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Neruological System
  • CNS: sensory pathways, motor pathways, Upper and lower motor neurons
  • PNS: cranial nerves, spinal nerves, autonomic nervous system, reflex arc
Central Nervous System
  • cerebral cortex: each hemishpere is divded into four lobes
  • Frontal lobe: personality, emotions
  • Parietal: primary center for sensation
  • Occipital: primary visual receptor
  • Temporal: primary auditory reception
  • Wernickie's area: temporal lobe, language comprehension
  • Broca's area: frontal lobe, motor control of speech, cannot talk
CNS sensory pathways
  • Sensory pathways transmit the sensation of pain, temp, and touch
  • Position: without looking you know where your body part is.
  • Vibration: ability to feel vibrating objects (vibration can trigger rashes is some forms of anemia)
  • Stereognosis: without looking you can tell what an object it.
CNS motor pathways
  • Cortical or pyramidal tract: fine motor skills, they mediate voluntary movement, purposeful discrete movement, writing, etc.
  • Extrapyramidal tracts: more primitive, control gross body movements, walking
  • Cerebella system: coordinates movement, maintains equilibrium, maintains posture
Peripheral Nervous System
  • Reflex Arc: basic defense system, involuntary quick reactions
  • Deep Tendon Reflexes: patellar knee jerk
  • Superficial: corneal reflex
  • Visceral: pupil response to light
  • Pathalogic: Babinski or plantar reflex
Cranial Nerves
  • 12 nerves
  • The exit and enter the brain rather than the spinal cord
  • PRimarily in the head and neck except the vagus
Spinal nerves
  • 31 pairs of nerves that arise from the spinal cord and supply the rest of the body
  • named for the region they exit the spine
  • 8 cervical, 12 thoracic, 5 lumbar, 5 sacral, 1 coccygeal
  • both sensory and motor nerves
  • dermatomes: follow spinal nerves
  • C5 keeps you alive
  • Breaks just above L2 afect bowel function
Subjective Neuro assessment
  • headache (PQRST)
  • head injury, loc, where hit
  • dizziness, vertigo, faint feeling
  • seizures? any hx? pseudo seizures can happen with stress
  • Tremors: worse or better with rest (pill rolling w/ parkinsons)
Subjective neuro assessment cont.
  • weakness? affecting one side?
  • coordination? balance when walking?
  • numbness or tingling?
  • difficulty swallowing or speaking?
  • past history of stroke or "brain attack"?
  • enviromental hazards: ETOH, etc
Objective neuro data
  • mental status
  • cranial nerves
  • motor system
  • sensory system
  • reflexes
Mental status exam
  • Jarvis pg 11
  • Orientation to time
  • registration: say three unrelated words, pause between each word, ask to repeat after 5 minutes, may repeat up to fine times, score first time only
  • naming: ask them to name an object they would know
  • reading: please read and do what this says...
Mini mental status exam
  • MMSE
  • includes a standard of 11 questions and takes 5-10 minutes to administer
  • concentrates only on cognitive functioning
  • valid detector for organic disease (dementia and delerium)
  • max score 30: 27 average, 23-18 is mild dementia, 17-0 is severe
MMSE questions
  • Time orientation
  • Place orientation
  • Registration of 3 words
  • subtract serial 7s from 100 to test attention and calculation
  • recall of three unrellated words
  • naming: show them an object
  • repetition: have them repeat what you say
  • comprehension: have them fold a paper and palace it on the floor
  • reading, writing, drawing
  • ask about knowledge of idioms
  • looking to a spouse/SO for answers is an early sign of dementia
Assessment of the 12 cranial nerves
  • CN I olfactory: shortest nerve, test sense of smell
  • CN II optic:test for visual acuity
  • CN III, IV, VI (occulomotor, trochlear, abducens): 6 cardinal EOMs
  • CN V trigeminal: mastication motor, touch forhead, cheek, and chin for sensory
  • CN VII facial: assess facial symmetry
  • CN VIII acoustic: assess hearing
  • CN IX, X glossopharyngeal and vagus: motor function of the tounge, gag reflex
PERRLA
  • tests cranial nerve III
  • pupils, equal, round, reactive to light, and accommidation
GCS
  • Eye opening: spontaneously 4, speech 3, pain 2, no response 1
  • Motor response: obeys verbal 6, localizes pain 5, flexion withdrawal 4, flexion abnormal 3, extension abnormal 2, no response 1
  • Verbal response: oriented x 3 5
  • confused 4, inappropriate 3, incmprehensible 2, no response 1
Assessment of the motor system
  • Muscle: assess size, compre L/R
  • Strength bilaterally
  • tone: tension vs contraction
  • Involunary movements: tremors, tics
  • Cerebella function: balance test, gait, romberg test (close eyes and stand with feet together), stand on one foot, rapid alternating movements (finger to finger or nose)
Muscle wasting
  • Muscle wasting occurs from long standing illness
  • can be seen in the hands as thenar wasting
Assessment of the sensory system
  • Pain: finger nails or sternal rub
  • Temp: hot vs cold
  • Touch: sharp vs dull
  • Vibration: tuning fork
  • stereognosis: recognition of objects
  • Graphesthesia: close eyes, draw number on hand, as for number
  • two point discrimination
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