The document provides an overview of performing a neurological examination, which includes obtaining a thorough health history, conducting a physical exam assessing five components (cerebral function, cranial nerves, motor system, sensory system, and reflexes), and ordering diagnostic tests. The physical exam progresses from higher levels of cortical function to lower levels and tests things like mental status, cranial nerves, muscle strength, coordination, balance, reflexes, and sensory function. Common diagnostic tests mentioned are CT, MRI, EEG, EMG, lumbar puncture, and CSF analysis.

1. ASSESSMENT: Neurologic ExaminationMa. Tosca Cybil A. Torres, RN, MAN

2. AN IMPORTANT ASPECT OF THE NEUROLOGIC ASSESSMENT IS THE HISTORY OF THE PRESENT ILLNESS

3. HEALTH HISTORYShould include: OnsetCharacterSeverityLocation Duration Frequency of s/sxAssociated complaintsPrecipitating and aggravating factorsProgression, remission, and exacerbationPresence and absence of similar symptoms among family membersReview of medical history History of falls or traumaUse of alcohol, medications and illicit drugs

4. Common Clinical ManifestationsPain (chronic or acute) SeizuresDizziness and vertigo Visual disturbances WeaknessAbnormal sensation

5. Physical Examination A neurological assessment is divided into five components: Cerebral function Cranial nervesMotor system Sensory system Reflexes Follows a logical sequence and progresses from higher levels of cortical function (ex: abstract thinking) to lower levels of function (ex: determination of the integrity of the peripheral nerves)

6. I. Assessing cerebral function Interpretation and documentation of neurologic abnormalities, particularly mental status abnormalities, should be SPECIFICandNONJUDGMENTAL.

7. Mental StatusAssessment begins by observing client’s appearance and behaviorPostureGesturesMovementsFacial expressionsMotor activity Manner of speech LOCOrientation

8. State of Awareness

9. Intellectual function Serial 7sInterpretation of well-known proverbs/idiomsCapacity to recognize similaritiesJudgement

10. Though Content Is the patient’s thoughts:

11. Spontaneous

12. Natural

13. Clear

14. Relevant

15. Coherent

16. Check: IllusionsHallucinationspreoccupations

17. Emotional Status Assess:Affect

18. Mood

19. Consistency of verbal communication to non verbal cues Perception Agnosia- inability to interpret or recognize objects seen through the special senses. Visual

20. Auditory

21. Tactile

22. Body parts and relationships Motor Ability Ask client to perform a skilled actSuccessful performance requires the ability to understand the activity desired and normal motor strength

23. Language Ability Aphasia- deficiency in language functionBroca’s Aphasia (non-fluent aphasia)- speech output is severely reduced and is limited mainly to short utterances of less than four words.Wernicke’s Aphasia (fluent aphasia) -ability to grasp the meaning of spoken words is chiefly impaired, while the ease of producing connected speech is not much affected.Global aphasia- most severe form of aphasia, and is applied to patients who can produce few recognizable words and understand little or no spoken language. Global aphasics can neither read nor write.

24. Broca’s Aphasia

25. Wernicke’s AphasiaEx: I called my mother on the television and did not understand the door. It was too breakfast, but they came from far to near. My mother is not too old for me to be young.

26. II. Examining the Cranial Nerves

28. III. Examining the Motor SystemAssess muscle size, tone, and strength, coordination, and balanceNote for rigidity, spasticity and flaccidity

29. Muscle Strength Grading 0 – No contraction1 – Slight contraction, no movement2 – Full range of motion without gravity3 – Full range of motion with gravity4 – Full range of motion , some resistance5 – Full range of motion, full resistance

30. Balance and CoordinationRapid, alternating movementsPoint-to-point testing Ataxia- incoordination of voluntary muscle action Romberg test

31. IV. Examining the ReflexesStretch or Deep Tendon Reflexes A brisk tap to the muscle tendon using a reflex hammer produces a stretch to the muscle that results in a reflex contraction of the muscle. The muscles tested, segmental level, and grading of DTR's is listed below.Grading DTR's 0 – Absent1 – Decreased but present2 – Normal3 – Brisk and excessive4 – With clonus

32. Reflexes Biceps reflexTriceps reflexBrachioradialis reflexPatellar reflexAnkle reflexSuperficial reflexesCorneal Abdominal reflexesGagCremastericPlantarperianal

33. V. Sensory ExaminationThe sensory examination is largely subjective and requires the cooperation of the patient.

34. Assessment of the sensory system involves: Tactile sensation Superficial pain Vibration Integration of sensation ProprioceptionStereognosis

35. Diagnostic EvaluationCT scan

36. CT scan

37. MRI

38. Cerebral angiography

39. MyelographyAn x-ray of the spinal subarachnoid space after injection of a contrast agent into the spinal subarachnoid space through a lumbar puncture

40. Post myelography careHead elevated to 30-45 degrees for 3H or as prescribed by the APEncouraged to increase OFI Assess VS and ability to void Untoward signs------headache, fever, stiff neck, photophobia, and seizures

41. Electroencephalography (EEG)

42. Electromyography (EMG)

43. Lumbar Puncture

44. CSF analysisQueckenstedt’s test

45. End of discussion