Neurological Assessment

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Neurological Assessment Powered By Docstoc
  Mental Status
  Cranial Nerves
                 Mental Status
   Mental status is a person’s emotional &
    cognitive functioning aimed towards satisfaction
    in work, caring relationships, & within the self.
   Mental health is relative & ongoing – people
    have “good” days & “bad” days.
   Usually there is a balance – allowing the person
    to function socially & occupationally
   Stress surrounding a traumatic life event
    sometimes tips the balance causing transient
   This is an expected response to trauma
   Assessment at this time can identify remaining
    strengths & help the individual mobilize
    resources and use coping skills
   Mental health assessment documents a
    dysfunction and determines how that
    dysfunction affects self-care & their functioning
    in everyday life.

   Mental status cannot be scrutinized directly (like
    heart sounds) rather it is inferred through
    assessment of their behavior…
   Consciousness
   Language
   Mood/affect
   Orientation
   Attention
   Memory
   Abstract reasoning
   Thought processes
   Thought content
   Perceptions
   Usually can assess mental status through the
    context of the health hx interview
   If you discover an abnormality in affect &
    behavior, a full mental status exam would be
     Family members concerned about memory loss or
      inappropriate social interaction
     Brain lesions (tumor, stroke)
     Aphasia (impairment of language secondary to brain
     Psychiatric mental illness, esp. with acute onset
   The following factors from the health hx could
    affect your interpretation the mental status
     Known illness or health problem (alcoholism)
     Current meds (side effects of confusion or
     Education or behavioral level (use as a baseline)

     Responses to questions indicating current stress,
      sleep habits, drug/alcohol use.
   Start with a general survey of the whole person
    from the moment you first encounter them…
     Look at physical appearance
     Body structure

     Mobility

     Behavior
                Nervous System
   Divided into 2 parts – central nervous
    system(CNS) & peripheral nervous system(PNS)

   CNS consists of brain & spinal cord

   PNS consists of 12 pairs of cranial nerves & 31
    pairs of spinal nerves
    (nerve is a bundle of fibers outside the CNS)
   PNS carries sensory messages to CNS from
    sensory receptors, and motor messages from
    CNS out to muscle & glands as well as
    autonomic messages that govern internal organs
    & blood vessels

   Cranial Nerves enter & exit brain rather than the
    spinal cord.
   12 pairs of CN supply primarily head & neck
    (except vagus nerve which travels to heart,
    respir. muscles, stomach, & glallbladder)
   Cerebral cortex is cerebrum’s outer layer of
    nerve cell bodies. Looks like “grey matter” b/c
    lacks myelin
   Center for highest human functioning for
    thought, memory, reasoning, sensations, &
    voluntary movements
   Each half of the cerebrum is a hemisphere – the
    left is dominant in 95% of people
   Each hemisphere has 4 lobes….
                    Frontal Lobe
   Personality, behavior,
    emotions, & intellectual
   Precentral gyrus initiates
    voluntary movements

   Broca’s area – mediates
    motor speech (if injured
    cannot talk. Can
    understand language,
    know what they want to
    say, but produce only a
    garbled sound)
                 Parietal Lobe
   Postcentral gyrus
    primary center for
                Occipital Lobe
   Primary visual
    receptor center
               Temporal Lobe
   Behind the ear –
    primarily auditory
    reception center

   Wernicke’s area –
    comprehension (if
    damaged, receptive
    aphasia. Hears
    sounds, but has no
   If neurologic cells are damaged (deprived of
    blood supply, cerebral artery becomes occluded),
    will have a loss of functioning
     Motor weakness
     Paralysis

     Loss of sensation

     Impaired ability to understand/process language
   Basal ganglia – bands of
    grey matter deep within
    the 2 cerebral
    hemispheres. Form the
    subcortical associated
    motor system or
    extrapyramidal system.
    Controls automatic
    associated movements –
    arm swing alternating
    with legs during walking.

   Thalamus – relay station.
    Sensory pathways of
    spinal cord & brain stem
    form a synapse on their
    way to cerebral cortex
   Hypothalamus – major
    control center (temperature,
    heart rate, b.p., sleep, anterior
    & posterior pituitary gland
    regulator, coordinator of
    autonomic nervous system
    activity & emotional status)

   Cerebellum – coiled structure
    located under the occipital
    lobe. Concerned with motor
    coordination of voluntary
    movements, equilibrium &
    muscle tone. Does not
    initiate movement but
    coordinates & smoothes it
                             Brain Stem
   Central core of brain, consisting
    mostly of nerve fibers

   Midbrain – anterior part, merges
    into thalamus & hypothalamus
   Pons – contains ascending &
    descending fiber tracts
   Medulla – continuation of spinal
    cord in the brain that contains all
    ascending & descending fiber
    tracts connecting brain & spinal
    cord. Vital autonomic centers for
    respir, heart, & GI function as
    well as nuclei for CN VIII
    through XII
                 Cranial nerves
   12 cranial nerves.
   Have a sensory, motor, or parasympathetic
    function (or combinations) (carry a combination
    of fibers)
   Most are assessed while examining other systems
    (head & neck, eyes, ears, nose, & mouth)
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                Cranial Nerve I
   Olfactory

   Sensory

   Smell
              Cranial Nerve II
   Optic

   Sensory

   Vision
              Cranial Nerve III
   Oculomotor

   Motor – motor & parasympathetic

   Motor – EOM movement, raises eyelids
   Parasympathetic – pupil constriction, lens shape
                Cranial Nerve IV
   Trochlear

   Motor

   Down & inward movement of eye
                 Cranial Nerve V
   Trigeminal

   Mixed – motor & sensory

   Motor – muscle of mastication
   Sensory – sensation of face, scalp, cornea,
    mucous membranes of mouth & nose
               Cranial Nerve VI
   Abducens

   Motor

   Lateral movement of eye
              Cranial Nerve VII
   Facial

   Mixed – motor, sensory, parasympathetic

   Motor – facial muscles, eyes close, labial speech
   Sensory – taste on anterior 2/3 of tongue
   Parasympathetic - saliva & tear secretion
              Cranial Nerve VIII
   Acoustic (or vestibulocochlear)

   Sensory

   Hearing & equilibrium
              Cranial Nerve IX
   Glossopharyngeal

   Mixed – motor, sensory, parasympathetic

   Motor – pharynx (phonation & swallowing)
   Sensory – taste of posterior 1/3 of tongue,
    pharynx (gag reflex)
   Parasympathetic – parotid gland & carotid reflex
               Cranial Nerve X
   Vagus

   Mixed – motor, sensory, parasympathetic

   Motor – pharynx & larynx ( talking &
   Sensory – general sensation from carotid body,
    carotid sinus, pharynx, viscera
   Parasympathetic – carotid reflex
              Cranial Nerve XI
   Spinal (or spinal accessory)

   Motor

   Movement of trapezius and sternomastoid
            Cranial Nerve XII
   Hypoglossal

   Motor

   Movement of tongue
   Headaches
   Head injury
   Dizziness/vertigo (rotational spinning sensation)
   Difficulty swallowing
   Difficulty speaking
   Loss of smell, taste, hearing, vision

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