NEUROLOGICAL ASSESSMENT

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Dec 13, 2013 (4 years and 19 days ago)

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NEUROLOGICAL ASSESSMENT

Donald Seery, M.D.

Via Christi Regional Medical Center

Family Practice

Wichita, KS

6 parts of Neurological Exam

Mental status

Cranial nerves

Motor

Sensory

Coordination

Reflexes

Mental Status

4 Basic States:

Alter

Lethargy

Semicoma

Coma

Cranial Nerves

CN I Olfactory

Cranial Nerves

CN II Optic

CN III Oculomotor

CN IV Trochlear

CN VI Abducens

Cranial Nerves: Midbrain

CN V Trigeminal

CN VII Facial

CN VIII Vestibulocochlea

Cranial Nerves: Medulla

CN IX Glossopharyngeal

CN X Vagus

CN XI Accessory

CN XII Hypoglossal

Motor

Key is drift of

Upper & lower

Extremities

Sensory

Pain

Temperature

Proprioception

(conscious/unconscious)

Light tough

Sensory: Key Points

Pain & Temp
-

cross at spinal level

Proprioception
-

conscious path crosses at
brainstem

-

unconscious proprioception is ipsilateral

Light tough
-

both


Coordination

Finger to nose & heel to shin

Rapid alternating movements

Key: testing cerebellum &

Basal Ganglia

Romberg

Takes 3 senses to maintain balance

Vision

Vestibular

Proprioception

Reflexes

Asymmetry important finding

Babinski
-

detects upper motor neuron lesion

Kernig’s
-

flex neck & hips also flex

Brudzinski’s
-

straight leg raising

The Unconscious Patient

Key Points

Hand drop from over head

Pupillary size & response to light

-

PERL

Abnormal eye movements

Grimacing, withdrawal from noxious stimuli

Babinski reflex