2. Objectives
At the end of this class the learner should be able
to
Explain the common Neurological symptoms
perform an assessment of Neurologic system
Explain the difference between normal and
abnormal findings
Interpret Neurological findings
2
BY Endalew.H
3. OVER VEIW OF A/P NERVEOUS SYSTEM
The nervous system consists of two divisions:
The central nervous system (CNS)
The brain and spinal cord.
The peripheral nervous system, made up of
the cranial and spinal nerves.
12 pairs of cranial nerves
31 pairs of spinal nerves
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4. OVER VEIW OF A/P NERVEOUS SYSTEM cont’d
The peripheral nervous system divided into
The somatic, or voluntary, nervous system,
The autonomic, or involuntary, nervous
system.
Sympathetic and parasympathetic
The function of the nervous system is to control
all motor, sensory, autonomic, cognitive, and
behavioral activities.
4
BY Endalew.H
5. OVER VEIW OF A/P CONT’d….
• The brain is divided into three major areas:
the cerebrum, the brain stem, and the
cerebellum.
• The cerebrum is composed of two
hemispheres,
The thalamus, the hypothalamus, and the
basal ganglia.
Additionally, connections for the
olfactory and optic nerves are found in
the cerebrum. 5
BY Endalew.H
6. OVER VEIW OF A/P CONT’D
The brain stem includes the midbrain, pons,
medulla, and connections for cranial nerves III
and IV through XII.
The cerebellum is located under the cerebrum
and behind the brain stem
The brain accounts for approximately 2% of
the total body weight;
It weighs approximately 1,400 g in an verage
young adult .
6
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7. OVER VEIW OF A/P CONT’d
The spinal cord
Structure extending from the cerebral
hemispheres and serving as the connection
between the brain and the periphery.
Approximately 45 cm (18 in) long
It extends from the foramen magnum to
the lower border of the first lumbar
vertebra, where it tapers to a fibrous band
called the conus medullaris.
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8. OVER VEIW OF A/P CONT’d
The spinal cord is surrounded by the Vertebra
and Meninges
The spinal cord is an H-shaped structure with
nerve cell bodies (gray matter) surrounded by
ascending and descending tracts
The anterior horns contain cells with fibers
that form the anterior (motor) root
The posterior (upper horns) portion contains
cells with fibers that enter over the posterior
(sensory)
.
8
BY Endalew.H
9. OVER VEIW OF A/P CONT’d
SPINAL NERVES
The spinal cord is composed of
31 pairs of spinal nerves: 8 cervical,12
thoracic, 5 lumbar, 5 sacral, and 1 coccygeal.
Each spinal nerve has a ventral root and a
dorsal root
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BY Endalew.H
10. GENERAL CONSIDERATIONS
Common Neurologic symptoms are
Loss of consciousness
Seizure (convulsion) ,fit
Visual Disturbances
Syncope (Fainting)
Weakness or paralysis of part of the body(paresis and
plegia)
Abnormal body movements like tremor, epilepsy, seizure
Neurologic pain
Altered or loss of sensation
Neurological Examinations
10
BY Endalew.H
11. Seizures are the result of abnormal paroxysmal discharges
in the cerebral cortex, which then manifest as an
alteration in sensation, behavior, movement, perception,
or consciousness
The alteration may be short, as in a blank stare lasting
only a second, or of longer duration, such as a tonic-
clonic, grand mal seizure .
Seizures can occur as isolated events, such as when
induced by a
High fever,alcohol or drug withdrawal, or
hypoglycemia.
May also be a sign of a brain lesion.
Neurological Examinations
11
BY Endalew.H
12. Visual Disturbances
Range from the decreased visual acuity associated
with aging to sudden blindness caused by glaucoma.
Lesions of the eye itself (eg, cataract),
Lesions along the pathway (eg,tumor),
Lesions in the visual cortex (from stroke)
Abnormalities of eye movement (as in the
nystagmus)
Compromise vision by causing diplopia or double
vision
Neurological Examinations
12
BY Endalew.H
13. Syncope or fainting
Is state of unconsciousness characterized by
temporary loss of LOC & spontaneous recovery
It may occur without warning, or may be preceded
by symptoms of faintness “presyncope”)
Resulted from reduction in blood flow & shortage
of O2 supply to brain.
BY Endalew.H 13
14. Abnormal Sensation
Numbness, abnormal sensation, or loss of
sensation is a neurologic manifestation of both
central and peripheral nervous system disease.
Altered sensation can affect small or large
areas of the body.
Neurological Examinations
14
BY Endalew.H
15. The brain and spinal cord cannot be examined
as directly as other systems of the body.
Thus, much of the neurologic examination is
an indirect evaluation that assesses the
function of the specific body part or parts
controlled or innervated by the nervous
system.
A neurologic assessment is divided into five
components:
Neurological Examinations
15
BY Endalew.H
17. Assessing Cerebral Function
Cerebral abnormalities may cause disturbances in
Mental status,
Intellectual functioning,
Thought content
Patterns of emotional behavior.
There may also be alterations in perception,motor and
language abilities,
MENTAL STATUS
Observing the patient’s appearance and behavior
noting dress, grooming,and personal hygiene.
Posture, gestures, movements, facial expressions..
Neurological Examinations cont’d
17
BY Endalew.H
18. INTELLECTUAL FUNCTION
A person with an average IQ can repeat seven digits without
faltering and can recite five digits backward.
Eg: Ask the patient to count backward from 100 or to subtract
7 from 100, then 7 from that, and so forth (called serial 7s)
The capacity to interpret well-known proverbs
Tests abstract reasoning, which is a higher intellectual
function
Can the patient make judgements about situations
Eg:If the patient arrived home without a house key, what
alternatives are there?
Neurological Examinations
18
BY Endalew.H
19. THOUGHT CONTENT
During the interview, it is important to assess the
patient’s thought content.
Are the patient’s thoughts spontaneous, natural,
clear, relevant, and coherent?
Does the patient have any fixed ideas, illusions,
preoccupations, delusion ,hallucination, or
paranoid
What are his or her insights ?
Neurological Examinations
19
BY Endalew.H
20. EMOTIONAL STATUS
An assessment of cerebral functioning also includes the
patient’s emotional status. Is the patient’s affect
(external manifestation of mood) natural and even, or
irritable and angry, anxious, apathetic or flat, or
euphoric?
Does his or her mood fluctuate normally, or does the
patient unpredictably swing from joy to sadness during
the interview? Is affect appropriate to words and
thought content?
Are verbal communications consistent with nonverbal
cues?
Neurological Examinations
20
BY Endalew.H
21. PERCEPTION
Agnosia is the inability to interpret or recognize
objects seen through the special senses.
The patient may experience auditory or tactile
agnosia as well as visual agnosia.
The patient is shown a familiar object and asked to
identify it by name.
E.g: Placing a familiar object (eg, key, coin) in the
patient’s hand and having him or her identify it with
both eyes closed is an easy way to assess tactile
interpretation.
Neurological Examinations
21
BY Endalew.H
22. LANGUAGE ABILITY
The person with normal neurologic function can
understand and communicate in spoken and written
language. Does the patient
answer questions appropriately? Can he or she read a
sentence
from a newspaper and explain its meaning? Can the
patient write
his or her name or copy a simple figure that the
examiner has
drawn? A deficiency in language function is called
aphasia.
Neurological Examinations
22
BY Endalew.H
23. Cognitive function
Orientation to time, place, and person.
A change in the patient’s LOC is the earliest and
most sensitive indicator that his neurologic
status has changed
Ex :what is your name?(Orientation to person)
What is today’s data?( Orientation to time)
Where are you now? (Orientation to place)
Neurological Examinations cont’d
23
BY Endalew.H
24. Assess the three aspects to memory
Immediate recall by saying a series of
numbers and having the patient repeat them.
Recent memory by asking the patient to recall
something after 5 minutes has elapsed.
Remote memory refers to events in the distant
past.
Neurological Examinations cont’d
24
BY Endalew.H
25. Assessment of level of consciousness
The Glasgow Coma Scale
It is an objective method
A score of seven or less is accepted as coma
depends on the
eye opening, best motor response
verbal response.
(the deepest come) to 15 (the full alertness).
Neurological Examinations cont’d
25
BY Endalew.H
30. Peripheral nerves
includes the cranial nerves, the spinal nerves, and
the autonomic nervous system
Cranial Nerves
There are 12 pairs of cranial nerves.
Most cranial nerves innervate the head, neck, and special
sense structure.
Three are entirely sensory (I, II, VIII), five are motor (III,
IV, VI,XI, and XII), and four are mixed (V, VII, IX, and X)
.
BY Endalew.H 30
31. Examination of the Cranial Nerves
Of the 12 CNs, some are named according to their
function.
Examples of these are the Olfactory (smell), Optic
(vision),
Oculomotor (eye movements),
Abducens (abduction of the eye),
Facial (facial expression), and vestibulocochlear
(hearing and balance) nerves.
Neurological Examinations cont’d
31
BY Endalew.H
32. Knowing the names of the CNs makes it easy to
remember their function,
Thereby making their examination self-evident.
The following is helpful in recalling the names
of the CNs:
On old Olympus towering tops, a Finn and
German viewed some hops.
Oh, oh, oh; to trek and feel a great valley; ah! ha!
Another is this
Neurological Examinations cont’d
32
BY Endalew.H
35. Assessment of the Cranial nerves
Cranial nerve I (Olfactory nerve)
Ask the patient to identify substances with his eyes
closed.
First be sure that each nasal passage is open by
compressing one side of the nose
Asking the patient to sniff through the other.
The patient should then close both eyes.
Occlude one nostril and test smell in the other with
such substances as a peal of an orange, coffee, soap
Neurological Examinations cont’d
35
BY Endalew.H
36. Complete loss of the sense of smell is called
Anosmia
Anosmia is most commonly follows severe
traumatic brain injury,
May also be due to frontal tumors,
Particularly olfactory groove meningioma,
post infectious abnormalities of the nasal
mucosa, eg. cold
Neurological Examinations cont’d
36
BY Endalew.H
37. Cranial nerve II (Optic nerve)
Test visual acuity for far vision and near vision
using Snellen chart (eye chart),
reading news paper at 35 cm for near vision.
Using hand held card (held @ 14 inches) or
Snellen wall chart, assess each eye separately.
Allow patient to wear glasses.
Direct patient to read aloud line with smallest
lettering that they are able to see.
Neurological Examinations cont’d
37
BY Endalew.H
40. Examine visual fields by confrontation The
visual fields can be roughly assessed in the
neurologist’s office or at the bedside with so-
called finger perimetry (or digital
confrontation), .
The examiner sits directly in front of the
patient and the patient fixes one eye on the
examiner’s nose.
Neurological Examinations cont’d
40
BY Endalew.H
41. The examiner then moves a finger in each of
the four quadrants of the visual field, testing
each eye separately.
The patient is asked whether he or she can see
the finger.
This method can reveal a major visual field
defect, e. g., Bitemporal hemianopsia .
Neurological Examinations cont’d
41
BY Endalew.H
43. Inspect the optic fundi with your
ophthalmoscope, paying special attention to the
optic discs .
Ophthalmoscope is used for Inspection of the
optic nerve papillae (optic discs) .
Abnormal: indicates
Optic nerve lesion,
Papilledema,
Enlarged retinal veins
Neurological Examinations cont’d
43
BY Endalew.H
44. Checking for color vision
Using Ishihara’s test
Asking the individual to identify different
colors in the surrounding.
Funduscopy
Can be used to visualize the optic disk which
could be inflamed or edematous due
to increased intracranial pressure.
Neurological Examinations cont’d
44
BY Endalew.H
45. Cranial nerve III ( Oculomoter nerve)
Test pupillary reaction.
CNs 2&3 -Pupilary Response
Pupils modulate amount of light entering eye (like shutter
on camera lens)
Dark conditions :dilate; Bright :constrict
Direct response =s constriction in response to direct light
Consensual response =s constriction in response to light shined
in opposite eye
Light impulses travel away (afferents) from pupil via CN 2
& back (efferents) to cilliary muscles that control dilatation
via CN 3
Neurological Examinations cont’d
45
BY Endalew.H
46. Describing Pupilary Response
Normal recorded as: PERRLA(Pupils Equal,
Round, Reactive to Light and Accommodation)
with accommodation = to constriction occurring
when eyes follow finger brought in towards them,
directly in middle (i.e. when looking “cross
eyed”).
Abnormal responses can be secondary to: direct
or indirect damage to either CN 2 or 3
Medications e.g. sympathomimetics
(cocaine),Atropine dilate; narcotics (heroin)constrict.
Neurological Examinations cont’d
46
BY Endalew.H
47. Oculomoter also supply the lavatory palpebrae
,ocularis muscle.
Ptosis:
May indicate damage to cranial nerve three,
which helps to open the eyelid and to keep it
opened
And also supply the pupilary constrictor
muscles and muscles of accommodation of the
lens.
Neurological Examinations cont’d
47
BY Endalew.H
49. Cranial nerve III, IV, and VI, (Oculomoter,
troclear, and abducent nerves)
The third, fourth, and sixth cranial nerves are
checked together
Oculomoter nerve supply four extra ocular
muscles the eye(superior rectus,inferior
rectus,inferior oblique,medial rectus muscle)
Also raises lid & mediates pupilary constriction.
Neurological Examinations cont’d
49
BY Endalew.H
51. Pupils (assessment of cranial nerves
III,)
Inspect for equality, size, and shape
relation to light and accommodation.
Troclear nerve (fourth) Supplies the
superior oblique of the eye muscle
Abducent nerve (sixth) supplies the
lateral rectus of the eye muscle.
Neurological Examinations cont’d
51
BY Endalew.H
53. Test for extra ocular movement of the eye.
Eye movements are tested by having the
patient keep the head stationary and follow
the examiner’s finger with his or her eyes.
The motility of the eye is assessed along the
vertical and horizontal axes
Neurological Examinations cont’d
53
BY Endalew.H
54. Cranial nerve V (Trigeminal nerve)
Sensory part
The corneal reflex test (the blinking reflex)
Test for facial sensation.
Motor part
Test for Jaw movements.
While palpating the temporal and masseter
muscles.
Ask the patient to clench his or her teeth.
Note the strength of muscle contraction.
Neurological Examinations cont’d
54
BY Endalew.H
56. Testing temperature sensation. By two test tubes,
filled with hot and cold water, ask to identify by
closing the eye
Test for light touch, using a fine wisp of cotton.
Ask the patient to respond whenever you touch
the skin.
Test the corneal reflex. Ask the patient to look up
and away from you.
Approaching from the other side, touch the
cornea lightly with a fine wisp of cotton. .
Neurological Examinations cont’d
56
BY Endalew.H
60. Cranial nerve VII (facial nerve)
Motor function
Assess by observing the face for symmetry ,Mobility
Test for facial movements such as frowning, whistling,
and smiling, show upper teeth.
Lift eye brows
The ability of the eyes to remain closed against your
resistance.
Sensory function
Test for tasting ability of the anterior 2/3 of the tongue
(using sugar, salt solution )
Neurological Examinations cont’d
60
BY Endalew.H
64. Cranial nerve VIII (auditory nerve)
Test for hearing.
Crude tests hearing –Rub fingers next to either
ear; whisper & ask pt repeat words, Watch tick
test
Assess hearing. If hearing loss is present,
Test for lateralization,(Weber Test)
Test for conductive hearing loss(Rinne Test)
Place vibrating fork mid line skull
Sound should be heard equally R and L ears,
bone conducts to both sides.
Neurological Examinations cont’d
64
BY Endalew.H
69. Cranial nerve IX (Glosso pharyngeal)
Test for tasting ability of the tongue for bitter
taste (posterior 1/3)
Cranial nerve IX and X (Glosso pharyngeal
and Vagus) nerve
Test for swallowing.
Note the rise of the soft palate and Uvula.
Test for gag reflex.
Neurological Examinations cont’d
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BY Endalew.H
72. Cranial nerve XI (spinal accessory nerve)(Motor)
Test for movement of the shoulder and neck
Innervates sternocleiod mastoid and trapezius
muscles
Palpate and note strength of trapezius muscles while
patient shrugs shoulders against resistance.
Palpate and note strength of each sternocleidomastoid
muscle as patient turns head against opposing
pressure of the examiner’s hand.
.
Neurological Examinations cont’d
72
BY Endalew.H
75. Cranial nerve XII (hypoglossal nerve)(Motor )
Inspect the tongue for Symmetry and movement.
Inspect the tongue, note: wasting , tremors,
fasciculation
Neurological Examinations cont’d
75
BY Endalew.H
77. Lesions of this nerve produce atrophy and
weakness of the tongue.
A unilateral lesion usually produces
the tongue deviates to the weaker side
because of the predominant force of the intact
contralateral m., which “pushes” the tongue
across the midline.
Neurological Examinations cont’d
77
BY Endalew.H
80. Assessment of Motor System
In motor system assessment focuses on:-
Body position (Gait and station)
Involuntary movements.
Characteristics of muscle (Bulk, Tone or Strength
(Power).
Inspection:
Sizes (inspect all muscle groups for size, compare
one side with other).
Muscle Strength (power)
Neurological Examinations cont’d
80
BY Endalew.H
81. Muscle strength is assessed and rated on a five-point
scale in all four extremities.
5/5. Normal full strength, muscle is able to move
actively against the effects of gravity and applied
resistance.
4/5- muscle is able to move actively against the effect
of gravity with weakness to applied resistance.
3/5 muscle is able to move with support against effect of
gravity alone.
Neurological Examinations cont’d
81
BY Endalew.H
82. 2/5 Muscle is able to move with gravity
eliminated.(able to move from side to side)
1/5 Muscle contraction is palpable and visible
trace or flicker movement occur.
0/5 Muscle contraction movement is not
detectable.(no muscle contraction)
Neurological Examinations cont’d
82
BY Endalew.H
83. Muscle Tone
Tone is the normal degree of tension (contraction) in
voluntarily relaxed muscles.
It shows as mild resistance to passive stretch.
To test muscle tone, move the extremities through a
passive range of motion.
When tone decreasesTone (hypotonic).
The muscles are soft, flabby or flaccid.
Increased muscle tone exists: if the muscles are
resistance to movement.(spasticity),Rigidity
Neurological Examinations cont’d
83
BY Endalew.H
84. Assessment of Coordination and Movement Balance
Coordination is smooth, accurate performance of motor
activity.
Testing coordination in the upper extremities include
Finger- to-finger test.
Finger- to-nose test
Rapid alternate movement of the hands.
Testing coordination in the lower extremities include:
Heel to-shin test.
Done by having patient to run the heel down the
anterior surface of the tibia, Test each leg in turn)
Neurological Examinations cont’d
84
BY Endalew.H
85. Examination for Balance
Romberg’s test:
Ask the person to stand up with feet together and
arms at the sides, once in a stable position,
Ask the person to close the eyes and to hold the
position, wait about 20 seconds
Slight swaying is normal.
Positive Romberg’s signs, loss of balance occurs
with cerebral ataxia, alcoholic intoxication)
Neurological Examinations cont’d
85
BY Endalew.H
86. Assessing for Reflex
Two types of reflex.
Superficial or cutaneous reflexes.
Deep tendon or muscle- stretch reflexes.
Superficial or cutaneous reflexes are elicited by
cutaneous or mucous membrane stimulation.
Abdominal reflex, plantar reflex, corneal reflex,
pharyngeal (gag) reflex, cremasteric reflex. (Only
in male)
Neurological Examinations cont’d
86
BY Endalew.H
87. Abdominal Reflex
Stroke patient’s abdomen diagonally from upper
and lower quadrants toward umbilicus.
Normal response :
Contraction of rectus abdominis.
Umbilicus moves toward stimulus.
Cremasteric Reflex
Gently stroke inner aspect of a male’s thigh.
Normal response: Testes rise.
BY Endalew.H 87
Neurological Examinations cont’d
89. Deep Tendon (muscle stretch) reflexes
Are elicited by striking a muscle’s tendon of
insertion using a reflex hammer.
Example – upper limbs
Normal response
Biceps (C5 C6)
Forearm flexion
Triceps (C7, C8)
Forearm extension
Neurological Examinations cont’d
89
BY Endalew.H
90. Lower Limbs
Patellar /knee Jerk (L3, L4)
Normal response- leg extension
Normal response- Plantar flexion of the foot
Neurological Examinations cont’d
90
BY Endalew.H
91. Abnormal Reflexes
Pathologic (abnormal) reflexes are reflexes that do not
normally occur.
Their presence indicates neurologic disorders (CNS
abnormality).
Babinskin’s Reflex- tested by gently scraping the sole
of the foot with a blunt paint.
Normal Response: (absent babinski’s response) is
plantar flexion of the toes.
Abnormal- is dorsiflexion of the big toe and often
fanning of other toes.
Neurological Examinations cont’d
91
BY Endalew.H
93. The reflex response is graded on a 4-point scale.
4+ hyperactive with clonus
3+hyper active
2+ Normal
1+ hypoactive
0 No response
Clonus: is the presence of rhythmic involuntary
contractions, most often at the foot and ankle.
Sustained clonus confirms CNS involvement
Neurological Examinations cont’d
93
BY Endalew.H
94. Assessment of Sensory Examination
includes:
Pain and temperature (by spinothalamic tract).
Position and vibration (by posterior column
tract)
Light touch.
Two-point discrimination.
Neurological Examinations cont’d
94
BY Endalew.H
96. Pain.
Use a sharp safety pin or other suitable tool.
Ask the patient, “Is this sharp or dull?”or,
when making comparisons, “Does this feel the
same as this?” Apply the lightest pressure
needed for the stimulus to feel sharp,
Neurological Examinations cont’d
96
BY Endalew.H
98. Temperature. (This is often omitted if pain
sensation is normal, but include it if there is
any question.)
Use two test tubes, filled with hot and cold
water, or a tuning fork heated or cooled by
water.
Touch the skin and ask the patient to identify
“hot” or “cold.
Neurological Examinations cont’d
98
BY Endalew.H
99. ASSISSIN FOR VIBRATION
Place a vibrating tuning fork over a finger
joint, and then over a toe joint.
Ask patient to tell you when vibration is felt
and when it stops.
If patient is unable to detect vibration, test
proximal areas as well.
If vibratory sensation is intact distally, it is
intact proximally.
BY Endalew.H 99
Neurological Examinations cont’d
101. Vibratory sensation intact bilaterally in upper
and lower extremities.
A b n o r m a l f i n d i n g s
Diminished/absent vibration sense:
Peripheral nerve damage caused by alcoholism,
diabetes, or damage to posterior column of
spinal cord.
BY Endalew.H 101
Neurological Examinations cont’d
103. Assessment for Stereognosis
A s s e s s m e n t T e c h n i q u e
With patient’s eyes closed, place a familiar object, such
as a coin or a key, in patient’s hand, and ask patient to
identify it.
Test both hands using different objects.
Stereognosis intact bilaterally.
A b n o r m a l f i n d i n g s
Abnormal findings suggest a lesion or other disorder
involving sensory cortex or a disorder affecting
posterior column.
BY Endalew.H 103
Neurological Examinations cont’d
105. With patient’s eyes closed, place a familiar object,
such as a coin or
a button, in patient’s hand, and ask patient to
identify it.
Test both hands using different objects.
Stereognosis intact bilaterally.
A b n o r m a l f i n d i n g s
Abnormal findings suggest a lesion or other
disorder involving sensory cortex or a disorder
affecting posterior column.
BY Endalew.H 105
Neurological Examinations cont’d
106. Assessment of Graphesthesia
A s s e s s m e n t t e c h n i q u e
With patient’s eyes closed, use point of a
closed pen to trace a number on patient’s hand,
and ask patient to identify the number.
Graphesthesia intact bilaterally.
Abnormal findings suggest lesion or other
disorder involving sensory cortex or disorder
affecting posterior column.
BY Endalew.H 106
Neurological Examinations cont’d
108. A S S E S S M E N T T E C H N I Q U E / N O R M A
L VA R I AT I O N S
Ability to differentiate between two points of
simultaneous stimulation.
Using ends of two toothpicks, stimulate two points on
fingertips simultaneously.
Gradually move toothpicks together, and assess
smallest distance at which patient can still discriminate
two points (minimal perceptible distance).
Document distance and location.
BY Endalew.H 108
Neurological Examinations cont’d
109. The normal discriminatory distance depends on
the area tested, with the fingertips being the most
discriminating.
Discriminates between two points on fingertips no
more than 0.5 cm apart and on hands no more
than 2 cm apart.
Abnormal findings suggest lesion or other
disorder involving sensory cortex or disorder
affecting posterior column.
BY Endalew.H 109
Neurological Examinations cont’d
111. Assessment of point localization
Ability to sense and locate area being stimulated.
With patient’s eyes closed, touch an area;
then have patient point to where he or she was touched.
Test both sides and upper and lower extremities.
Normal response: Point localization intact.
A B N O R M A L F I N D I N G S
Abnormal findings suggest lesion or other disorder
involving sensory cortex or disorder affecting posterior
column.
BY Endalew.H 111
Neurological Examinations cont’d
113. Meningeal Signs
Classic signs of meningitis include
Nuchal rigidity (extension of neck stiffness),
Kernig’s sign and Brudzinski’s signs.
To assess for Kernig’s sign :
have the patient lie supine with one leg flexed.
Tell him or her to try to extend the leg while you
apply pressure to the knee contraction and pain of
the hamstring muscles and resistance to extension
are positive signs of meningitis.
BY Endalew.H 113
Neurological Examinations cont’d
114. To assess for Brudzinski’s sign
Have the patient lie supine with her or his head
flexed to her or his chest. Flexion of the hips is
a positive sign of meningitis.
BY Endalew.H 114
Neurological Examinations cont’d
116. References
B. Bates,Guide th physical examination and
history taking,10th edition
Michael swash,hutchison’s clinical methods,9th
edition,2003
Lewis, h.d(2002)Medical-Surgical, nursing
assessment and management of clinical
problem 5th edition,2002
Suzanne c. Branda g.(2008)Medical-Surgical,
nursing.11th edition,2008
