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.