig’s sign -excessive pain in the lower back when examiner attempts to straighten knees with client supine and knees and hips flexed
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  • 101. SPECT
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