Neurologic System
Chapter 23
Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.
Chapter 23: Neurologic System

Structure and Function

Subjective Data—Health History Questions

Objective Data—The Physical Exam

Abnormal Findings
Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.
Slide 23-2
Chapter 23: Neurologic System
Structure and Function
Central Nervous System (CNS)

Cerebral cortex

Hypothalamus

Frontal lobe

Cerebellum

Parietal lobe

Brainstem

Occipital lobe

Midbrain

Wernicke’s area

Pons

Broca’s area

Medulla

Basal ganglia

Thalamus

Spinal cord
Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.
Slide 23-3
Chapter 23: Neurologic System
Cerebral Cortex
Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.
Slide 23-4
Chapter 23: Neurologic System
Components of the Central
Nervous System
[PRODUCTION NOTE: Please insert Figure 23-2 (from Jarvis Physical
Examination and Health Assessment, 5e, ISBN: 978-1-4160-3243-4)]
© Pat Thomas, 2006.
Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.
Slide 23-5
Chapter 23: Neurologic System
Structure and Function
(cont.)
Pathways of the CNS
 Crossed representation
 Sensory pathways



Spinothalamic tract
Posterior (dorsal) column
Motor pathways

Corticospinal or pyramidal tract
 Extrapyramidal tracts
 Cerebellar system


Upper motor neurons
Lower motor neurons
Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.
Slide 23-6
Chapter 23: Neurologic System
Sensory Pathways
© Pat Thomas, 2006.
Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.
Slide 23-7
Chapter 23: Neurologic System
Motor Pathways
© Pat Thomas, 2006.
Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.
Slide 23-8
Chapter 23: Neurologic System
Structure and Function
(cont.)
Peripheral Nervous System

Cranial nerves

Spinal nerves

Autonomic nervous system

Reflex arc
Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.
Slide 23-9
Chapter 23: Neurologic System
Reflex Arc
Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.
Slide 23-10
Chapter 23: Neurologic System
Subjective Data—
Health History Questions

Headache

Head injury

Dizziness/vertigo

Seizures

Tremors

Weakness
Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.
Slide 23-11
Chapter 23: Neurologic System
Health History Questions
(cont.)

Incoordination

Numbness or tingling

Difficulty swallowing

Difficulty speaking

Significant history

Environmental/occupational hazards
Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.
Slide 23-12
Chapter 23: Neurologic System
Objective Data—
The Physical Exam

Preparation




Screening neurologic examination
Complete neurologic examination
Neurologic recheck
Equipment needed







Penlight
Tongue blade
Cotton swab
Cotton ball
Tuning fork (128 or 256 Hz)
Percussion hammer
Occasionally need: familiar aromatic substance
Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.
Slide 23-13
Chapter 23: Neurologic System
Objective Data—The Physical Exam
(cont.)
Test Cranial Nerves

VII—Facial

I—Olfactory

II—Optic

III—Oculomotor,
IV—Trochlear,
VI—Abducens

VIII—Acoustic
(vestibulocochlear)
V—Trigeminal

IX—Glossopharyngeal,
X—Vagus


Motor function

Sensory function

Corneal reflex

Motor function

Sensory function

Motor function

Sensory function

XI—Spinal accessory

XII—Hypoglossal
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Slide 23-14
Chapter 23: Neurologic System
Objective Data—The Physical Exam
(cont.)
Motor System—Inspect and palpate

Muscles

Size

Strength

Tone

Involuntary
movements

Cerebellar function

Balance tests
• Gait
• Tandem walking
• Romberg’s test
• Shallow knee bend

Coordination and skilled
movements
• Rapid alternating movements
• Finger-to-finger test
• Finger-to-nose test
• Heel-to-shin test
Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.
Slide 23-15
Chapter 23: Neurologic System
Objective Data—The Physical Exam
(cont.)
Sensory System

Person is alert,
cooperative, and
comfortable

Guidelines for sensory
testing

Spinothalamic tract

Pain

Temperature

Light touch

Posterior column tract

Vibration

Position (kinesthesia)

Tactile discrimination
(fine touch)
•
•
•
•
•
Stereognosis
Graphesthesia
Two-point discrimination
Extinction
Point location
Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.
Slide 23-16
Chapter 23: Neurologic System
Objective Data—The Physical Exam
(cont.)

Test the stretch or deep
tendon reflexes








Technique
Grading
Reinforcement
Biceps reflex
Triceps reflex
Brachioradialis reflex
Quadriceps reflex
Achilles reflex (“ankle jerk”)
• Clonus

Test the superficial
reflexes



Abdominal reflex
Cremasteric reflex
Plantar reflex
Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.
Slide 23-17
Chapter 23: Neurologic System
Objective Data—The Physical Exam
(cont.)


Neurologic recheck
Level of consciousness







Person
Place
Time
Motor function
Pupillary response
Vital signs
Glasgow Coma Scale (GCS)
Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.
Slide 23-18
Chapter 23: Neurologic System
Sample Charting
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Slide 23-19
Chapter 23: Neurologic System
Sample Charting
(cont.)
Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.
Slide 23-20
Chapter 23: Neurologic System
Sample Charting
(cont.)
Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.
Slide 23-21
Chapter 23: Neurologic System
Abnormal Findings
Abnormalities in Muscle Movement

Paralysis

Rest tremor

Fasciculations

Intention tremor

Tic

Chorea

Myoclonus

Athetosis

Tremor
Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.
Slide 23-22
Chapter 23: Neurologic System
Abnormal Findings for Advanced
Practice
Abnormal Gaits

Spastic hemiparesis

Cerebellar ataxia

Parkinsonian (festinating)

Scissors

Steppage or footdrop

Waddling

Short leg
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Slide 23-23
Chapter 23: Neurologic System
Abnormal Findings
Common Patterns
of Sensory Loss

Peripheral neuropathy

Individual nerves or roots

Spinal cord hemisection (Brown-Séquard
syndrome)

Complete transection of spinal cord

Thalamus

Cortex
Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.
Slide 23-24
Chapter 23: Neurologic System
Abnormal Findings
Abnormal Postures

Decorticate rigidity

Decerebrate rigidity

Flaccid quadriplegia

Opisthotonos
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Slide 23-25
Chapter 23: Neurologic System
Which area of the brain is most likely
affected if the patient is having trouble
with the finger-to-nose test?
A. Cerebellum
B. Cerebrum
C. Hypothalmus
D. Brain stem
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Slide 23-26
Chapter 23: Neurologic System
Vibratory sense is most frequently
affected in cases of
A. Heart disease
B. Crohns’ disease
C. Lung Cancer
D. Diabetes
Elsevier items and derived items © 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.
Slide 23-27