Denise Coffey MSN, RN

Central Nervous System (CNS)

 Cerebral cortex
 Hypothalamus
 Frontal lobe
 Cerebellum
 Parietal lobe
 Brainstem
 Occipital lobe
 Midbrain
 Wernicke’s area
 Pons
 Broca’s area
 Medulla
 Basal ganglia
 Spinal cord
 Thalamus

Slide 23-2
Pathways of the CNS
 Crossed representation
 Sensory pathways
 Spinothalamic tract
 Posterior (dorsal) column
 Motor pathways
 Corticospinal or pyramidal tract
 Extrapyramidal tracts
 Cerebellar system
 Upper motor neurons
 Lower motor neurons

Slide 23-3
Slide 23-4
[PRODUCTION NOTE: Please insert Figure 23-2 (from Jarvis Physical
Examination and Health Assessment, 5e, ISBN: 978-1-4160-3243-4)]

© Pat Thomas, 2006.

Slide 23-5
© Pat Thomas, 2006.

Slide 23-6
 Headache
 Head injury
 Dizziness/vertigo
 Seizures
 Tremors
 Weakness

Slide 23-7
 Preparation
 Screening neurologic examination
 Complete neurologic examination
 Neurologic recheck
 Equipment needed
 Penlight
 Tongue blade
 Cotton swab
 Cotton ball
 Tuning fork (128 or 256 Hz)
 Percussion hammer
 Occasionally need: familiar aromatic substance

Slide 23-8
Test Cranial Nerves
 VII—Facial
 I—Olfactory
 Motor function
 II—Optic  Sensory function
 III—Oculomotor,  VIII—Acoustic
IV—Trochlear, (vestibulocochlear)
VI—Abducens  IX—Glossopharyngeal,
 V—Trigeminal X—Vagus
 Motor function
 Motor function
 Sensory function
 Sensory function
 XI—Spinal accessory
 Corneal reflex
 XII—Hypoglossal

Slide 23-9
Motor System—Inspect and palpate
 Muscles  Cerebellar function

 Size  Balance tests

 Gait
 Strength  Tandem walking
 Romberg’s test
 Tone  Shallow knee bend
 Involuntary  Coordination and skilled
movements movements
 Rapid alternating movements
 Finger-to-finger test
 Finger-to-nose test
 Heel-to-shin test

Slide 23-11
Sensory System
 Person is alert,  Posterior column tract
cooperative, and  Vibration
comfortable  Position (kinesthesia)
 Guidelines for sensory  Tactile discrimination
testing (fine touch)
 Stereognosis
 Spinothalamic tract
 Graphesthesia
 Pain  Two-point discrimination
 Temperature  Extinction
 Light touch  Point location

Slide 23-12
 Test the stretch or deep  Test the superficial
tendon reflexes reflexes
 Technique  Abdominal reflex
 Grading  Cremasteric reflex
 Reinforcement  Plantar reflex
 Biceps reflex
 Triceps reflex
 Brachioradialis reflex
 Quadriceps reflex
 Achilles reflex (“ankle jerk”)
 Clonus

Slide 23-13
 Neurologic recheck
 Level of consciousness
 Person
 Place
 Time
 Motor function
 Pupillary response
 Vital signs
 Glasgow Coma Scale (GCS)

Slide 23-14
 Oculomotor response (Cranial nerve III)
 Size, equality, and roundness of pupils
assessed
 Size measured in millimeters
 Evaluated for symmetry in size and response to
light stimulus
 Brisk, sluggish, non-reactive
 Consensual reaction of opposite pupil at same
time
 Assess accommodation by holding finger 4-6
inches from client’s nose and then pull out to
18 inches.
 As finger moves away pupil will accommodate
by dilating, as finger moves closer, constricting
 PEARLA- Pupils equal and reactive to light
and accommodation
 Ability to follow commands
 Muscle tone
 Muscle strength
 Coordination
 Balance (Romberg test)
 Posturing (Decorticate, Decerebrate)
 Tactile sensation
 Pain
 Temperature
 Vibratory sensation
 Tactile discrimination
 Superficial
 Deep tendon
 Biceps
 Triceps
 Patellar
 Achilles
 Plantar (Babinski Response)
 Clear and appropriate
 Confused
 Inappropriate
 Garbled
 Aphasia (Expressive, Receptive)
 Limited hearing
 Use of hearing aids
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