NUR 218 Neurological Assessment Lecture

wernicke's area

- in left temporal lobe associated with language comprehension
- when damaged = receptive aphasia
- person hears sound, but it has no meaning, like hearing a foreign language
- most common type of fluent aphasia

brocca's area

- frontal lobe mediates motor speech
- when injured in dominant hemisphere, expressive aphasia result
- person cannot talk, person can understand language and knows what they want to say, but can produce only garbled/gibberish sound

Babinski reflex

- stroke up the lateral aspect and across ball of foot --> extension of the great toe, fanning of toes is a positive Babinski reflex
- present at birth and disappears around 24 months --> if present in adults could be a sign of abnormal neural tissue, could be a spinal cord injury

CN I (1)

- SENSORY
- olfactory nerve
- test sense of smell in those who report loss of smell (anosmia), head trauma, and abnormal mental status, and presence of intracranial lesion suspected

CN II (2)

- SENSORY
- optic nerve
- test visual acuity and visual fields
- Snellen and Rosenbaum charts

CN III, IV, and VI (3, 4, and 6)

- MOTOR
- oculomotor, trochlear, and abducens nerve
- PERRLA for pupils
- assess extraocular movements by cardinal fields of gaze
- look for nystagmus is back-and-forth oscillation of eyes

CN V (5)

- MOTOR: asses muscles of mastication by palpating temporal and masseter muscles as person clenches teeth, muscles should feel equally strong on both sides, try to separate jaws by pushing down on chin; normally can't
- SENSORY: test light touch sensation by touching a person's forehead, cheeks, and chin GENTLY
- test all 3 divisions: ophthalmic, maxillary, and mandibular

CN VII (7)

- facial nerve
- MOTOR: smile, frown, close eyes tightly, show teeth; puffed cheeks
- SENSORY: not routinely tested, test sense of taste

CN VIII (8)

- acoustic nerve (vestibulocochlear)
- SENSORY
- test hearing acuity by ability to hear normal conversation and by whisper test

CN IX and X (9 and 10)

- glossopharyngeal and vagus nerves
- MOTOR: depress tongue and not pharyngeal movement as person says "ahhh", uvula and soft palate should rise in midline; note gag reflex, voice should sound smooth, not strained
- SENSORY: too difficult to test

CN XI (11)

- MOTOR
- spinal accessory
- rotating the head --> check equal strength by asking person to rotate head against resistance
- shrug shoulders against resistance

CN XII (12)

- hypoglossal nerve
- inspect tongue --> no wasting or tremors
- forward thrust in midline
- as patient to say "light, tight, dynamite"

stereognosis

ask person to hold a familiar object and identify it (using tactile information)

graphesthesia

ability to "read" a number by having it traced on the skin

level of consciousness (LOC)

a change in ________ is the single most important factor in a neurological assessment

glasgow coma scale

- standardized, objective assessment of LOC
- eye opening response, motor response, and verbal response
- fully alert, normal function score of 15 (alert, oriented +3)
- score of 7 or less reflects coma

decorticate

- upper extremities: flexion of arm, wrist, and fingers; adduction of arm: tight against thorax
- lower extremities: extension, internal rotation, plantar flexion; indicates hemispheric lesion of cerebral cortex
(evident of stroke)

decerebrate

- upper extremities: stiffly extended, adducted, internal rotation, palms pronated
- lower extremities: stiffly extended, plantar flexion; teeth clenched; hyperextended back
(indicates lesions in brain stem at midbrain or upper pons)