Neurological PPT Student Spring 2026

Neurological Assessment Overview

Chapter 35: Assessment of the Nervous System

  • Essential components of neurological assessments include:

    • Patient history

    • Physical assessment

    • Complete neurological assessment consisting of:

    • Mental status

    • Cognition & Consciousness (A&O)

    • Cranial nerves

    • Mobility and motor function

    • Deep tendon reflexes

    • Sensory function

    • Cerebellar function

Assessment of Mental Status

  • Evaluation includes:

    • Level of Consciousness:

    • Alert

    • Lethargic

    • Stuporous

    • Comatose

    • Cognition:

    • Tests are administered to assess memory and attention.

Assessment of Cranial Nerves

  • Identification of specific cranial nerves related to patient issues:

    • CN V: Trigeminal nerve. Associated condition is trigeminal neuralgia, which is a painful, intermittent disorder primarily affecting women.

    • CN III: Oculomotor nerve, tested using PERRLA (Pupils Equal, Round, Reactive to Light and Accommodation).

Assessment of Motor Function

  • Indicators of motor function include:

    • Involuntary tremors or movements:

    • Pill-rolling motion of thumbs and fingers at rest.

    • Intention tremors of both hands.

    • Hand strength:

    • Assessment by comparison bilaterally.

    • Cerebral integrity assessments:

    • Pronator drift test.

    • Posturing:

    • Decorticate posturing

    • Decerebrate posturing

Assessment of Reflex Activity

  • Deep tendon reflexes assessed by healthcare providers:

    • Muscles tested:

    • Biceps, triceps, brachioradialis, quadriceps, and Achilles tendon.

    • Cutaneous reflexes include:

    • Plantar reflexes

    • Babinski sign

    • Interpretation of results:

    • Hyperactive indicates damage to the brain or upper spinal cord.

    • Hypoactive denotes damage to the lower spinal cord or neuromuscular diseases.

Assessment of Sensory Function

  • Assess based on acuity level:

    • Guillain-Barré syndrome: Rare inflammatory disorder causing ascending muscle weakness or paralysis.

  • Testing includes:

    • Pain and temperature perception (compared bilaterally).

    • Touch discrimination (performed with eyes closed).

Assessment of Cerebellar Function

  • Evaluating the fine coordination of muscle activity:

    • Tests include:

    • Heel to shin test

    • Hands with palms up and down

    • Arm positions (touch finger to nose three times each, with eyes opened then closed).

    • Gait assessment: Walk across the room.

    • Balance tests:

    • Tip-toe and heel-to-toe walking.

    • Equilibrium tests:

    • Romberg sign: Swaying when eyes are closed indicates a proprioceptive problem.

    • Swaying with eyes open and closed indicates a cerebellar problem.

Glasgow Coma Scale

  • Measures level of consciousness:

    • Eye Opening:

    • Spontaneous = 4

    • To sound = 3

    • To pain = 2

    • Never = 1

    • Motor Response:

    • Obeys commands = 6

    • Localizes pain = 5

    • Normal flexion (withdrawal) = 4

    • Abnormal flexion = 3

    • Extension = 2

    • None = 1

    • Verbal Response:

    • Oriented = 5

    • Confused conversation = 4

    • Inappropriate words = 3

    • Incomprehensible sounds = 2

    • None = 1

    • A maximum score of 15 indicates full consciousness.

Psychosocial Assessment

  • Responses may vary based on whether a condition is acute or chronic.

  • Depression can lead to cognitive and behavioral changes similar to delirium or dementia.

  • Consider using a depression screening tool.

  • Cultural and spiritual backgrounds are important

Diagnostic Assessment

  • Laboratory assessments include:

    • CBC (Complete Blood Count)

    • BMP (Basic Metabolic Panel)

    • ABG (Arterial Blood Gas)

  • Imaging assessments:

    • Plain x-rays

    • Cerebral angiography (arteriography) with precautions for contrast agents.

    • CT scan

    • MRI (Magnetic Resonance Imaging)

    • CT-PET (Computer Tomography-Positron Emission Tomography)

Other Diagnostic Assessment

  • Electromyography (EMG):

    • Identifies nerve and muscle disorders, and spinal cord diseases like myasthenia gravis.

  • Electroencephalography (EEG):

    • Records electrical activity of cerebral hemispheres.

    • No fasting required; avoid sedatives or stimulants before the test.

  • Transcranial Doppler Ultrasonography:

    • Uses sound waves to measure blood flow through arteries.

Lumbar Puncture

  • A procedure performed to access the spinal canal, identifying conditions affecting the central nervous system.

Chapter 36: Concepts of Care for Patients with Conditions of the CNS: The Brain

Alzheimer’s Disease (AD)

  • Most common form of dementia characterized by:

    • Reduction in brain weight

    • Atrophy and loss of cortical neurons

    • Microscopic changes:

    • Neurofibrillary tangles, neuritic plaques, beta-amyloid deposits.

    • Neurotransmitter abnormalities affecting:

    • Acetylcholine (ACh)

    • Norepinephrine

    • Dopamine

    • Serotonin

Etiology and Genetic Risk

  • Exact cause remains unknown.

  • Key risk factors include:

    • Age > 65 years

    • Gender: Women > Men

    • Genetic predisposition

  • Prevalence:

    • Approx. 5.7 million people in the U.S. over 65 years are affected by AD.

Health Promotion

  • Currently, no proven methods for preventing AD.

    • Chronic health problems may contribute:

    • Dietary habits

    • Exercise

    • Smoking cessation

    • Reducing excessive alcohol consumption

Assessment

  • History:

    • Onset, duration, progression, and course of symptoms, including functional status.

  • Physical assessment segmented into stages:

    • Stage I (Mild):

    • Symptoms last up to 4 years; independent in ADLs, experiencing memory loss, and personality changes.

    • Stage II (Moderate):

    • Lasting 2 to 3 years; major cognitive impairments; possible psychotic behaviors; dependency in ADLs.

    • Stage III (Severe):

    • Patients are bedridden, fully dependent in ADLs, and experience severe cognitive deterioration.

Assessment (Cont.)

  • Laboratory and imaging assessment:

    • Definitive diagnosis via brain tissue examination at autopsy; genetic testing and imaging via CT or MRI are supportive, not conclusive.

Interventions

  • Cognitive stimulation and structured environments to support self-management and care.

  • Validation therapy acknowledged the patient's feelings and concerns as appropriate in later stages.

  • Prevent injuries and falls; manage caregiver stress effectively using resources.

Medications

  • No medications can cure or significantly slow progression.

    • Cholinesterase inhibitors to delay acetylcholine degradation (Donepezil, Galantamine, Rivastigmine) with potential side effects of bradycardia.

    • NMDA receptor antagonists (Memantine) may help manage symptoms.

    • Antidepressants (SSRIs) to treat anxiety and mood disorders.

    • Psychotropic drugs for behavioral health issues must be used cautiously.

Parkinson Disease (PD)

  • A progressive neurodegenerative disorder primarily affecting mobility with four cardinal symptoms:

    • Tremor

    • Muscle rigidity

    • Bradykinesia or akinesia

    • Postural instability

  • Cognitive changes include dementia and psychoses in later stages.

Etiology and Incidence

  • Risk factors include environmental exposure and genetic predispositions; incidence is higher in men.

    • Annually, there are 60,000 new cases among individuals over 50.

Assessment

  • Collection of symptom history is crucial; physical assessment checks for resting tremors, rigidity, and facial expressions.

Stages of Parkinson Disease

  • Stage 1 (Initial): Unilateral involvement in limbs with minimal weakness.

  • Stage 2 (Mild): Bilateral limb involvement; onset of balance and gait disturbances.

  • Stage 3 (Moderate): Postural instability arising.

  • Stage 4 (Severe Disability): Marked akinesia and rigidity.

  • Stage 5 (Complete ADL Dependence): Patient