NEUROLOGICAL
ASSESSMENT
History
• Headaches?
• Convulsions
• Vertigo
• Syncope
• Dysphagia
• Dysphasia
• History of Head Injury
History
• Paresis
• Paralysis
• Tremors
• Incontinence
• Dysmetria
Psychiatric History
• Any emotional problems?
• Tense / anxious
• Insomnia
• Depression
• Ever sought psychological counseling or psychiatric help?
Neurological Exam
• I. Mental Status
• II. Cranial Nerves I - XII
• III. Motor System
• IV. Sensory System
• V. Reflexes
Mental Status
• Consciousness / Orientation
TIME
PLACE
PERSON
Oriented X 3
or Awake, Alert, Oriented X 3
or AAO X 3
Levels of Consciousness (LOC)
• Alert
•
•
•
•
•
Lethargic
Obtunded
Stuporous
Semicomatose
Comatose
– Decorticate
– Decerebrate
Glascow Coma Scale
• Best Eye Opening Response
•
Best Verbal Response
•
Best Motor Response
Glascow Coma Scale
• Best Eye Opening Response
Purposeful and spontaneous ………..4
To voice …………………………….3
To pain ……………………………...2
No response …………………………1
Untestable …………………………..U
Glascow Coma Scale
• Best Verbal Response
Oriented …………………..………..5
Disoriented ………………………….4
Inappropriate words ….……………..3
Incomprehensible sounds ...…………2
No response …………………………1
Untestable …………………………...U
•
Best Motor Response
Glascow Coma Scale
• Best Motor Response
Obeys commands…………..………..6
Localizes pain ...…………………….5
Withdraws to pain ...….……………..4
Flexion to pain...…………………..…3
Extension to pain ……………………2
No response …………………………1
Untestable …………………………...U
Mental Status
• General Behavior
•
•
•
•
Speech / Language
Dress
Hygiene
Mood
Mental Status
• Facial Expression
• Verbal Expression
• Emotional Status
• Thought Content
Mental Status
• Intellectual Performance
– Memory
– Attention
– Abstract Reasoning
– Judgement
– Sensory Perception & Coordination
– Information
– Vocabulary
Mini-Mental Status Exam
Cranial Nerves I - XII
I
Olfactory
Smell
II
Optic
Vision
III Oculomotor EOMs / Pupils
IV Trochlear
EOMs
V
Trigeminal
Face/Jaw
VI Abducens
EOMs
Cranial Nerves I - XII
VII
Facial
Facial Expression/Taste
VIII Auditory
Hearing
IX Glossopharyngeal Taste/Swallow
X
Vagus
Swallow, Pharynx etc.
XI Spinal Accessory Head & Shoulders
XII
Hypoglossal
Tongue Position
3 Systems of Motor System
• Corticospinal Tract
•
Extrapyramidal System
•
Cerebellar System
Motor System
• Body Position
• Involuntary Movements
• Muscle Bulk
• Muscle Tone
• Muscle Strength
Elbow, Wrist, Grip, Finger Abduction,
Opposition of Thumb, Trunk, Hip,
Coordination of Muscle Movement
• Rapid Alternating Movements (RAM)
– Arms
– Legs
• Point to Point Movements
– Arms
– Legs
• Gait
– Tandem Walk
Coordination of Muscle Movement
• Gait
– Tandem Walk
– Walk on Toes, Heels
– Hop in Place
– Shallow Knee Bend
– Rise from Sitting Position
– Step up on Sturdy Stool
Coordination of Muscle Movement
• Stance
– Romberg Test
– Pronator Drift
Sensory System
Spinal Nerves
Cervical
Thoracic
Lumbar
Sacral
Coccygeal
Dermatomes
Sensory System
Knee, Ankle
•
•
Compare symmetrical areas on arms, legs, trunk
Compare distal with proximal for:
Pain
Temperature
Touch
Vibration
Position
Sensory System
Discriminative Sensations
Stereognosis
Graphesthesia
Two-point Discrimination
Point Localization
Extinction
Reflexes
Grading:
0 = No response
1+= Diminished, Low Normal
2+ = Average, Normal
3+ = Brisker than Average
4+ = Hyperactive
Reflexes
Knee (Patellar)
Ankle (Achilles)
Plantar (Babinski) Response
Triceps
Biceps
Brachioradialis
Neonatal Reflexes
Moro
Palmar Grasp
Rooting Reflex
Stepping (Dancing)
Tonic Neck (Fencing)
Babinski
Denver Developmental Screening Test
• Accomplishments for children between birth & 6 years
• 4 Scales:
Personal-Social
Fine Motor
Language
Gross Motor