Neuro

Neurological Assessment
Advanced Physical Assessment

Subjective
Chief
Complaint
HA, Dementia, Tremor, CVA, numbness, weakness, dizziness
HPI
Gather pertinent information to guide you to the patient

problem
OLDCART
PMH
Includes all sections as outlined in the syllabus

Pediatric Different format; Birth Hx; Developmental Hx;
HEADSS
Occupational & Environmental History
Family History
Psychosocial and Spiritual History
Adolescent Assessment HEADSS
Sexual,
Reproductive, Obstetric and Gynecologic History
ROS
Not covered in HPI

Health Maintenance Issues
Objective
(Document in a head to toe sequence)
Constitutional
General
appearance (NAD; WDWN) and vital signs
Lungs
Auscultate
Lat
for adventitious sounds: CTAB A&P&
CV
Auscultate
for abnormal heart sounds: RRR; No

murmurs, clicks, rubs
Neuro
Exam
Mental Status
Cranial Nerves
Motor Function
Reflexes
Sensory Function
Cerebellar Function
Nervous System
Central Nervous System
Peripheral Nervous System
CNS Brain Lobes and Functions
Composed of three parts

Brainstem
Cerebellum
Cerebrum
Four Lobes
Frontal
Parietal
Temporal
Occipital
Receives sensory input from
the spinal cord as well as
from its own nerves (e.g.,
olfactory and optic nerve)
Processes various sensory
inputs and initiates
appropriate and coordinated
motor outputs.
Structure and Function
Structure and Function
Mental Status
Mini Mental Exam (30 points)
Orientation
Registration
Attention and Calculation
Recall
Language
Depression Scale
Various Scales available
Anhedonia and Feeling Depressed
Yesavage Geriatric Depression Scale
http://www.bcbsga.com/provider/noapplication/plansbenefits
/diseasemgmt/notertiary/pw_ad050083.pdf
Cranial Nerve Function

Smell
I Olfactory
II
Optic
Vision (Visual fields; Snellen &

Ophthalmoscopic exam)
III Oculomotor Eye movements; pupillary constriction;

accomodation (EOMs, PERLA, visual
fields)
IV Trochlear
Eye movements (EOMs, PERLA, visual

fields)
General sensation of face, scalp and

teeth; chewing movements (Clench teeth;
corneal reflex)
Trigeminal
VI Abducens
Eye movements (EOMs, PERLA, visual

fields)
VII Facial
Taste; general sensation of palate and

external ear; lacrimal gland and
submandibular and sublingual gland
secretion;
facial expression (Smile; frown;
Cranial Nerve
VII Auditory
I (Vestibulocochle
ar)
Function
Hearing; equilibrium (Whisper;
Weber; Rinne)
IX Glossopharyngea Taste; general sensation of pharynx

l
and ear; elevates palate; parotid
gland secretion (Gag reflex; Ah)
X
Vagus
Taste; general sensation of pharynx,

larynx, and ear; swallowing;
phonation; parasympathetic to
heart and abdominal viscera (Gag
reflex; Ah)
XI Spinal Accessory Phonation; head, neck, and shoulder

movements (Turn head against
resistance; shrug shoulders)
XII Hypoglossal
Tongue movements (Stick out

tongue; push against cheek)
Motor Function
Assess the motor system
Muscle strength
Muscle bulk; strength; tone

Scale of 0 5
Page 668
Assess BUE
Assess BLE
Reflexes
Reflex Arc
Hyper-reflex response
CVA
Hyperthyroidism
Hypo-reflex response
Herniated
intervertebral disc
Biceps Reflex
Triceps Reflex
Brachioradialis Reflex
Patellar Reflex
Achilles Reflex
Babinski Reflex
Sensory Function
Cotton to all distal

extremities
Sharp & Dull do not
use a pin!!!
Vibration
Test bilateral index fingers and great toes

Examiners finger is under patients finger &
should also feel the vibration
Peripheral Neuropathy
Cerebellar
Touch my
finger, touch
your nose
Cerebellar
Observe
gait
Walk
on heels
Walk
on toes
Tandem
walk
Cerebellar
Perform
Romberg
Headache Pain
Migraine
Cluster
Tension
Sinusitis
HTN
Temporal arteritis
Elevated inflammatory
markers
High doses of cortisone
Loose eyesight if not treated
Meningitis
Brudzinskis sign
Kernigs sign
Red Flags Require Imaging Studies

Sign/Symptom
Differential Diagnoses
Sudden onset; worst

headache or
new/different
Subarachnoid hemorrhage
Increasing in severity or
frequency
Temporal arteritis; mass; lesion
Beginning after 50 years

of age, especially if
there is jaw pain
Meningitis; brain abcess; CA
Focal neurologic signs or

symptoms (other than
aura)
Mass, lesion, stroke, vascular

malformation
Papilledema
Mass, lesion, meningitis
Headache subsequent to Intracranial hemorrhage; subdural

head trauma
hematoma
Advanced
Physical Assessment
Comatose Patient
Glasgow test
Causes
Meningeal infection
Kernigs sign flexion/extension of the lower leg

Brudzinskis sign flexion of the neck
Increased intracranial pressure

Subarachnoid Hemorrhage
Cerebral lesion
Brain stem lesion
Metabolic encephalopathy
Seizure activity
Assessment
Pupil response
CNS Spinal Cord Injury
Connects PNS to brain

Receives information from
sensory neurons and
transmits to the brain
Highway for messages from
the motor areas in the brain
through motor neurons
Responsible for simple
reflexes
Effects of Various Lesions

Lower
Motor
Neuron
Pyrimidal
Tract
Extrapyrami
dal Tract
Major Effect
Flaccid
paralysis
Spastic
paralysis
Hyperactive
reflexes
Muscle
Appearance
Atropy
Fasciculation
s
Mild atrophy
from disuse
Rest tremor
Muscle Tone
Decreased
Increased
Increased
Muscle
Strength
Decreased or Decreased or
absent
absent
Normal
Coordination
Absent or
poor
Slowed
Absent or poor
No paralysis

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What are the components of a neurological exam?

What are the components of a neurological exam?

What are some common causes of headaches?

What are some common causes of headaches?

Neurological Assessment

Advanced Physical Assessment

HA, Dementia, Tremor, CVA, numbness, weakness, dizziness

Gather pertinent information to guide you to the patient

Includes all sections as outlined in the syllabus

Adolescent Assessment HEADSS

Reproductive, Obstetric and Gynecologic History

Not covered in HPI

(Document in a head to toe sequence)

appearance (NAD; WDWN) and vital signs

for adventitious sounds: CTAB A&P&

for abnormal heart sounds: RRR; No

Peripheral Nervous System

Advanced Physical Assessment

CNS Brain Lobes and Functions

Composed of three parts

Structure and Function

Advanced Physical Assessment

Structure and Function

Advanced Physical Assessment

Advanced Physical Assessment

Advanced Physical Assessment

Advanced Physical Assessment

Mini Mental Exam (30 points)

Various Scales available

Anhedonia and Feeling Depressed

Yesavage Geriatric Depression Scale

Advanced Physical Assessment

Advanced Physical Assessment

Advanced Physical Assessment

Cranial Nerve Function

Vision (Visual fields; Snellen &

III Oculomotor Eye movements; pupillary constriction;

Eye movements (EOMs, PERLA, visual

General sensation of face, scalp and

Eye movements (EOMs, PERLA, visual

Taste; general sensation of palate and

IX Glossopharyngea Taste; general sensation of pharynx

Taste; general sensation of pharynx,

XI Spinal Accessory Phonation; head, neck, and shoulder

Tongue movements (Stick out

Assess the motor system

Muscle bulk; strength; tone

Advanced Physical Assessment

Advanced Physical Assessment

Advanced Physical Assessment

Advanced Physical Assessment

Advanced Physical Assessment

Advanced Physical Assessment

Advanced Physical Assessment

Advanced Physical Assessment

Advanced Physical Assessment

Cotton to all distal

Advanced Physical Assessment

Test bilateral index fingers and great toes