Neurologic System Assessment Quiz

Neurologic System Assessment

• A complete neurologic assessment involves evaluating five key areas:
  • Level of Consciousness (LOC) and Mental Status
  • Cranial Nerves
  • Motor and Cerebellar Systems
  • Sensory System
  • Reflexes

Level of Consciousness (LOC) and Mental Status

• Level of Consciousness (LOC): Evaluates a person's arousability and responsiveness to stimuli. Changes in LOC might indicate a deteriorating condition.

  • Alert: Fully awake and aware of surroundings.
  • Lethargic: Opens eyes to stimulation, answers questions slowly, may drift back to sleep
  • Obtunded: Opens eyes to loud voice or stimulation, slow responses; unaware of environment; may drift back to sleep.
  • Stuporous: Awakens only to vigorous shake or painful stimuli, does not follow commands, may try to withdraw from stimulation
  • Comatose: Unresponsive to all stimuli

• Mental Status: Evaluates orientation to time, place, and person.

  • Assess facial expressions, eye contact, and affect and hygiene.
  • Assess speech (tone, clarity, and pace).
  • Observe thought processes and perceptions.

Cranial Nerves Assessment

• Assess various cranial nerves (I-XII) for function.
  • Cranial Nerve I (Olfactory): Smell identification
  • Cranial Nerve II (Optic): Vision (Snellen chart, near vision, and accommodation testing)
  • Cranial Nerves III, IV, and VI (Oculomotor, Trochlear, and Abducens): Extraocular movements, pupillary responses to light, and accommodation
  • Cranial Nerve V (Trigeminal): Motor function (masseter and temporal muscle palpation during jaw clenching), sensory function (applying sharp/dull stimuli) corneal reflex.
  • Cranial Nerve VIII (Acoustic): Hearing (Whisper test, Rinne, and Weber tests)
  • Cranial Nerve VII (Facial): Facial expressions, taste, and salivary glands
  • Cranial Nerve IX (Glossopharyngeal) and Cranial Nerve X (Vagus): Motor function (swallowing, Gag reflex, assessing movement of the uvula, opening mouth and saying "ah"), Sensory function.
  • Cranial Nerve XI (Spinal Accessory): Neck and shoulder movements, and resistance testing.
  • Cranial Nerve XII (Hypoglossal): Tongue strength and mobility.

Motor Function

• Evaluate muscle strength, tone, and size bilaterally.
  • Assess muscle strength by asking patient to perform movements against resistance
  • Muscle Tone: Assess resistance felt during passive movements
  • Muscle size: Atrophy vs. Hypertrophy

Cerebellar Function

• Assess gait, balance, and coordination.
  • Tandem walk
  • Romberg's test
  • Finger to nose test

Sensory System Assessment

• Evaluate light touch, pain, and temperature sensation
  • Assess vibratory sensation
  • Assess sensitivity to position (proprioception).
  • Assess tactile discrimination (stereognosis, point localization)
  • Assess graphesthesia

Deep Tendon Reflexes Assessment

• Reflex response scale
  • +1: Present but decreased
  • +2: Normal
  • +3: Increased or brisk, not indicative of a disorder
  • +4: Hyperactive, very brisk, clonus; indicative of disorder

Brain Stem Reflex Assessment

• Protective Reflexes: Cough and gag reflexes, corneal reflex
• Oculocephalic Reflex: Doll's eye reflex

Superficial Reflexes Assessment

• Plantar reflex (Babinski): Test the plantar reflex for normal toe flexion and a positive Babinski reflex where toes fan out (except in newborns)

Postures assessment

• Decorticate rigidity: characterized by flexion of the arms, wrists, and fingers, adduction of arms to chest and extension of legs
• Decerebrate rigidity: characterized by extension of arms and legs, hyperextension of the neck

Vital Signs and Neurologic State assessment

• Cushing's Triad: Includes changes in breathing, bradycardia (slow heart rate), widened pulse pressure, suggests increased intracranial pressure (ICP).