447409371-78222493-Neurological-Assessment-and-Examination-1-ppt.ppt

NEUROLOGICAL EXAMINATION BASIC CONCEPT IN ANIMAL LAB FOR NMC PERMISSION.

1. Neurological Assessment
and Examination

2. Neurological Assessment
and Examination
The basic aim is to answer the following:
Is there a neurological problem?
What is the site of the lesion in the nervous system?
(anatomical diagnosis)
What are the pathological conditions that can cause
the lesion? (pathological diagnosis)
What is the most likely diagnosis?

3. The neurological assessment involves:
I.History of illness
II.Clinical examination:
1.Handedness of the patient
2.Physical developement and general appearance
3.Vital signs
4.General examination
-Head and neck
-Chest
-Abdomen
-Lower limbs
-skeletal
5.Neurological examination
Neurological Assessment and Examination

4. I.The Neurological History:
Neurological Assessment and Examination
History involves questioning and observing
the patient.
Observe how the patient walks into the
examining room, how he speaks, and how he
climbs to examination couch.

5. I.The Neurological History:
Neurological Assessment and Examination
Personal data
Neurological complaint
Present history
Past history
Family history
Drug history
Social history

6. II. Neurological examination
1-Mental state
2-Speech
3-Cranial nerves
4-Limbs and trunk -Posture and deformity
-Muscle state
-Muscle tone
-Muscle power
-Sensations .Superficial
. Deep
. Cortical
-Reflexes. Superficial
. Deep
. Pathological
-Coordination and gait
-Sphincters

7. Neurological Examination:
Neurological Assessment and Examination
Mental state:
1.Conscious state
This can be assessed by using the "Glasgow Coma Scale".
2.Orientation
3.Memory
4.Emotional state
5.Presence of delusions or hallucinations

8. Neurological Assessment and Examination
The Glasgow Coma Scale
1.Eye Opening Response
-Spontaneous 4 points
-To verbal command 3 points
-To pain 2 points
-No response 1 point
2.Best Verbal Response
-Oriented 5 points
-Disoriented (Confused) 4 points
-Inappropriate words 3 points
-Incomprehensible speech (sounds) 2 points
-No response 1 point
3.Best Motor Response
-Obeys commands 6 points
-Localizing to pain 5 points
-Flexion withdrawal in response to pain 4 points
-Spastic flexion (decorticate posturing) 3 points
-Extension in response to pain (decerebrate posturing) 2 points
-No response 1 point

9. Neurological Assessment and Examination
The Glasgow Coma Scale
Categorization:
-A score is applied to each category and the total summed to
give an overall value ranging from 3-15.
Head Injury Classification:
-Severe Head Injury GCS score of 8 or less
-Moderate Head InjuryGCS score of 9 to 12
-Mild Head Injury GCS score of 13 to 15

10. Neurological Examination:
Neurological Assessment and Examination
Speech:
There are four main speech disorders:
1.Mutism
2.dysphonia
3.Dysarthria
4.Dysphasia

11. Neurological Examination:
Neurological Assessment and Examination
Cranial Nerves Examination:
CN I.Olfactory nerve:
Tested by patient sniffing non irritant odors in each nostril
separately.
-Causes of anosmia in neurosurgery:
1.Following head injury; skull base fracture.
2.Tumors involving anterior cranial fossa.

12. Neurological Assessment and Examination
Cranial Nerves Examination:
CN II. Optic nerve:
1.Fundus examination:
a.Papilloedema
b.Optic atrophy
2.Visual acuity: by Snellen's chart
3.Visual field: using either confrontation or perimeter
(automated, or Bjerrum screen).
4.Light reflex

13. Neurological Assessment and Examination
Cranial Nerves Examination:
CN III, IV, VI.
1.Position of the eyelids
2.Pupils
-Size, shape, equality
-Light and accommodation reflexes
3.Extraocular movement

14. Neurological Assessment and Examination
Cranial Nerves Examination:
CN V. Trigeminal nerve:
-Motor:Is tested while the patient
clenches their teeth; testing the power
of jaw opening and lateral deviation of
the jaw.
-Sensory:Test facial sensation over the
three divisions (ophthalmic, maxillary,
mandibular).
-Reflexes:Test corneal and Jaw jerk
reflexes.

15. Neurological Assessment and Examination
Cranial Nerves Examination:
CN VII. Facial nerve:
Motor:Facial movements (upper and
lower face)
-Upper motor neuron facial palsy
-Lower motor neuron facial palsy
Sensory: Sensation over the anterior two
third of the tongue.
Reflexes: Glabellar, shrimer's test.

16. Neurological Assessment and Examination
Cranial Nerves Examination:
CN VIII. Vestibulocochlear nerve:
-Vestibular part:Balance, Nystagmus,
Caloric test
-Cochlear part:Hearing acuity, Rinne's
and Weber's tests

17. Neurological Assessment and Examination
Cranial Nerves Examination:
CN IX. Glossopharyngeal nerve:
-Motor:stylopharyngeus muscle.
-Sensory:posterior third of the tongue.
-Reflexes:Gag reflex via the pharyngeal
mucosa.

18. Neurological Assessment and Examination
Cranial Nerves Examination:
CN X. Vagus nerve:
-Motor:uvula movement.
-Reflexes:Gag reflex.

19. Neurological Assessment and Examination
Cranial Nerves Examination:
CN XI. Accessory nerve:
-Test Trapezius and Sternomastoid
muscles (contour and power).

20. Neurological Assessment and Examination
Cranial Nerves Examination:
CN XII. Hypoglossal nerve:
-Extrude the tongue and push the inner
side of the cheek with it. Also detect
wasting, weakness and fasciculations.It
will deviate toward side of weakness.

21. Neurological Examination:
Neurological Assessment and Examination
Examination of the limbs and trunk:
-Posture and deformity
-Muscle state
-Muscle tone
-Muscle power
-Sensations
-Reflexes
-Coordination and gait
-Sphincters

22. Examination of the limbs and trunk:
Neurological Assessment and Examination
Posture and deformity
-The patient's posture may indicate an underlying
neurological disability.
-Posture due to sciatica, poliomyelitis, decerebrate
posture.
-Deformity due to peripheral nerve injury.

23. Examination of the limbs and trunk:
Neurological Assessment and Examination
Muscle state
-Muscle atrophy and wasting
-Muscle hypertrophy
-By inspection or measuring the muscle circumference.

24. Examination of the limbs and trunk:
Neurological Assessment and Examination
Muscle tone
-Tested by passive flexion extension movement of the
wrist, elbow, hip, knee, and ankle joints.
-Decreased tone:
a.Lower motor neuron lesions.
b.Cerebellar lesions.
-Increased tone:
a.Clasp knife spacticity: upper motor neuron lesions.
b.Lead pipe and Cog wheel rigidity: in extra pyramidal system
affection.
c.clonus (ankle and patellar clonus) are indicative of marked
hypertonia.

25. Examination of the limbs and trunk:
Neurological Assessment and Examination
Muscle power
-The power should be tested in all limbs, comparing each
side.
-The muscle power is graded from 0-5.
-Compare between upper and lower motor neuron
weakness.

26. Examination of the limbs and trunk:
Neurological Assessment and Examination
Sensation
1.Superficial sensation
a. pain (pinprick). b. temperature.
c. light touch (crude touch). d. fine touch.
2.Deep sensation:
a. joint position. b. joint movement.
c. pressure sense. d. vibration sense.
3.Cortical sensation:
a. tactile localization.b. two point discrimination.
c. stereognosis. d. graphaesthesia

27. Neurological Assessment and Examination
Examination of the limbs and trunk:
Reflexes:
Superficial reflexes:
a.Plantar reflex S1
b.Abdominal reflex T7-T12
c.Cremasteric reflex L1
d.Anal reflex S4-S5
Deep reflexes:
a.Biceps jerk C5-C6
b.Triceps jerk C6-C7
c.Brachioradialis jerkC5-C6
d.Ankle jerk S1
e.Knee jerk L3-L4

28. Examination of the limbs and trunk:
Neurological Assessment and Examination
Reflexes:
Pathological reflexes:
a.Pyramidal reflexes: the Hoffman reflex (C7-C8), and Finger jerk.
b.Primitive reflexes (Grasp reflex, and Glabellar reflex).
c.Babinski reflex

29. Examination of the limbs and trunk:
Neurological Assessment and Examination
The Reflexes:
-Reduced tendon reflexes:
It occurs in cases of lower motor neuron lesions.
-Increased tendon reflexes:
It occurs in cases of pyramidal lesions (upper motor neuron
lesions).

30. Examination of the limbs and trunk:
Neurological Assessment and Examination
Coordination:
upper limbs:
-finger-nose test
-finger-finger test
-diadochokinesia
lower limbs:
-heel-shin test
-diadochokinesia

31. Neurological Assessment and Examination
Examination of the limbs and trunk:
Coordination:
Romberg's test
Tandem gait
Defect in coordination can be caused by:
-Cerebellar disorders (cerebellar ataxia).
-Posterior column lesions (sensory ataxia).
-Muscular weakness.

32. Examination of the limbs and trunk:
Neurological Assessment and Examination
Gait:
-Circumduction gait
-High stepping gait
-Shuffling gait
-Ataxic gait
-Waddling gait
-Spastic gait
-Stamping gait

33. Neurological Examination:
Neurological Assessment and Examination
Skeletal Examination:
1.Cranium:size, measurements (important in
hydrocephalus), and deformity.
2.Spine:bulge or fracture.

34. Brain death:
Neurological Assessment and Examination
1.Lack of pupil response to light.
2.Lack of corneal reflex to stimulation.
3.Lack of occulocephalic reflex.
4.Failure of vestibulo-occular reflex (Caloric test).
5.Failure of Gag or cough reflex on bronchial stimulation.
6.No motor response in face or muscles supplied by the cranial
nerves in response to painful stimuli.
7.Failure of respiratory movement when the patient is disconnected
from the ventilator and the PaCO
2is allowed to rise to 50 mmHg.
8.Hypothermia.
9.Flat EEG.
10.Low constant intracranial pressure (ICP).

35. Data show design & preparation by :
Dr. El-Sayed Amr -[phone]