The document provides information on a presentation about neurological assessment. It includes: - An overview of the anatomy and physiology of the nervous system, dividing it into the central and peripheral nervous systems. - Descriptions of the main components of the central nervous system including the brain and spinal cord. - Details on the 12 pairs of cranial nerves and their functions. - An explanation of the goals and process of performing a neurological examination, including the areas examined and equipment needed.

1. PRESENTED BY-
CINDRELLA BURGE
MEDICAL SURGICAL DEPT.
MSC NURSING 1st YEAR
TEERTHANKER MAHAVEER
COLLEGE OF NURSING
PRESENTATION
ON
NEUROLOGICAL ASSESSMENT

2. ANATOMICAL
AND
PHYSIOLOGICAL
REVIEW OF
NERVOUS
SYSTEM

3.  The human nervous system is a highly
specialized system responsible for the control
and integration of body’s many activities.
 Is a physically connected network of cells, tissues
and organs that allow us to communicate with
and react to the environment and perform life
activities.
 Divided into central nervous system and
peripheral nervous system.

4. Types
Nervous system
Central nervous
system
The brain
Brain, cerebrum,
cerebellum,
diencephalon.
The spinal cord
Other parts
Meninges
Cerebrospinal
fluid
Neurons
Peripheral
nervous system
Somatic nervous
system
Autonomic
nervous system

6. CENTRAL NERVOUS SYSTEM
 Receives, interprets and sends signals to Peripheral
nervous system
 2 main parts- BRAIN & SPINAL CORD
Brain- main control centre
Spinal cord- connects and relays nerve impulse to the
brain
 During embryonic development, the CNS first appears
as a simple tube, the neural tube, which extends down
the dorsal median plan of the developing embryo’s
body.

7. BRAIN
 The brain is the largest and most complex mass of
nervous tissue in the body.
 Contains 100 billion multipolar neurons.
 one of largest organs in body:
 men: 1,600 g (3.5 lbs) women: 1,450 g (3.2 lbs)
 one of most metabolically active organs in body
 comprises only 2% of total body weight it yet
 gets 15% of blood
 consumes 20% of our oxygen need at rest (more
when mentally active)
 decrease in glucose: dizziness convulsions
unconsciousness.

9. A brain is divided into-
CEREBRUM
 largest portion and associated with:
 higher mental functions, voluntary activity,
 memory,
 language,
 receives and responds to sensory signal
 control motor function.

10. DIENCEPHALON
 processes sensory input
 moods, memory, manages internal environment
 epithalamus thalamus hypothalamus

11. BRAIN STEM
 Includes the midbrain, pons, and medulla
 Function of brain stem-
 Swallowing,
 Coughing,
 Sneezing, and
 Vomiting

13.  Length. The spinal cord is approximately 17 inches
(42 cm) long.
 Major function. The spinal cord provides a two-way
conduction pathway to and from the brain, and it is a
major reflex center (spinal reflexes are completed at
this level).
 Location. Enclosed within the vertebral column, the
spinal cord extends from the foramen magnum of the
skull to the first or second lumbar vertebra, where it
ends just below the ribs.
 Spinal nerves. In humans, 31 pairs of spinal nerves
arise from the cord and exit from the vertebral column
to serve the body area close by.
 Cauda equina. The collection of spinal nerves at the
inferior end of the vertebral canal is called cauda
equina because it looks so much like a horse’s tail.

14. PERIPHERAL NERVOUS
SYSTEM-
 consists of the cranial and spinal nerves
 that arise from the central nervous system and
travel to the remainder of the body.
 is made up of the somatic nervous system that
oversees voluntary activities
 the autonomic nervous system controls
involuntary activities.

16. I Olfactory
 FUNCTION – smell S

17. II Optic
 FUNCTION- VISION S

18. III Oculomotor
 FUNCTION- EYE MOVEMENT M

19. IV TROCHLEAR
 FUNCTION- EYE MOVEMENT M

20. V Trigeminal
 FUNCTION- Sensory and motor- face. B

21. VI Abducens
 FUNCTION- Eye movement. M

22. VII Facial
 FUNCTION- Motor- face, taste. B

23. VIII Auditory (vestibulocochlear)
 FUNCTION- Hearing/ balance. S

24. IX Glossopharyngeal
 FUNCTION- Motor- throat taste. B

25. X Vagus
 FUNCTION - Motor/ sensory- viscera
(autonomic). B

26. XI SPINAL
ACCESSORY
 FUNCTION-
Motor- head and neck. M

27. XII hypoglossal
 FUNCTION- Motor- lower throat. M

28. Spinal Nerves
 Thirty-one pairs of mixed nerves make up the
spinal nerves.
 Spinal nerves are grouped according to the level
from which they arise and are numbered in
sequence, beginning with those in the cervical
region.
 Each spinal nerve arises from two roots:
A dorsal/ sensory root, and
A ventral/ motor root.

29. -8 pairs of
cerviral spinal
nerves
-12 pairs of
thoracic spinal
nerves
-5 pairs of
lumbar spinal
nerves
-5 pairs of
sacral spinal
nerves
-1 pair of
coccyx spinal
nerves

30.  Nervous system composed of NEURONS AND
NEUROGLIA.
 Neurons transmit nerve impulses along nerve fibres
to other neurons. Neurons typically have a cell
body, axons and dendrites.

31. Cont…
 Cell body- contains the nucleus, and cytoplasm
is the metabolic center of the neuron.
 Dendrites- are short processing extending from
the cell body. They receive nerve impulses from
synapses of axons of other neuron and conduct
impulse towards the cell body.
 Nerve axon- projects varing distances from the
cell body, raging from several micrometers to
more than a meter.its function is to carry nerve
impulses to other neurons.

32.  Myelin- Many axons are wrapped by an insulating
substance called myelin, which is actually made from
glial cells. Myelin acts as insulation much like the
plastic or rubber that is used to insulate electrical
wires.
o There are gaps in the myelin covering of an axon.
Each gap is called a node of Ranvier.
 Nerves are made up of bundles of nerve fibres, in
peripheral nervous system, electrochemical nerve
impulse are transmitted along each of the axons to
peripheral organs; in case of sensory nerves, from
the periphery back to central nervous system.
 Neuroglia - also glial cells,
o carry out a variety of functions to aid and protect
components of the nervous system.

33. FUNCTIONS OF NERVOUS
SYSTEM:
 Sensing the world
o Vision
o Hearing
o Smell
o Taste
o Touch
 Transmitting information
 Processing information
 Receiving information about the environment around
us (sensation).
 Generating responses to that information (motor
responses)

34. A. The nervous system based on function , can be
divided into 2-
a. Sensation (sensory functions) and
b. Response (motor functions).
B. The nervous system can be divided into 2 parts on
the basis of a functional difference in responses.
The somatic nervous system (SNS) is responsible
for conscious perception and voluntary motor
responses.
The autonomic nervous system (ANS) is
responsible for involuntary control of the body, usually
for the sake of homeostasis (regulation of the internal

35. INTRODUCTION
 The purpose of neurological examination is to
determine the presence or absence of disease in the
nervous system.
 A neurological examination is the assessment of
sensory neurons, and motor responses, especially
reflexes, to determine whether the nervous system is
impaired
 Nurses are involve in examining the neurological and
physical status of the patient as part of the total
physical assessment.

36. GOALS OF NEUROLOGICAL
EXAMINATION-
 To determine whether in fact neurological
dysfunction exists or not.
 To identify which components of the neurological
system are affected – motor, sensory, cranial.
 To locate the site of the problem
 To generate the possible list of etiologies.
 To document or screen of baseline function for
those who are otherwise healthy.

37. EQUIPMENTS NEEDED FOR
NEUROLOGICAL EXAMINATION
 Sheet
 Gloves
 Reflex hammer
 Tongue depressor
 Tuning fork
 Snellen chart
 Pen light or otoscope
 Cotton swabs
 Watch
 Common pin
 Fruit- orange, lemon
 Pen, keys, coin
 Sugar
 Salt
 Coffee
 water

38. History taking

39. System for neurological examination
General inspection
 Glasgow coma scale
 Higher mental function
 Speech and language
 Cranial nerves
 Trunk and limbs
Inspection
Tone
Power
Sensation
Reflexes
Coordination
 gait

40. 1. Mental
Status
Level of
conscious
ness
(Glasgow
Coma
Scale)

41. Cont…
 Degree of interaction
 Attention
 Orientation
 Following commands

42. 2. Language and speech
 fluency,
 repetition,
 naming,
 reading,
 writing,
 volume

43. 3. Memory
 Immediate recall
 Recent
 Remote

44. 4. Higher intellectual function
 General knowledge
 Judgment
5. Mood

45. 6. CRANIAL NERVE

46. CN 1: Olfactory
Ask the patient-
Have you ever noticed any
change in the sense and smell?
If NO, proceed to the next CN.
If YES, TEST –
Occlude one nostril, close eyes,
identify smell ..coffee, mint,
orange.

47. CN 2: Optic
VISUAL
ACUITY
 Using hand
held card or
Snellen wall
chart, assess
each eye
separately.
 From 14 inches
 Direct patient
to read aloud
line till smallest
lettering that
they’re able to

48. confrontation test
 Visual fields
Ask patient to
count the fingers
Can you see the whole of
my face?

49. CN 3: Oculomotor, CN 4: Trochlear,
CN 6: Abducens
 Visual inspection, pupil dilation checking.
 Involuntary shaking of eye – movement of eye
without shaking

50. CN 5: Trigeminal
 Facial sensation
 Corneal reflex

51. CN 7: Facial
 Ask pt. to
 Smile
 Puff out cheeks
 Close both lips and resist to open them
 Close both eyes and resist to open them
 Raise eyebrows
 Corneal reflex
 Checking abnormal mass at the site of scalp, or
skin break down.

52. CN 8: Vestibulocochlear
 WEBER’ TEST  RINNE TEST

53. Rinne test
 Normal- AC >BC
 Abnormal-
-ve rinne- louder on moistoid process
+ve rinne- bilateral SNHL (
SENSORINEURAL HEARING LOSS)

54.  Screen hearing
By rubbing fingers near the ear
Ask pt. to tell when and on which side the rubbing
is.
Or
Murmur at the distance , then ask the pt. what you
have said.

55. CN 9: Glossopharyngeal, CN 10:
Vagus
•gag reflex
Testing centers on motor function
–Swallowing
–Voice
–Cough
- Talking

56. CN 11: Spinal accessory
 Head turn-
STERNAMASTOID
 Shoulder shrug
TRAPEZIUS

57. CN 12: Hypoglossal
 Movement of the tongue

58. 7. MOTOR
 Muscle bulk
 Tone- roll the wrist to see resistance i.e.
increase or decrease.
 Measuring Strength: Grading system
0: no movement
1: can see muscle contraction but no movement
2: can move with gravity eliminated
3: can move against gravity
4: can resist opposition to some extent, but not
full (+, - also)
5: full strength

59. 8. REFLEXES
 Superfici
al -
abdomin
al reflex
 Reflex
Arc –
Deep
Tendon
Reflex

60.  Babinski’s
Reflex
(Adult)
 Plantar
reflex

61. 9. SENSORY
 Light touch
 Pinprick
 Temperature
 Vibration
 Joint position sense

62. cont…
 Stereognosis
 Graphesthesia

63. 10. CEREBELLAR
 Assess for-
stiff posture,
lack of arm swing ,
unequal steps,
dragging of foot, and
presence of Ataxia- lack of
coordination

64.  Finge
r-
nose-
finger
 Heel-
knee-
shin
•Romberg:
Stand upright, place
feet together, then
close eyes, palms up.
- loss of balance means
+ Romberg test

65. 11. GAIT
Posture of body and limbs
•Length, speed, and of steps
•Arm swing
•Turns
•Test with normal gait, toe walking, and heel
walking, tandem walking

66. Bibliography:
Basavanthappa BT, 4th edition, text book of
medical surgical nursing
Brunner and Suddarth’s ,13th edition, text book of
medical surgical nursing
Chintamani, U.S. editor Lewis, Indian editor
Mrinalini Mani, text book of medical surgical
nursing.

67. THANKYOU