The document describes the structure and function of the neurological system. It notes that the neurological system consists of the central nervous system (CNS), which includes the brain and spinal cord, and the peripheral nervous system (PNS), which includes the somatic and autonomic divisions. It provides details on the four main divisions of the brain, the brain stem, cerebellum, and spinal cord. It also describes the 12 pairs of cranial nerves and their functions. The document outlines steps for collecting subjective and objective neurological assessment data, including mental status exams and tests of cranial nerves, motor function, coordination, sensations, and reflexes.

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NCM 101.1

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– Neurological system consists of
• Central nervous system (CNS): brain
and spinal cord
• Peripheral nervous system (PNS):
somatic and autonomic divisions

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• CNS: covered by meninges; bathed by
cerebrospinal fluid
– Brain: located in cranial cavity; 4 major
divisions
• Cerebrum divided into R and L
hemisphere; consists of 4 lobes (frontal,
parietal, temporal, occipital)

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• Brain
– Brain stem: consists of
• Midbrain (relay center)
• Pons (links brain structures)
• Medulla oblongata (controls respiratory
function, heart rate and force, blood
pressure)

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• Brain
– Cerebellum: located behind brain stem
under cerebrum; divided into R & L
hemisphere; functions
• Coordination and smoothing of
voluntary movements; maintenance of
equilibrium and muscle tone

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• Spinal cord
– Located in vertebral canal; extends from
medulla oblongata to L1 (first lumbar
vertebra); IS NOT AS LONG AS SPINAL
CANAL
– Functions: conducts impulses;
responsible for simple reflex activity

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• Neural pathways
– Sensory impulses (originate in afferent
nerve fibers of peripheral nerves; are
carried through posterior [dorsal] root into
spinal cord)
– Motor impulses (conducted to muscles by
2 descending pathways: pyramidal and
extrapyramidal)

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• Peripheral Nervous System (PNS)
– Carries information to and from CNS
– Consists of 12 pairs of cranial nerves
– PNS somatic fibers carry CNS impulses
to skeletal muscles
– PNS autonomic fibers carry CNS
impulses to smooth, involuntary muscles
(ex. heart and glands)

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• PNS: Cranial Nerves
– I Olfactory – smell
– II Optic- vision & visual field
– III Oculomotor-pupils
– IV Trochlear-follow moving objects
– V Trigeminal-sensations

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• PNS: Cranial Nerves
– VI Abducens-move eye laterally
– VII Facial-taste
– VIII Acoustic (vestibulocochlear)-tuning
fork
– IX Glossopharyngeal-gag & swallowing
– X Vagus – throat muscle

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• PNS: Cranial Nerves
– XI Spinal accessory-
sternocleidomastoid & trapezius
– XII Hypoglossal-stick out tongue

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• Collecting subjective data
– Interview approach
• History of current health problem
• Past and family histories
• Lifestyle and health practices

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• Collecting objective data
– Client preparation
– Equipment and supplies
• Cranial nerve exam
• Motor and cerebellar exam
• Sensory and reflex exams

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• Key Assessment points
– Identify structures and functions of CNS
and PNS
– Understand meaning of mental status and
LOC
– Correctly apply and interpret mental
status exam and Glasgow coma scale
(GCS)

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• Key Assessment points
– Identify 12 cranial nerves and their
sensory and motor functions
– Thoroughly assess: movement, balance,
coordination, reflexes

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• Physical Assessment
– Mental Status and LOC
• Observe: appearance and behavior;
mood, feelings, expressions; thought
processes and perceptions; cognitive
abilities; orientation; concentration

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• Physical Assessment
– Mental Status and LOC
• Observe: recent and remote memory;
use of memory to learn new
information; abstract reasoning;
judgment; visual, perceptual, and
constructional abilities

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• Physical Assessment
– Test cranial nerves
– Assess condition and movement of
muscles, and test balance and
coordination
– Assess sensations and reflexes

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• Physical Assessment
– Perform Brudzinski’s sign and Kernig’s sign
– Brudzinki’s sign-involuntary flexion of the
arm, hip & knee when the neck is passively
flexed; it occurs in patients with meningitis
– Kernig’s sign- a diagnostic sign for
meningitis marked by a loss of the ability of
a supine patient to completely straighten the
leg when it is fully flexed at the knee & hip

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Kernig’s Sign

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• Validation and Documentation of findings