Assessment of the NS Neurological Assessment A complete

Assessment of the NS

Neurological Assessment A complete neurological assessment consists of five steps: 1. Mental status exam 2. Cranial nerve assessment 3. Reflex testing 4. Motor system assessment 5. Sensory system assessment

Neurological Assessment As the patient enters the room, check the following: - Gait - Dress, grooming & personal hygiene - Posture & motor behavior. - Facial expression. - Speech manner, mood & relation to persons and things around him

Types of walking gait Waddling gait Spastic gait Stamping Gait Drunken Gait Shuffling gait

Mental assessment Conscious Level Alert: Awake & verbally responsive Lethargic: - Sleepy or drowsy but can be awaken & respond appropriately to command Stupor: - The patient becomes unconscious spontaneously & is very hard to awaken Semi coma: - The patient is not awake but will respond purposefully to deep pain Coma: - The patient is completely unresponsive

Glasgow coma scale (GCS) Grad 6 Grad 5 Grad 4 Obeying command Localizing response to pain. Withdrawal to pain - pulls limb away from painful stimulus. Grad 3 Flexor response to pain - pressure on nail bed causes abnormal flexion of limbs Grad 2 Extensor posturing to pain - stimulus causes limb extension Grad 1 No response to pain.

Assess Grades by Verbal response Grade 5 Grade 4 Grade 3 Grade 2 Grade 1 Oriented - knows who & where they are why he is here, the year, season & month. Confused - patient responds in conversation with some disorientation & confusion. Inappropriate speech - random or exclamatory speech, no conversational exchange. Incomprehensible speech - no words uttered, only moaning. No verbal response.

EYE OPENING Grade 4 Grade 3 Grade 2 Grade 1 Spontaneous eye opening. Eye opening in response to speech - that is, any speech or shout. Eye opening in response to pain. No eye opening.

Cerebellar Functions Ipsilateral body abnor malities due to (double cross). Ø Nystagmus (Disrupt coordination of eye movements). Ø Dysarthria (Scanning speech) Ø Past pointing, Dysmetria, Dysdiadochokinesia. (Disrupt coordination of limb). Ø Ataxia (Impair balance during movement). Ø Intention tremor Ø Hypotonia, but no change in muscle force. Ø Pendulum reflex. Ø No change in sensory thresholds

Cerebellar Disease

Cranial Nerves Evaluating the cranial nerves is an important part of the neurological examination. - Olfactory - Facial - Optic - Vistibulo-cochlear - Oculomotor - Glossopharyngeal - Trochlear - Vagus - Trigeminal - Accessary - Abducens - Hypoglossal

Eye reflexes Corneal reflex Conjunctival reflex Blinking reflex Light reflexes: Accommodation to light. Consensual reflex. Accommodation to distance.

Corneal reflex & Conjunctival reflex Response & Pathway

Blinking reflex

Pupil light reflexes

Normal Pupil 1. Equal

Normal Pupil § React to light (Accommodation to light) Light Dark Exposure to light: Ipsi-lateral Contra-lateral

Small / Unequal pupil No light or consensual reflex There s accommodation to distance

Normal Pupil § React to light (Accommodation to distance).

Normal Pupil § React to light (Accommodation to distance).

Stretch reflex

Monosynaptic reflex Knee Jerk L 2 – L 3 Supinator Jerk C 5 - C 6 Ankle Jerk L 5–S 1 Triceps Jerk C 6 - C 7 Biceps Jerk C 5 - C 6

Superficial reflexes

Ankle Clonus

Equipments for sensory Exam. - Safety pin - Cotton - Tuning fork - Reflex hummer - Flashlight - Ophthalmoscope - Vision screeners - Gloves - Coffee

Sensory function

Sensation and Cerebral Cortex Two Point Discrimination Localization of sensation

Motor function

Involuntary movement