Neurological Assessment Mental Status and Neurological Assessment 2015 - 2016 L / Hanaa Eisa

Learning outcome At the end of this Lesson the study p will be able to: Discuss the divisions of the nervous system and their functions. Relate blood flow to the brain to the functional area supplied. Describe the characteristics of the most common neurological complaints. Perform a mental status assessment and document the results.

Learning outcome cont’d Explain the pathophysiology of any abnormal results obtained. Document a complete health history as it relates to the neurological system.

Introduction The nervous system consists of : The central nervous system (CNS) The peripheral nervous system The autonomic nervous system. Together these three components integrate all physical, emotional, and intellectual activities.

Nervous System Anatomy Central Nervous System Brain Spinal cord Peripheral Nervous System Cranial nerves Spinal nerves

Central nervous system-spinal cord

Peripheral Nervous System-12 Pairs of Cranial Nerves Originate in the brain Control many activities in the body Take impulses to and from the brain

Cranial nerves and their target regions Sensory nerves are shown in blue motor nerves shown in red 8

Anatomy and physiology Protective layers Scalp Skull Meninges Dura mater (الأم الجافية) Arachnoid mater (أم عنكبوتية ) Pia mater (الأم الحنون)

Central nervous system Brain Cerebrum: right and left hemispheres Cerebral cortex Memory storage and recall Sensation Vision, hearing, motor function

Lobes of the Cerebrum Parietal Somatic sensory Frontal Higher intellectual function Speech production Psilateral motor control

Lobes of the Cerebrum Temporal Hearing Memory Speech perception Occipital Vision Limbic Emotion

Brain Diencephalon: Body temperature regulation pituitary hormone control autonomic nervous system responses Cerebellum Maintains posture and equilibrium Brain stem Respiratory and cardiac regulation, level of awareness, reticular activating system

Spinal cord Gray matter White matter Dorsal horn Ventral horn

Blood supply Circle of Willis Carotid arteries Cerebral arteries Basilar artery Cerebellar arteries

Cranial nerves Motor, sensory, or both Olfactory (I) Optic (II) Oculomotor (III) Trochlear (IV) Trigeminal (V) Abducens (VI) Facial (VII) Acoustic (VIII) Glossopharyngeal (IX) Vagus (X) Spinal accessory (XI) Hypoglossal (XII)

Reflexes Specific response to adequate stimulus Monosynaptic Polysynaptic Classes Muscle strength or deep tendon Superficial Pathological

Reflexes Deep tendon Grading scale 0 – 4+ Compare right to left Biceps, triceps, patellar Superficial Abdominal, bulbocavernosus Pathological

Health History Age Early adult , Middle adult , Older adult Gender Female or Male Race African, American

Common chief Characteristics of chief complaints Quality Quantity Associated manifestations Aggravating factors Alleviating factors Setting Timing Common chief complaints Seizure , Syncope , Pain Paresthesia , Disturbances in gait Visual changes Vertigo Memory disorders Difficulty with swallowing or speech

Past health history Medical Injuries and accidents Neurologic specific Non-neurologic specific Surgical Medications Communicable diseases Injuries and accidents Family health history Social history Alcohol, tobacco, drug use Sexual practices Work and home environment Health maintenance activities

Motor System Extra pyramidal rigidity Coordination Gait Station

Gerontological variations Increased risk for ischemic brain injuries Decreased rate of nerve conduction Decreased number of neurons Decreased neurotransmitter production Sensory alterations Cognitive changes

Spinal nerves Dermatome: Band of skin innervated by the sensory Root of a single spinal nerve

Physical assessment of the neurologic system Testing cranial nerves Testing Motor function Testing Sensory function Testing Reflexes (Always consider left to right symmetry)

Areas of the neurologic system assessment Testing cranial nerves I to XII I . Olfactory: smell ll. Optic: vision

Eyes – techniques of examination Visual acuity Near vision: Use (Jaeger or Rosenbaum chart (hand-held card). Can also use to test visual acuity at the bedside , hold 14 inches (about 30 cm) from patient’s eyes Jaeger chart Rosenbaum chart

III. Oculomotor , IV. Trochlear ,VI. Abducens Test Extraocular Movements Test pupillary reaction to light

CN V. Trigeminal examine for motor and sense

VIII. Acoustic Weber Test (by using a tuning fork). Rinne test: to compares air and bone conduction Romberg test: Ask the patient to remain still and close their eyes (for about 20 seconds).

Areas of the neurologic system assessment Motor function Observation of gait and balance Administration of the Romberg test Administration of the finger-to-nose test Observation of rapid alternating action movements

Areas of the neurologic system assessment Sensory function Observation of light touch identification Sharp, dull determination Graphesthesia (Number identification)

Areas of the neurologic system assessment Reflexes : Stimulus-response activities of the body. Biceps Triceps Patellar (knee) Abdominal

Level of consciousness(LOC) LOC state continuum from alertness to coma. Fully alert client responds to questions spontaneously. Comatose client may not respond to verbal stimuli. The LOC was tests in three major areas Eye response , motor response and verbal response . An assessed totaling 15 points indicates client is alert and completely oriented . A comatose client scores 7 or less.

Glasgow coma scale

Thank you