Essential Components of Neurological Assessment

Sep 25, 2024

Neurological Assessment Lecture Notes

Introduction

  • Focus on neurological assessment of a patient.
  • Key components: level of consciousness, motor function, pupillary function, respiratory function, and vital signs.
  • Importance of understanding these components prior to class.

Level of Consciousness

  • Most crucial part of the neurological exam.
  • Glasgow Coma Scale (GCS):
    • Objective tool measuring eye opening, verbal response, and motor response.
    • Max score of 15, indicating higher levels of function.
  • Levels of consciousness:
    • Alert: Aware and oriented.
    • Confused: Awake but disoriented.
    • Delirium: Uncontrolled excitement/emotion.
    • Lethargic: Sleepy but easily arousable.
    • Obtunded: Difficult to arouse, confused.
    • Stuporous: Near unconsciousness.
    • Comatose: Unconscious and unresponsive.

Motor Function

  • Assessment includes motor strength, tone, and reflexes.
    • Gross and fine motor skills.
    • Reflex evaluation; corresponding cranial nerve review advised.
  • Levels of motor response:
    • Spontaneous: Follows commands.
    • Localization: Responds to painful stimuli.
    • Withdrawal: Moves away from pain.
    • Decortication: Abnormal posturing, related to corticospinal pathway lesions.
    • Decerebration: Linked to brain stem injury.
    • Flaccid: No movement, even with painful stimuli.

Pupillary Function

  • PERLA: Pupils Equal, Round, Reactive to Light and Accommodation.
    • Assess pupil size, shape, and reaction to light.
    • Pay attention to past eye surgeries or medications affecting pupil appearance.
  • Oculocephalic Reflex: Eye movement with head rotation.
  • Caloric Test: Cold or warm water in ear canal; eyes should move toward water.

Respiratory Function

  • Evaluate breathing patterns:
    • Cheyne-Stokes: Alternating apnea and rapid breathing.
    • Central Neurogenic Hyperventilation: Deep and rapid breaths.
    • Apneustic Breathing: Gasping inspiration with pauses.
    • Cluster Breathing: Series of respirations followed by apnea.
    • Ataxic Respirations: Irregular breathing and pauses.
  • Ensure airway is clear and maintained.

Vital Signs

  • Monitor blood pressure, heart rate, and rhythm.
  • Cushing's Triad: Late sign of increased intracranial pressure.
    • Symptoms: severe hypertension, widened pulse pressure, bradycardia.

Conclusion

  • Comprehensive assessment necessary for neurologically impaired patients.
  • Understanding these components critical for patient care.