Denise Coffey MSN, RN
Central Nervous System (CNS)
 Cerebral cortex
 Hypothalamus
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Frontal lobe
Parietal lobe
Occipital lobe
Wernicke’s area
Broca’s area
Basal ganglia
 Thalamus
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Cerebellum
 Brainstem
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Midbrain
Pons
Medulla
Spinal cord
Slide 23-2
Pathways of the CNS
 Crossed representation
 Sensory pathways
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Motor pathways
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Spinothalamic tract
Posterior (dorsal) column
Corticospinal or pyramidal tract
Extrapyramidal tracts
Cerebellar system
Upper motor neurons
Lower motor neurons
Slide 23-3
Slide 23-4
[PRODUCTION NOTE: Please insert Figure 23-2 (from Jarvis Physical
Examination and Health Assessment, 5e, ISBN: 978-1-4160-3243-4)]
© Pat Thomas, 2006.
Slide 23-5
© Pat Thomas, 2006.
Slide 23-6
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Headache
Head injury
Dizziness/vertigo
Seizures
Tremors
Weakness
Slide 23-7
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Preparation
Screening neurologic examination
 Complete neurologic examination
 Neurologic recheck
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Equipment needed
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Penlight
Tongue blade
Cotton swab
Cotton ball
Tuning fork (128 or 256 Hz)
Percussion hammer
Occasionally need: familiar aromatic substance
Slide 23-8
Test Cranial Nerves
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I—Olfactory
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II—Optic
III—Oculomotor,
IV—Trochlear,
VI—Abducens
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V—Trigeminal
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Motor function
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Sensory function
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Corneal reflex
VII—Facial
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Motor function
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Sensory function
VIII—Acoustic
(vestibulocochlear)
IX—Glossopharyngeal,
X—Vagus
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Motor function
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Sensory function
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XI—Spinal accessory
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XII—Hypoglossal
Slide 23-9
Motor System—Inspect and palpate
 Muscles
 Cerebellar function
Size
 Strength
 Tone
 Involuntary
movements
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Balance tests
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Gait
Tandem walking
Romberg’s test
Shallow knee bend
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Rapid alternating movements
Finger-to-finger test
Finger-to-nose test
Heel-to-shin test
Coordination and skilled
movements
Slide 23-11
Sensory System
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Person is alert,
cooperative, and
comfortable
Guidelines for sensory
testing
Spinothalamic tract
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Pain
Temperature
Light touch
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Posterior column tract
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Vibration
Position (kinesthesia)
Tactile discrimination
(fine touch)
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Stereognosis
Graphesthesia
Two-point discrimination
Extinction
Point location
Slide 23-12
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Test the stretch or deep
tendon reflexes
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Technique
Grading
Reinforcement
Biceps reflex
Triceps reflex
Brachioradialis reflex
Quadriceps reflex
Achilles reflex (“ankle jerk”)
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Test the superficial
reflexes
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Abdominal reflex
Cremasteric reflex
Plantar reflex
 Clonus
Slide 23-13
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Neurologic recheck
Level of consciousness
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Person
Place
Time
Motor function
Pupillary response
Vital signs
Glasgow Coma Scale (GCS)
Slide 23-14
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Oculomotor response (Cranial nerve III)
Size, equality, and roundness of pupils
assessed
Size measured in millimeters
Evaluated for symmetry in size and response to
light stimulus
Brisk, sluggish, non-reactive
Consensual reaction of opposite pupil at same
time
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Assess accommodation by holding finger 4-6
inches from client’s nose and then pull out to
18 inches.
As finger moves away pupil will accommodate
by dilating, as finger moves closer, constricting
PEARLA- Pupils equal and reactive to light
and accommodation
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Ability to follow commands
Muscle tone
Muscle strength
Coordination
Balance (Romberg test)
Posturing (Decorticate, Decerebrate)
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Tactile sensation
Pain
Temperature
Vibratory sensation
Tactile discrimination
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Superficial
Deep tendon
Biceps
Triceps
Patellar
Achilles
Plantar (Babinski Response)
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Clear and appropriate
Confused
Inappropriate
Garbled
Aphasia (Expressive, Receptive)
Limited hearing
Use of hearing aids
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