NEUROLOGICAL ASSESSMENT

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NEUROLOGICAL ASSESSMENT

• Donald Seery, M.D.
• Via Christi Regional Medical Center
• Family Practice
• Wichita, KS

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6 parts of Neurological Exam

• Mental status
• Cranial nerves
• Motor
• Sensory
• Coordination
• Reflexes

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Mental Status

• 4 Basic States
• Alter
• Lethargy
• Semicoma
• Coma

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Cranial Nerves

• CN I Olfactory

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Cranial Nerves

• CN II Optic
• CN III Oculomotor
• CN IV Trochlear
• CN VI Abducens

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Cranial Nerves Midbrain

• CN V Trigeminal
• CN VII Facial
• CN VIII Vestibulocochlea

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Cranial Nerves Medulla

• CN IX Glossopharyngeal
• CN X Vagus
• CN XI Accessory
• CN XII Hypoglossal

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Motor

• Key is drift of
• Upper lower
• Extremities

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Sensory

• Pain
• Temperature
• Proprioception
• (conscious/unconscious)
• Light tough

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Sensory Key Points

• Pain Temp - cross at spinal level
• Proprioception - conscious path crosses at
  brainstem
• - unconscious proprioception is ipsilateral
• Light tough - both

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Coordination

• Finger to nose heel to shin
• Rapid alternating movements
• Key testing cerebellum
• Basal Ganglia

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Romberg

• Takes 3 senses to maintain balance
• Vision
• Vestibular
• Proprioception

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Reflexes

• Asymmetry important finding
• Babinski - detects upper motor neuron lesion
• Kernigs - flex neck hips also flex
• Brudzinskis - straight leg raising

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The Unconscious PatientKey Points

• Hand drop from over head
• Pupillary size response to light
• - PERL
• Abnormal eye movements
• Grimacing, withdrawal from noxious stimuli
• Babinski reflex