Neurological Assessment

Advanced Physical Assessment

Advanced Physical Assessment

Subjective
Chief

Complaint

HA, Dementia, Tremor, CVA, numbness, weakness, dizziness

HPI

Gather pertinent information to guide you to the patient

problem
OLDCART

PMH

Includes all sections as outlined in the syllabus

Pediatric Different format; Birth Hx; Developmental Hx;
HEADSS
Occupational & Environmental History
Family History
Psychosocial and Spiritual History

Adolescent Assessment HEADSS

Sexual,

Reproductive, Obstetric and Gynecologic History

ROS

Not covered in HPI

Health Maintenance Issues
Advanced Physical Assessment

Objective

(Document in a head to toe sequence)

Constitutional
General

appearance (NAD; WDWN) and vital signs

Lungs

Auscultate

Lat

for adventitious sounds: CTAB A&P&

CV

Auscultate

for abnormal heart sounds: RRR; No

murmurs, clicks, rubs

Neuro

Exam

Mental Status
Cranial Nerves
Motor Function
Reflexes
Sensory Function
Cerebellar Function
Advanced Physical Assessment

Nervous System
Central Nervous System

Peripheral Nervous System

Advanced Physical Assessment

CNS Brain Lobes and Functions

Composed of three parts

Brainstem
Cerebellum
Cerebrum
Four Lobes
Frontal
Parietal
Temporal
Occipital
Receives sensory input from
the spinal cord as well as
from its own nerves (e.g.,
olfactory and optic nerve)
Processes various sensory
inputs and initiates
appropriate and coordinated
motor outputs.
Advanced Physical Assessment

Structure and Function

Advanced Physical Assessment

Structure and Function

Advanced Physical Assessment

Advanced Physical Assessment

Advanced Physical Assessment

Advanced Physical Assessment

Mental Status

Mini Mental Exam (30 points)

Orientation
Registration
Attention and Calculation
Recall
Language

Depression Scale

Various Scales available

Anhedonia and Feeling Depressed

Yesavage Geriatric Depression Scale

http://www.bcbsga.com/provider/noapplication/plansbenefits
/diseasemgmt/notertiary/pw_ad050083.pdf

Advanced Physical Assessment

Advanced Physical Assessment

Advanced Physical Assessment

Cranial Nerve Function

Smell
I Olfactory
II

Optic

Vision (Visual fields; Snellen &

Ophthalmoscopic exam)

III Oculomotor Eye movements; pupillary constriction;

accomodation (EOMs, PERLA, visual
fields)
IV Trochlear

Eye movements (EOMs, PERLA, visual

fields)

General sensation of face, scalp and

teeth; chewing movements (Clench teeth;
corneal reflex)

Trigeminal

VI Abducens

Eye movements (EOMs, PERLA, visual

fields)

VII Facial

Taste; general sensation of palate and

external ear; lacrimal gland and
submandibular and sublingual gland
Advanced Physical Assessment
secretion;
facial expression (Smile; frown;

Cranial Nerve
VII Auditory
I (Vestibulocochle
ar)

Function
Hearing; equilibrium (Whisper;
Weber; Rinne)

IX Glossopharyngea Taste; general sensation of pharynx

l
and ear; elevates palate; parotid
gland secretion (Gag reflex; Ah)
X

Vagus

Taste; general sensation of pharynx,

larynx, and ear; swallowing;
phonation; parasympathetic to
heart and abdominal viscera (Gag
reflex; Ah)

XI Spinal Accessory Phonation; head, neck, and shoulder

movements (Turn head against
resistance; shrug shoulders)
XII Hypoglossal

Tongue movements (Stick out

tongue; push against cheek)
Advanced Physical Assessment

Motor Function

Assess the motor system

Muscle strength

Muscle bulk; strength; tone

Scale of 0 5
Page 668

Assess BUE
Assess BLE

Advanced Physical Assessment

Reflexes

Advanced Physical Assessment

Reflex Arc

Hyper-reflex response

CVA
Hyperthyroidism

Hypo-reflex response

Herniated
intervertebral disc

Advanced Physical Assessment

Biceps Reflex

Advanced Physical Assessment

Triceps Reflex

Advanced Physical Assessment

Brachioradialis Reflex

Advanced Physical Assessment

Patellar Reflex

Advanced Physical Assessment

Achilles Reflex

Advanced Physical Assessment

Babinski Reflex

Advanced Physical Assessment

Sensory Function

Cotton to all distal

extremities
Sharp & Dull do not
use a pin!!!

Advanced Physical Assessment

Vibration

Test bilateral index fingers and great toes

Examiners finger is under patients finger &
should also feel the vibration
Peripheral Neuropathy

Advanced Physical Assessment

Cerebellar
Touch my
finger, touch
your nose

Advanced Physical Assessment

Cerebellar
Observe

gait

Walk

on heels

Walk

on toes

Tandem

walk
Advanced Physical Assessment

Advanced Physical Assessment

Cerebellar
Perform
Romberg

Advanced Physical Assessment

Headache Pain

Migraine
Cluster
Tension
Sinusitis
HTN
Temporal arteritis

Elevated inflammatory
markers
High doses of cortisone
Loose eyesight if not treated

Meningitis

Brudzinskis sign
Kernigs sign
Advanced Physical Assessment

Red Flags Require Imaging Studies

Sign/Symptom

Differential Diagnoses

Sudden onset; worst

headache or
new/different

Subarachnoid hemorrhage

Increasing in severity or
frequency

Temporal arteritis; mass; lesion

Beginning after 50 years

of age, especially if
there is jaw pain

Meningitis; brain abcess; CA

Focal neurologic signs or

symptoms (other than
aura)

Mass, lesion, stroke, vascular

malformation

Papilledema

Mass, lesion, meningitis

Headache subsequent to Intracranial hemorrhage; subdural

head trauma
hematoma
Advanced
Physical Assessment

Comatose Patient

Glasgow test
Causes

Meningeal infection

Kernigs sign flexion/extension of the lower leg

Brudzinskis sign flexion of the neck

Increased intracranial pressure

Subarachnoid Hemorrhage
Cerebral lesion
Brain stem lesion
Metabolic encephalopathy
Seizure activity

Assessment

Pupil response
Advanced Physical Assessment

CNS Spinal Cord Injury

Connects PNS to brain

Receives information from
sensory neurons and
transmits to the brain
Highway for messages from
the motor areas in the brain
through motor neurons
Responsible for simple
reflexes

Advanced Physical Assessment

Effects of Various Lesions

Lower
Motor
Neuron

Pyrimidal
Tract

Extrapyrami
dal Tract

Major Effect

Flaccid
paralysis

Spastic
paralysis
Hyperactive
reflexes

Muscle
Appearance

Atropy
Fasciculation
s

Mild atrophy
from disuse

Rest tremor

Muscle Tone

Decreased

Increased

Increased

Muscle
Strength

Decreased or Decreased or
absent
absent

Normal

Coordination

Absent or
poor

Slowed

Absent or poor

Advanced Physical Assessment

No paralysis