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• Neurology evaluations involve determining if a problem is related to neurology, locating the lesion, and identifying the lesion's etiology.
• Evaluation steps include a history of complaint/symptoms, neurological exam for signs, neuroanatomy knowledge, patient history, and neuroimaging.

Changes in Consciousness

• Alterations in consciousness require assessment of reasons, symptoms, and causes
• Consciousness levels include:
  • Conscious and alert: Normal state
  • Somnolence: Sleepy but easily awakened
  • Lethargy: Sleepy, difficult to awaken
  • Stupor: Responsive only to painful stimuli
  • Coma: Unresponsive to all stimuli

Global Cortical Involvement

• Major stroke
• Trauma
• Infections
• Metabolic conditions (severe hypoglycemia, hypoxia, hypercarbia)
• Toxications

Reticular System Involvement

• Stroke
• Tumor
• Trauma

Brain Death

• Brain death is irreversible and involves the total circulatory arrest of the brain and brain stem.
• Diagnostic criteria include coma, apnea, and loss of brain stem reflexes.
• Cerebral metabolism is absent in brain death, identifiable via imaging as the "empty box" sign

Meningeal Symptoms and Causes

• Increased intracranial pressure symptoms include headache, double vision, and vomiting.
• Meningeal irritation signs include neck stiffness (resistance to neck flexion).
• Kernig's sign indicates meningeal irritation, where extending the knee at 90 degrees when the hip is flexed causes pain
• Brudzinski's sign indicates meningeal irritation, where involuntary lifting of the legs occurs during passive neck flexion while supine.

Cranial Nerve Symptoms

• Cranial nerve symptoms relates to the twelve cranial nerves

CN 1: Olfactory

• Impacts the sense of smell
• Anosmia and hyposmia are symptoms
• COVID-19, tumors of the olfactory nerve, neurodegenerative disorders, and Parkinson's disease can affect the function

CN 2: Optic

• Impacts visual acuity and visual fields
• Assessed through light reflex testing
• Problems in the optic nerve result in pupil dilation issues and issues with accommodation

Visual Field Defects

• Visual field defects are affected by lesions along the visual pathway, and may include:
  • Central scotoma
  • Monocular vision loss
  • Bitemporal hemianopia
  • Contralateral homonymous hemianopia/quadrantopia (superior or inferior) with or without macular sparing.

Papilledema

• Papilledema is optic disc swelling due to optic neuritis or increased intracranial pressure.

CN 3, 4, 6: Oculomotor, Trochlear, Abducens

• Cranial nerves that control the eye muscles
• Involved in eyelid movement, and eye movement

CN 3

• Specifically controls most eye muscles except the lateral rectus and superior oblique
• Superior oblique controlled by CN 4
• Lateral rectus controlled by CN 6

Eye Movement Function

• Lateral Rectus Muscle Abducens Nerve, or CN 6
• Superior Oblique Muscle: Trochlear Nerve, or CN 4
• All other muscles are controlled by the Oculomotor Nerve, or CN3.
• Conditions like strabismus and diplopia are related to the motor function

CN III Palsy

• CN III palsy results in ptosis, mydriasis, and "Down and Out" eye position.

Pupil Changes

• Pupil changes can present as Anisocoria, where the pupils are of differing sizes due to miosis (constriction) or mydriasis (dilation).
• Horner Syndrome presents pupils that are constricted due to sympathetic denervation

CN 5: Trigeminal

• The trigeminal nerve has 3 divisions: V1(opthalmic), V2(maxillary), and V3(mandibular)
• CN 5 is involved in the corneal reflex along with CN 7
  • V1 is sensory while CN 7 facilitates motor output

CN 7: Facial

• Facial nerve is responsible for the muscles of facial expression.
• Facial Paralysis is associated to CN7
• Responsible for taste in the anterior 2/3 of the tongue
• Involved in the corneal reflex, and works along side CN 5

CN 8: Vestibulocochlear Nerve

• Affects hearing and balance
• Disruption can cause hearing loss or result in vertigo

CN 10: Vagus

• Responsible for the pharyngeal muscles
• Involved in gag reflex via CN 9 and CN 10 functioning together
• Dysfunction can result in dysphagia and changes in speech where it sounds Nasonated

Motor System

• Motor System functionality can be diagnosed to reveal different presentations of Plegia or Paresis

Paresis

• Partial weakness
• Hemiparesis, or one side weakness can occur with Spinal Cord Injuries
• Quadriparesis and Monoparesis present differently

Plegia

• Complete paralysis
• Can occur as Hemiplegia, Quadriplegia and Monoplegia

Reflexes

• Reflex abnormalities are deep tendon related

Areflexia

• Absence of a reflexive respones
• Can be a symptom of Sensory and Lower Motor Neuron pathologies

Hiperreflexia

• Increased reflex response
• Can be a symptom of Upper Motor Neuron pathologies

Spinothalamic Sensory System

• Involves modalities of light touch, temperature, and pain

Dorsal column system

• Senses Vibration and Proprioception

Peripheral Nerve Dysfunction Symptoms

• Peripheral nerve dysfunction include Anesthesia (absence), Paraesthesia(abnormal sensation/tingling), Dysaesthesia (unpleasant sensation), Hyperesthesia (increased sensitivity), and Hypoesthesia (diminished sensitivity),

Cerebellar System Symptoms

• Symptoms include Nystagmus, Diplopia, Dysartria, and Vertigo
• Balance and Tremor can be a symptom
• Patients may also present with Dysmetria and Dysdiadochokinesia

Movement disorders

• In hyperkinetic disorders, the patient may have: -Chorea or random writhing movements -Tremors, categorized as action, intentional, rest, or postural -Dystonia, where the patient has involuntary position in joints
• Parkinson's presents the reverse condition
• Patients present with hypokinesis.

Parkinson's Disease

• Patients show features like; diminished facial expression, soft and weak voice, slowness of movement
• Restin Tremor is present at rest
• There are balance issues

Speech Problems

• Can present as Aphasia when the patient has had a stroke
• Issues with stuttering or weakness in vocal projections indicate other Speech Problems
• Speech can sound Nasonated, which indicates issues with CN 9/10 functionality

Aphasia

• Damage to Broca's area causes expressive aphasia with effortful but meaningful speech, but comprehension is still intact
• Where damage to Wernicke's area causes receptive aphasia characterized by fluent speech that is lacking in comprehension