Assessing neuro-system

1. Assessing neuro-system Dr. Zyad Saleh

2. History of Present Health Concerns • Headaches • Seizures • epilepsy, metabolic disorders, head injuries, and high fevers. • determining the type of seizure Where the seizure starts and what occurs before and after • an aura (an auditory, visual, or motor sensation)

3. Dizziness • inner ear infection. • Cerebellum • the vestibular part of cranial nerve VIII • Numbness and Tingling • damage to the brain, spinal cord, or peripheral nerves • Senses (smell or to taste) • smell  cranial nerve I (olfactory) or a brain tumor. • taste  cranial nerves VII (facial) or IX (glossopharyngeal).

4. ringing in ears or hearing loss • cranial nerve VIII • vision • Changes in vision  cranial nerve II (optic), increased intracranial pressure, or brain tumors. • double or blurred vision  cranial nerves III (oculomotor), IV (trochlear), or VI (abducens) • Transient blind spots  cerebrovascular accident (CVA).

5. Difficulty Speaking • Injury to the cerebral cortex • Difficulty Swallowing • CVA • Cranial nerves IX (glossopharyngeal), X (vagus), or XII (hypoglossal).

6. Muscle Control • lost bowel or bladder control • spinal cord injury or tumors. • muscle weakness or any loss of movements (paralysis)  CVA • repetitive involuntary trembling, quivering, shaking, or other movements

7. Memory Loss • Remote memory (past dates and historical accounts)  cerebral cortex disorders. • Recent memory (24-hour memory)  Alzheimer

8. Physical Assessment • Test CN I (olfactory). • correctly identifies scent presented to each nostril. • Test CN II (optic). • Client has 20/20 vision • Client reads print at 14 inches without difficulty. • Full visual fields

9. Assess CN III (oculomotor), IV (trochlear), and VI (abducens). • Eyelid covers about 2 mm of the iris. • Ptosis (drooping of the eyelid) • Eyes move in a smooth, coordinated motion in all directions (the six cardinal fields).

10. Nystagmus (rhythmic oscillation of the eyes)  cerebellar disorders. • Limited eyes movement through the six cardinal fields of gaze  increased intracranial pressure. • Paralytic strabismus  paralysis of the oculomotor, trochlear, or abducens nerves

11. pupils constrict simultaneously. • Constricted fixed pupils  narcotics abuse or damage to the pons. • Constricted pupils unresponsive to light or accommodation lesions of the sympathetic nervous system. • Dilated pupils (6-7mm) or Unilateral dilated pupils unresponsive to light or accommodation  oculomotor nerve paralysis.

12. Assess CN V (trigeminal). • Temporal and masseter muscles contract bilaterally.

13. Test sensory function. • correctly identifies sharp and dull stimuli and light touch to the forehead, cheeks, and chin. • lesions of the trigeminal nerve

14. Test corneal reflex • Eyelids blink bilaterally. • lesions of the trigeminal nerve or lesions of the motor part of cranial nerve VII (facial).

15. Test CN VII (facial). • smiles, frowns, wrinkles forehead, shows teeth, puffs out cheeks, purses lips, raises eyebrows, and closes eyes against resistance. • Movements are symmetric.

16. Sensory function of CN VII (anterior two-thirds of the tongue) • Client identifies correct flavor.

17. Test CN VIII (acoustic/vestibulocochlear). • hears whispered words from 1–2 feet. • Weber test: Vibration heard equally well in both ears. • Rinne test: AC > BC

18. Test CN IX (glossopharyngeal) and X (vagus). • (motor function) Uvula and soft palate rise bilaterally and symmetrically on phonation. • lesions of cranial nerve X (vagus) • Test the gag reflex • cranial nerve IX (glossopharyngeal) or X (vagus).

19. Check the client’s ability to swallow • Dysphagia or hoarseness may indicate a lesion of cranial nerve IX (glossopharyngeal) or X (vagus) • Test CN XI (spinal accessory). • symmetric, strong contraction of the trapezius muscles. • strong contraction of sternocleidomastoid muscle on the side opposite the turned face.

20. Test CN XII (hypoglossal). • Tongue movement is symmetric and smooth, and bilateral strength is apparent.

21. Motor and Cerebellar Systems • Assess condition and movement of muscles. • Assess the size and symmetry of all muscle groups • Muscles are fully developed and symmetric in size

22. Assess the strength and tone of all muscle groups • Relaxed muscles contract voluntarily and show mild, smooth resistance to passive movement. • All muscle groups equally strong against resistance, without flaccidity, spasticity, or rigidity.

23. Note any unusual involuntary movements • Fasciculation (rapid twitching of resting muscle)  fatigue. • Tic (twitch of the face, head, or shoulder)  stress • Tremors (rhythmic, oscillating movements)  anxiety.

24. Evaluate gait and balance. (Note posture, freedom of movement, symmetry, rhythm, and balance). • Gait is steady; opposite arm swings. • maintains balance with tandem walking. Walks on heels and toes with little difficulty. • Disorders of the motor, sensory, vestibular, and cerebellar systems.

25. Perform the Romberg test. • Perform the Romberg test. • Client stands erect with minimal swaying, with eyes both open and closed. • Bends knee while standing on one foot; hops on each foot without losing balance.

26. Perform the Romberg test. • Swaying and moving feet apart to prevent fall  vestibular dysfunction, or cerebellar disorders.

27. Assess coordination. (finger-to-nose test) • Client touches finger to nose with smooth, accurate movements, with little hesitation. • cerebellar disease.

28. Assess rapid alternating movements. • Client touches each finger to the thumb rapidly. • Client rapidly turns palms up and down. • Client is able to run each heel smoothly down each shin. • cerebellar disease

29. Sensory System • Assess light touch, pain, and temperature sensations. • Client correctly identifies light touch (what and where). • correctly differentiates between dull and sharp sensations and hot and cold temperatures over various body parts.

30. Anesthesia  absence of touch sensation Hypesthesia  decreased sensitivity to touch Hyperesthesia  increased sensitivity to touch Analgesia  absence of pain sensation Hypalgesia  decrease pain sensation Hyperalgesia  increased sensation of pain

31. Test vibratory sensation. • Client correctly identifies sensation. • Test sensitivity to position. • correctly identifies directions of movements. • Assess tactile discrimination (fine touch). • Client correctly identifies object. (Stereognosis.)

32. test point localization - correctly identifies area touched. • test graphesthesia • correctly identifies number written. • Two-point discrimination • test extinction,

33. Reflexes

34. Reflexes • Test biceps reflex. • Elbow flexes and contraction of the biceps Muscle • Assess brachioradialis reflex. - wrist extension and supination • Test triceps reflex. • Elbow extends, triceps contracts.

35. Assess patellar reflex. • Knee extends, quadriceps muscle contracts. • Test Achilles reflex. • Plantarflexion

36. Assess plantar reflex. • Flexion of the toes occurs • toes will fan out (positive Babinski response).

37. Test abdominal reflex. • Abdominal muscles contract; the umbilicus deviates toward the side being stimulated.

38. Tests for Meningeal Irritation or Inflammation client can easily bend head and neck forward. Pain in the neck and resistance to flexion Test for Brudzinski’s sign. Pain and flexion of the hips and knees Test for Kernig’s sign. Pain and increased resistance to extending the knee