Neurological History and Physical Assessment

Neurological History and Physical Assessment

Overview of the Nervous System

• The nervous system is divided into the following components:

  • Central Nervous System (CNS):

  • Comprises the brain and spinal cord.

  • Peripheral Nervous System (PNS):

  • Consists of 12 pairs of cranial nerves and 31 pairs of spinal nerves.

  • Autonomic Nervous System (ANS):

  • Controls involuntary body functions.

• Important to understand changes in the nervous system, especially in older adults.

Objectives

• Apply knowledge of anatomy and physiology in the assessment of the neurological system.

• Accurately perform history and examination of the neurological system.

Cranial Nerves Breakdown

• Cranial nerves can be classified as sensory or motor:

  • Olfactory (I):

  • Sensory function: Nose (smell).

  • Optic (II):

  • Sensory function: Eye (vision).

  • Trochlear (IV):

  • Motor function: Superior oblique muscle (eye movement).

  • Abducent (VI):

  • Motor function: External rectus muscle (eye movement).

  • Oculomotor (III):

  • Motor function: All eye muscles except those supplied by IV and VI.

  • Trigeminal (V):

  • Sensory function: Face, sinuses, teeth.

  • Motor function: Muscles of mastication.

  • Facial (VII):

  • Motor function: Muscles of facial expression.

  • Vestibulocochlear (VIII):

  • Sensory function: Inner ear (hearing and balance).

  • Glossopharyngeal (IX):

  • Sensory function: Posterior part of tongue, tonsil, pharynx.

  • Motor function: Pharyngeal musculature.

  • Vagus (X):

  • Motor function: Heart, lungs, bronchi, gastrointestinal tract.

  • Sensory function: Heart, lungs, gastrointestinal tract, external ear.

  • Accessory (XI):

  • Motor function: Sternocleidomastoid and trapezius muscles.

  • Hypoglossal (XII):

  • Motor function: Tongue.

Effects of Stress on Spinal Joints

• Subluxations: Damage to spinal joints due to stress (physical, emotional, chemical) leading to:

  • Loss of mobility.

  • Spinal degeneration (arthritis).

  • Interference with the nervous system.

• Nerve interference compromises the body's innate self-healing and self-regulating abilities.

Subluxated Areas and Potential Effects

1. Cervical Spine:

   • Effects: Headaches, insomnia, high blood pressure, chronic tiredness, dizziness.

2. Thoracic Spine:

   • Effects: Sinus trouble, allergies, pain around the eyes, fainting spells, certain blindness cases.

3. Lumbar Spine:

   • Effects: Lower back pain, numbness in legs, urinary issues.

4. Pelvis:

   • Effects: Reproductive issues, hip problems, leg cramps.

Changes in the Nervous System in Older Adults

• Reduction in:

  • Nerve cells,

  • Cerebral blood flow,

  • Metabolism.

• Manifestations:

  • Slower reflexes and delayed responses,

  • Changes in balance leading to increased fall risk.

• The nervous system is affected by all other body systems and alters sleep patterns, particularly in stages III and IV.

Anatomical Review of the Brain

• Divisions of the brain:

  • Cerebrum:

  • Frontal Lobe: Involved in motor skills and language processing.

  • Parietal Lobe: Processes sensory information.

  • Temporal Lobe: Involved in auditory processing.

  • Occipital Lobe: Responsible for visual processing.

• Cerebellum:

  • Functions in equilibrium, muscle tone, and proprioception.

Main Brain Structures

• Brain Stem:

  • Includes midbrain, pons, and medulla oblongata, responsible for relaying information and controlling essential functions such as breathing and swallowing.

Physical Assessment Techniques

• Focused History Taking contains several key components:

  1. Chief Complaint (CC): Understanding the patient's primary concerns.

  2. Psychosocial Data:

  • Stressors, coping mechanisms, substance use (tobacco, alcohol, recreational drugs), and congruence between occupation and educational achievement.

  1. Exposures: Consideration of risks from food, toxins, travel history.

  2. Past Medical History: Includes understanding of prior neurological disorders (strokes, seizures), current diagnoses, and treatments (hospitalizations, medications).

  3. Family History: Important for identifying hereditary neurological conditions.

  4. Symptom Review: Headaches, dizziness, seizures, mood changes, etc.

Physical Examination/

Neurological System Assessment Tools

• Equipment Required:

  • Penlight, tongue blade, tuning fork, etc., for specific sensory and motor evaluations.

Five Components of Neurological Assessment

1. Mental Status

2. Cranial Nerves

3. Sensory System

4. Balance/Coordination

5. Reflexes/Strength

Assessment of Cranial Nerves

• Cranial Nerve I (Olfactory): Smell using substances, observing for abnormalities.

• Cranial Nerve II (Optic): Visual acuity and peripheral vision tested with charts.

• Cranial Nerves III, IV, and VI (Oculomotor, Trochlear, Abducens): Eye movement and pupillary response tests.

• Cranial Nerve V (Trigeminal): Sensory and motor function assessed in the face.

• Cranial Nerve VII (Facial): Facial muscle strength and sensory tests for taste.

• Cranial Nerve VIII (Acoustic): Hearing tests using whisper and tuning fork methods.

Deep Tendon Reflexes (DTRs)

• Scored from 0 (no response) to 4 (hyperactive).

• Specific responses for various muscle groups (e.g., patellar, triceps).

Clinical Implications for Abnormal Findings

• Abnormal results in neurological assessments can indicate serious conditions such as stroke, neurological disorders, or infections.

Common Diagnoses in Neurology

1. Headache

2. Dizziness

3. Focal neurological complaints

4. Memory problems / dementia

5. TIA or CVA (Transient Ischemic Attack or Cerebrovascular Accident)

6. Behavioral problems

Documentation of Findings

• Documentation should encompass:

  • Observation of mental status, sensory processing, and reflexes.

  • Summary of cognitive abilities and mood evaluations in the context of a mental status exam.

Summary

• Focus assessments on history and physical findings to guide diagnostic and treatment strategies.