Chapter 11: Assessing Neurological

What three components are assessed in mental status?

• Orientation

• Memory

• level of consciousness (LOC)

What are the four levels of orientation?

Person, place, time, situation

What tool is used to assess cognitive function and orientation?

Mini-Mental State Examination (MMSE)

Difficult to arouse; sluggish responses

Obtunded

Unresponsive to verbal stimuli; minimal response to pain

Stupor

No response to any stimuli

Comatose

What cranial nerve is tested with visual acuity?

CN II (Optic)

What cranial nerves are tested with ocular motility (6 cardinal fields)?

CN III (Oculomotor), IV (Trochlear), VI (Abducens)

What is PERRLA and which CNs are tested?

Pupils Equal, Round, Reactive to Light and Accommodation (CN II & III)

How is CN V (Trigeminal) tested?

Facial sensation (sharp/dull or cotton wisp); jaw clench (masseter, temporal)

How is CN VII (Facial) tested?

Facial expressions: smile, frown, puff cheeks, close eyes against resistance

What are signs of CN VII abnormality?

Facial asymmetry, Bell's palsy, drooping mouth or eye

Bell’s Palsy

inflammation of the facial nerve of unknown cause resulting in muscle weakness or paralysis on one side of the face. CN VII (Facial)

What cranial nerve is tested with the whisper test?

CN VIII (Vestibulocochlear)

How are CN IX (Glossopharyngeal) and X (Vagus) tested?

Say "ah" (uvula rise), assess swallowing, gag reflex, voice clarity

What are signs of CN IX/X abnormality?

Absent gag, dysphagia, hoarse voice, asymmetrical uvula rise

How is CN XI (Spinal Accessory) tested?

Shrug shoulders and turn head against resistance

How is CN XII (Hypoglossal) tested?

Stick out tongue, assess symmetry, movement side to side

What is dysphasia vs. dysphagia?

• Dysphasia: speech difficulty

• Dysphagia: difficulty swallowing

What is aphasia?

Inability to speak or understand language (receptive or expressive)

What is expressive aphasia?

Difficulty producing speech (Broca’s area)

What is receptive aphasia?

Difficulty understanding spoken/written language (Wernicke’s area)

What are signs of increased intracranial pressure (ICP)?

Vomiting (possibly projectile), headache, change in LOC, vision changes

What is paresthesia?

Tingling or numbness, often in hands/feet; common in diabetes

What chronic diseases are associated with neurological deficits?

Diabetes (neuropathy), stroke, MS, myasthenia gravis, thyroid disorders

What are stroke risk factors?

Hypertension, atrial fibrillation, smoking, diabetes, age, obesity

What is the difference between ischemic and hemorrhagic stroke?

• Ischemic = clot/blockage

• Hemorrhagic = bleeding in the brain

What are early symptoms of stroke?

Sudden numbness, confusion, trouble speaking, vision changes, headache

What are the 5 states of alertness in infants?

Level 1: quiet sleep
Level 2: active sleep
Level 3: quiet awake
Level 4: active alert
Level 5: crying

What reflexes are tested in the newborn neuro exam?

Sucking, rooting, Moro, palmar, plantar, Babinski

What is a normal newborn cry?

Strong, lusty, medium pitch

What are abnormal neuro findings in a newborn?

High-pitched cry, flaccidity, seizures, decreased tone, absent reflexes

What is the Moro reflex?

Startle reflex where infant throws out arms then pulls them in

What age-related neuro changes occur in older adults?

Slower reflexes, memory decline, balance problems, brain shrinkage

What is a normal age-related eye change seen on inspection?

Arcus senilis: gray-white ring around the cornea

What are some abnormal neurological symptoms to report immediately?

Sudden speech changes, unilateral weakness, altered LOC, unequal pupils