Transcript NEUROLOGICAL EXAMINATION

Neurological Examination
Health Assessment
HNI/HNC 370
Professor Janet Galiczewski
RN,MSN,ANP,CCRN
A & P of the Neurological
System
Central Nervous System: Brain & Spinal
cord
 Peripheral Nervous System:12 pairs
cranial nerves, 31 pairs spinal nerves.
 Autonomic Nervous System:
 sympathetic & parasympathetic.
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Central Nervous System
Brain protected by the skull.
 Between brain & skull lie three connective
tissue layers called meninges.
 Outer layer - Dura Mater
 Middle layer - Arachnoid; between
arachnoid & inner meningeal layer is the
subarachnoid space. CSF found here.
 Inner layer - Pia Mater
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Cerebral Spinal Fluid –circulates around
the brain & spinal cord
 provides cushion
 removes metabolic waste
 provides nutrition
 maintains normal ICP
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Brain
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Consists of the cerebrum, cerebellum, brainstem
& diencephalon.
Made up of gray matter & white matter.
Blood flows to the brain by two internal carotid
arteries, two vertebral arteries.
Drains away through venous sinuses that empty
into the jugular veins.
Circle of Willis (provides circulation if 1 of 4
main vessels interrupted.
Cerebrum
Largest part of the brain; composed of two
hemispheres.
 Each hemisphere divided into 4 lobes:
 Frontal: personality, speech, memory,
behavior, emotion, intellectual function.
 Parietal:sensation.
 Temporal: hearing taste, smell.
 Occipital: visual reception.
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Diencephalon
Lies on top of the brainstem; contains the
Hypothalmus & Thalamus.
 Hypothalamus- maintains homeostasis,
body temp., hunger, thirst, storage &
secretion of hormones.
 Thalmus – main part of Diencephalon,
relays info to parts of cerebral cortex,
regulates states of sleep & wakefulness,
damage can lead to “coma state”.
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Brainstem consists of:
Midbrain: processes visual & auditory
info, initiates involuntary motor responses,
maintains consciousness.
 Pons: connects cerebellum to brainstem,
motor control.
 Medulla Oblongata: connects brain &
spinal cord, involuntary functions
responsible for primitive life maintenance,
heart function, breathing, sneezing,
coughing, vomiting.
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Cerebellum
Coordination of voluntary movement
 Equilibrium, balance
 Muscle Tone
 Proprioception (without looking, knowing
where your body parts are in space &
relationship to each other.)
 Each hemisphere controls movement for the
same side of the body (ipsilateral).
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Spinal Cord
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Continuation of the medulla oblongata
Begins at base of the skull (foramen magnum).
Protected by the vertebrae
Ends L1 & L2 branches into lumber & sacral
nerves roots called cauda equina.
Nerve fibers grouped into tracts run through spinal
cord transmit sensory, motor, autonomic impulses
between higher centers in the brain & body.
Peripheral Nervous System
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Cranial Nerves 12 pairs
Spinal Nerves 31 pairs emerge from different
segments of the spinal cord.
 8 cervical
 12 thoracic
 5 lumbar
 1 coccygeal
 5 sacral
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Each pair of spinal nerves is formed by the union
of an efferent or motor ventral root & an afferent
or sensory dorsal root attached to the spinal cord.
Motor (efferent) root carry impulses from brain to
the spinal cord to the muscles & glands.
Sensory (afferent) root carry impulses from
sensory receptors of the body through the spinal
cord to the brain.
Each pair of spinal nerves & its corresponding part
of the spinal cord innervates specific body
segments.
Dermatomes - Band of skin innervated by
the sensory nerve root of a single spinal
segment. Distal point tested first.
 Hypoesthesia: decreased sensation
 Hyperesthesia: excessive sensation
 Anesthesia: loss of sensation
 Paresthesia: numbness, tingling, burning.
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Reflex Arc - deep tendon reflexes are
segmental responses to stimulation of a
tendon.
Autonomic Nervous System
Considered part of the Peripheral Nervous
System.
 Sympathetic: activated during stress (fight
or flight).
 Parasympathetic: conserving energy (rest
& digest)
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Cerebral Function
Brief (mini) Mental Status
 LOC
 Remote memory
 Recent memory
 Orientation (person, place, time)
 Mood
 Thought content
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Cranial Nerves
Olfactory I
 Optic II
 Oculomotor III
 Trochlear IV
 Trigeminal V
 Abducens VI
 Facial VII
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Acoustic VIII
Glossopharyngeal IX
Vagus X
Spinal Accessory XI
Hypoglossal XII
Cerebellar Function
Tests balance & coordination
 Point to Point: Upper Extremities, Lower
Extremities.
 Alternating Movements: Upper
Extremities. Lower Extremities.
 Gait
 Tandem Gait
 Romberg
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Sensory
Touch: Upper Extremities; Distal &
Proximal.
 Lower Extremities; Distal & Proximal.
 Pain
 If pain response abnormal-Temperature.
 Vibration: Upper & Lower Extremities.
 Motion & Position
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Sensory (cont.)
Forms of Sensation: Two Point
Discrimination-Fingers & Thigh.
 Stereognosis
 Extinction
 Point Location
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Motor
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Muscle Size
Muscle Tone
Spasticity
 Rigidity
 Flaccidity
Resting or Intentional Tremors
 Rest Tremor
 Intention Tremor
 Essential tremors
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Motor (cont).
Choreiform Movements
 Tic
 Myoclonus
 Fasciculations
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Test Muscle Strength: 5/5 normal
 See handout for scale of Muscle strength
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Sensory – Motor Deep Tendon
Reflexes
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Deep tendon Reflexes are involuntary responses &
involve afferent neurons (sensory) & efferent
neurons (motor).
To Elicit a DTR briskly tap the tendon of a
partially stretched muscle.
For reflex to fire, all components of the reflex arc
must be intact – sensory nerve fibers, spinal cord
synapses, motor nerve fibers, neuromuscular
junction, & muscle fibers.
Reflexes - Spinal Cord Segment
Reflex
 Triceps
 Patellar
 Achilles
 Biceps
 Brachioradialis
Spinal Cord Seg.
 Cervical 6, 7
 Lumbar 2, 3, 4
 Sacral 1
 Cervical 5, 6
 Cervical 5, 6
Sensory Motor: Deep Tendon
Reflexes
Biceps
 Triceps
 Brachioradialis
 Patella
 Achilles
 Superficial Plantar (Babinski)
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Reflex Scale
4+ - Very brisk; hyperactive
 3+ - Brisker than average
 2+ - Average
 1+ - Diminished
 0 - Absent
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