H.A: CU16 Neurologic System

OLFACTORY

what is CN I

OPTIC

what is CN II

OCULOMOTOR

what is CN III

TROCHLEAR

what is CN IV

TRIGEMINAL

what is CN V

ABDUCENS

what is CN VI

FACIAL

what is CN VII

ACOUSTIC / VESTIBULOCOCHLEAR

what is CN VIII

GLOSSOPHARYNGEAL

what is CN IX

VAGUS

what is CN X

SPINAL ACCESSORY

what is CN XI

HYPOGLOSSAL

what is CN XII

Cranial Nerve

• III

• IV

• VI

• XI

• XII

What are the Motor impulse

Cranial Nerve

• I

• II

• VIII

What are the Sensory impulse

Cranial Nerve

• V

• VII

• IX

• X

What are both Sensory/Motor impulse

CN I: Olfactory

Carries smell impulses from nasal mucous membrane to brain

CN II: Optic

Carries visual impulses from eye to brain Visual Acuity, Visual Fields, Fundoscopic Exam

CN III: Oculomotor

Contracts eye muscles to control eye movements (interior lateral, medial, and superior), constricts pupils, and elevates eyelids

CN III: Oculomotor

Cardinal Field of gaze (EOM), eyelid elevation, pupil reaction, doll's eye phenomenon

CN IV: Trochlear

Contracts one eye muscle to control inferomedial eye movement EOM

CN V: Trigeminal

Carries sensory impulses of pain, touch, and temperature from the face to the brain

CN V: Trigeminal

Influences clenching and lateral jaw movements (biting, chewing)

CN V: Trigeminal

Motor: Strength of temporalis and masseter muscles

Sensory: light touch, superficial pain and temperature to face, corneal reflex

CN VI: Abducens

Controls lateral eye movements

CN VII: Facial

Sensory

Taste, anterior 2/3 of tongue Stimulates secretions from salivary glands (submaxillary and sublingual) Stimulates tears from lacrimal glands

CN VII: Facial

Motor

Facial movement Facial expressions (smiling, frowning, closing eyes)

CN VIII: Acoustic / Vestibulocochlear

Contains sensory fibers for hearing and balance

Cochlear

Gross hearing, Weber and Rinne tests

Vestibular

Vertigo, equilibrium, nystagmus

CN VIII: Cochlear

Gross hearing, Weber and Rinne tests

CN VIII: Vestibular

Vertigo, equilibrium, nystagmus

CN IX: Glossopharyngeal

Sensory

Taste, posterior 1/3 of tongue

Sensory fibers of the pharynx that result in the gag reflex when stimulated

CN IX: Glossopharyngeal

Motor

Provides secretory fibers to parotid salivary glands

Promotes swallowing movements

CN X: Vagus

Carries sensations from the throat, larynx, heart, lungs, bronchi, gastrointestinal tract, and abdominal viscera

CN X: Vagus

Promotes swallowing, talking, and production of digestive juices

CN XI: Spinal Accessory

Innervates neck muscles (sternocleidomastoid and trapezius) that promote movement of the shoulders and head rotation

CN XI: Spinal Accessory

Promotes some movement of the larynx

CN XII: Hypoglossal

Innervates tongue muscles that promote the movement of food and talking

optic disc

• 1.5 mm

• round or slightly oval

• well-defined margins

• creamy pink with paler physiologic cup

Ptosis

drooping of the eyelid

Level of Consciousness

1. Alert

2. Lethargic

3. Stuporous

4. Comatose

Alert

Follows commands in a timely fashion

Lethargic

Appears drowsy, may drift off to sleep during examination

Stuporous

Requires vigorous stimulation (shaking, shouting) for a response

Comatose

Does not respond appropriately to either verbal or painful stimuli

Glasgow Coma Scale

• eye opening response

• most appropriate verbal response

• most integral motor response (arm)

Eye Opening Response

Spontaneous Opening 4

To Verbal Command 3

To Pain 2

No Response 1

Most Appropriate Verbal Response

Oriented 5

Confused 4

Inappropriate Words 3

Incoherent 2

No Response 1

Most Integral Motor Response (arm)

Obeys Verbal Commands 6

Localized Pain 5

Withdraws From Pain 4

Flexion (decorticate rigidity) 3

Extension (decerebrate rigidity) 2

No Response 1

AGNOSIA

• Visual

• Tactile

• Auditory

ASTEREOGNOSIS

Inability to correctly identify objects

AKINESIA

Complete or partial loss of voluntary muscle movement

APHASIA

Absence or impairment of ability to communicate through speech, writing, or signs

APRAXIA

Inability to carry out learned sequential movements or commands

CIRCUMLOCUTION

Inability to name object verbally, so patient talks around object or uses gesture to define it

DYSARTHRIA

Defective speech; inability to articulate words; impairment of tongue and other muscles needed for speech

DYSPHASIA

Impaired or difficult speech

DYSPHONIA

Difficulty with quality of voice; hoarseness

NEOLOGISMS

Made-up, nonsense, meaningless words

PARAPHRASIA

Loss of ability to use words correctly and coherently; words are jumbled or misused

TREMORS

Involuntary movement of part of body

INTENSION TREMOR

Involuntary movement when attempting coordinated movements

FASCICULATION

Involuntary contraction or twitching of muscle fibers

REFLEXES 0

No response

REFLEXES 1+

Decreased and less active than normal

REFLEXES 2+

Normal usual response

REFLEXES 3+

More brisk or active than normal but not indicative of a disorder

REFLEXES 4+

Hyperactive, very brisk, clonus, abnormal and indicative of a disorder

Brachioradialis Reflex

• Flex elbow with palm down

• Find the tendon above the radius (usually 2 inch above the wrist)

• Strike with the hammer (flat)

• Repeat on the other side

• Evaluates spinal levels C5 & C6

Biceps Reflex

• Partially bend arm at elbow with palm up

• Place your thumb over the biceps tendon

• Strike your thumb with the pointed side of the reflex hammer

• Repeat on the other side

• Evaluates the function of spinal levels C5 and C6

Triceps Reflex

• Ask client to hang arm freely support it w/ non-dominant hand

• Find tendon above the olecranon process

• Tap it with the hammer (flat)

• Repeat on the other side

• Evaluates the function of spinal levels C6, C7, and C8

Patellar Reflex

• Both legs hang freely off the side of the examination table

• Find the patellar tendon (below patella)

• Strike with hammer (flat)

• Repeat on the other side

• Gently flex the knee and strike the patella (client’s who cannot sit up)

• Evaluates the function of spinal levels L2, L3, and L4

Achilles Reflex

• Both legs hang freely off the side of the examination table, dorsiflex the foot

• Strike the Achilles tendon with hammer (flat)

• Repeat on the other side

• Flex one knee and support that leg against the other leg, dorsiflex the foot, tap the tendon using the flat side (client’s who cannot sit up)

• Evaluates the function of spinal levels S1 and S2

Plantar Reflex

• Stroke lateral aspect of the sole from heel to ball of foot

• Use the end of the hammer

• Repeat on the other side

• Evaluates the function of spinal levels L4, L5, S1, and S2

Abdominal Reflex

• Lightly stroke the abdomen on each side, above and below the umbilicus

• Evaluates the function of spinal levels T8, T9, and T10 with the upper abdominal reflex

• Spinal levels T10, T11, and T12 with the lower abdominal reflex

Cremasteric Reflex

• Lightly stroke the inner aspect of the upper thigh

• Evaluates the function of spinal levels T12, L1, and L2

Test for MENINGEAL IRRITATION

• Supine

• Place hands behind the patient’s head and flex the neck forward until the chin touches the chest

Brudzinski’s Sign

As you flex the neck watch the clients hips and knees in reaction to your maneuver

Kernig’s Sign

Flex the client’s leg at both hip and the knee, then straighten the knee