CENTRAL NERVOUS SYSTEM ASSESSMENT

HEALTH HISTORY DETAILS ABOUT THE ONSET CHARACTER,SEVERITY ,LOCATION ,DURATION AND FREQUENCY OF SYMPTOMS AND ASSOCIATED COMPLAINTS PRECIPITATING ,AGGREVATING AND RELIEVING FACTORS ,PROGRESSION,REMISSION AND EXACEREBATION THE PRESCENCE OR ABSENCE OF SIMILAR SYMPTOMS AMONG FAMILY MEMBERS

ASSESSMENT INCLUDE HEALTH HISTORY PHYSICAL EXAMINATION

SUBJECTIVE DATA HEADACHE HEADINJURY DIZZINESS/VERTIGO SEIZURE TREMORS WEAKNESS INCORDINATION NUMBNESS OR TINGLING DIFFICULTY SPEAKING SIGNIFIANT PAST HISTORY ENVIRONMENTAL/OCCUPATIONAL HAZARDS

OBJECTIVE DATA THE NEUROLOGICAL EXAMINATION INCLUDE MENTAL STATUS CRANIAL NERVES MOTOR SYSTEM SENSORY SYSTEM REFLEXES

MENTAL STATUS EXAMINATION

CRANIAL NERVE EXAMINATION

OBSERVING THE PATIENT THE PATIENT’S APPEARANCE AND BEHAVIOUR NOTING THE DRESS, GROOMING AND PERSONAL HYGINE POSTURE, GESTURE,MOVEMENTS FACIAL EXPRESSION AND MOTOR ACTIVITY ASSESSING ORIENTATION TO TIME,PLACE AND PERSON

CRANIAL NERVES CRANIAL NERVE 1-OLFACTORY NERVE CRANIAL NERVE 2-OPTIC NERVE CRANIAL NERVE 3,4&6 OCULOMOTOR ,TROCHLEAR AND ABDUCENS NERVE CRANIAL NERVE 5-TRIGEMINAL NERVE CRANIAL NERVE 7-FACIAL NERVE CRANIAL NERVE 8-ACOUSTIC NERVE CRANIAL NERVE 9&10 –GLOSSOPHARYNGEAL AND VAGUS NERVE CRANIAL NERVE 11-SPINAL ACCESSORY NERVE CRANIAL NERVE 12-HYPOGLOSSAL NERVE

EQUIPMENTS

OLFACTORY NERVE The Olfactory nerve (CN I) is simply tested by offering something familiar for the patient to smell and identify, for orange/lemon peel, coffee, or vinegar.

OPTIC NERVE

Visual inattention can be tested by moving both fingers at the same time and checking the patient identifies this.

fundoscopy

OCULOMOTOR ,TROCHLEAR,ABDUCENS Asking the patient to keep their head perfectly still directly in front of you, you should draw two large joining H’s in front of them using your finger and ask them to follow your finger with their eyes. It is important the patient does not move their head.

Trigeminal nerve (CN V) IT involved in sensory supply to the face and motor supply to the muscles of mastication. Initially test the sensory branches by lightly touching the face with a piece of cotton wool followed by a blunt pin in three places on each side of the face

FACIAL NERVE (CN VII) supplies motor branches to the muscles of facial expression. This nerve is therefore tested by asking the patient to crease up their forehead (raise their eyebrows), close their eyes and keep them closed against resistance, puff out their cheeks and reveal their teeth.

ACOUSTIC NERVE The Vestibulocochlear nerve (CN VIII) provides innervation to the hearing apparatus of the ear and can be used to differentiate conductive and sensori-neural hearing loss using the Rinne and Weber tests. To carry out the Rinner test, place a sounding tuning fork on the patient’s mastoid process and then next to their ear and ask which is louder. A normal patient will find the second position louder.

To carry out the Weber’s test, place the tuning fork base down in the centre of the patient’s forehead and ask if it is louder in either ear. Normally it should be heard equally in both ears.

Glossopharyngeal nerve (CN IX The Glossopharyngeal nerve (CN IX) provides sensory supply to the palate. It can be tested with the gag reflex or by touching the arches of the pharynx.

Vagus nerve (CN X) Vagus nerve (CN X) provides motor supply to the pharynx. Asking the patient to speak gives a good indication to the efficacy of the muscles. The uvula should be observed before and during the patient saying “aah”. Check that it lies centrally and does not deviate on movement

SPINAL NERVE The Accessory nerve (CN XI) gives motor supply to the sternocleidomastoid and trapezius muscles. To test it, ask the patient to shrug their shoulders and turn their head against resistance.

Trapezius muscle against resistancetest

Hypoglossal nerve (CN XII) Hypoglossal nerve (CN XII) provides motor supply to the muscles of the tongue. Observe the tongue for any signs of wasting or fasciculations. Ask the patient to stick their tongue out. If the tongue deviates to either side, it suggests a weakening of the muscles on that side

Hypoglossal examination

MOTOR SYSTEM CEREBELLAR FUNCTION INSPECT THE MUSCLE GROUP FOR SIZE COMPARE THE RIGHT SIDE WITH LEFT SIDE LOOK FOR ANY ASYMMETRY CEREBELLAR FUNCTION BALANCE TEST-OBSERVE THE PERSON WALK WITH 10-20FEET TURN OVER AND RETURN TO THE STARTING(ABNORMALLY WIDE BASE SUPPORT NEEDED) FINGER TO FINGER TEST FINGER TO NOSE TEST

THE SENSORY SYSTEM BY SENSORY TESTING MAKING SURE THAT PERSON IS ALERT,CO-OPERATIVEAND HAS ADEQUATE ATTENSIONSPAN IT IS DONE BY SUPERFICALPAIN, TEMERATURE,LIGHT TOUCH,

TEST THE REFLEXES Reflex testing incorporates an assessment of the function and interplay of both sensory and motor pathways. It is simple yet informative and can give important insights into the integrity of the nervous system at many different levels.

DEEP TENDON REFLEXES STIMULATE THE REFLEXE BY DIRECTING A SHORT,SNAPPY BLOW TO THE REFLEXE HARMER ONTO THE MUSCLE’S INSERTION TENDON. THE REFLEXE RESPONSE IS GRADED ON 4-POINT SCALE 4+ VERRY BRISK,HYPPERACTIVE WITH CLONUS,INDICATIVE OF DISEASE 3+ BRISKER THAN AVERAGE,MAY INDICATE DISEASE 2+ AVERAGE ,NORMAL 1+ DIMINISHED ,LOW NORMAL 0 NO RESPONSE

BICEPS REFLEX easily done this is most with the seated. patient Identify the location of the biceps tendon. To do this, have the patient flex at the elbow while you observe and palpate the antecubital fossa. The tendon will look and feel like a thick cord.

Biceps Reflex Testing

TRICEPS REFLEX Triceps Tendon

BRACHO RADIALIS REFLEXES