neuro assessment/daignostics

• 1) mental status
• 2) cranial nerves
• 3) motor system
• 4) sensory system
• 5) reflexes

• -seen w/ lesions that interupt corticospinal (motor) pathways between upper neurons in brain and spinal cord
• -arms flexed, fists clenched, legs extended

• -disruption of motor neurons of the brainstem and midbrain
• -arms stiff and extended, forearms pronated, DTRs exaggerated

-may be seen w/ tetany, seizures (grand-mal), meningitis

• GSC= used to assess LOC, usually the first sign that is altered w/ incr. ICP
• 1) motor response (e.g. obeys commands, loczlized to noxious stimuli, withdraws from noxious stimuli...)
• 2) verbal response
• 3) eye opening (e.g. spontaneous, open to speech...)

Normal= 15, 7 or less = comatose, "less than 8, intubate!"

• -general appearance
• -moon/affect
• -thought content (e.g. delusions, hallucinations)
• -intellectual capacity
• -ADL assessment = good baseline to evaulate progressive neuro disease

• -sensory and motor function
• -may be impaired by incr. ICP, surgery of head/neck tumor, trauma

2, 3, 4, 6

-incr. ICP causes direct pressure, assess w/ simple vision test (e.g. ask pt. to read something or put 2 fingers up and say how many?)

• -incr. ICP causes indirect pressure bc they exit at the brainstem at the level of the tetorial notch, so they are affected when the brain shifts
• -these CN (3,4,6) are responsible for extraocular movements, and CN 3 is responsible for pupil constriction
• -assess using
• Pupils
• Equal
• Rround
• Reactive
• Light
• Accomodation (pupils shouls slightly constrict as you move finger toward pt's face)

-evaulates the lower motor neurons (anterior horn cell and the motor fibers that leave it) and the sensory fibers within the particular levels of the spine

• 4+ hyperactive (may be assoc. w/ upper motor neuron disease of the cerebral cortex)
• 3+ brisker than normal (not necessarily pathologic)
• 2+normal
• 1+ diminished (may be normal)
• 0 absent (assoc. w/ lower neuron disease, like Guillan-Barre)

• -Abdominals- equal movement of umbilicus (absent movement = damage in pyramidal tract (pyramidal tract deals w/ regulation of fine muscle movements))
• -Cremasteric- rising of the testicle and scrotum
• -Plantar- (Babinski) fanning of toes (normal in baby, not adult), or dorsiflexion of great toe

• 1) VS (checking for HTN, bradycardia, widened pulse pressure, change in resps)
• 2) pupil size, shape, reaction
• 3) eye opening
• 4) verbal response
• 5) motor response
• 6) extremity strength
• the most accurate indicator of changing neurological status is LOC!!!

• -insertion of spinal needle into subarachnoid space between 3rd and 4th or 4th and 5th lumbar vertabrae (=no danger bc spinal cord ends at L1-L2) but temporary leg pain or muscle twitching may result from spinal root irritation
• -used to obtain CSF pressure readings or to relieve pressre in certain conditions, may be used to obtain CSF for analysis, inject contrast medium, inject anesthesia

-rusk of uncal herniation and infection, contraindicated w/ incr ICP or infection at the puncture site

• -local anesthetic
• -fetal position
• -bedrest in FLAT position for 4-8 hrs post procedure to prevent spinal cord HA
• -icr. fluids to 3000 mL for 24-48 hrs
• -post procedure: monitor for CSF leak, hematoma, infection, bleeding, numbness, decr. ability to move extremities, inability to void, signs of meningeal irritation (nuchal rigidity, photosensitiviey, Kernigs and Brudzinskis sign)
• -lavel and number specimen tubes, transport to lab immediately

• -records activity of the cerebral hemisphere to: (main uses)
• 1)determine orgin of seizure activity
• 2)monitor cerebral activity during surgical anesthesia
• 3)determine brain death

• -if the test is to be performed under sleep deprived conditions, tell pt to awaken at about 2 or 3 am and stay awake for rest of night
• -instruct pt to aviod CNS depressants or stimulants, and withhold anticonvulsants only if prescribed by physicain
• -tell pt not to drink caffeine on day of test (stimulant)
• -have pt wash hair and not put sprays/oils in the day of test

-provides info about the FUNCTION of the brain, specifically glucose and O2 metabolism and cerebral bloodflow (CT provides info about structure only)

-used to detect areas of metabolic alteration (dementia, epilepsy, psych and degenerative disorders, neoplasms, Alzheimers)

-Deoxyglucose is injected which is tagged to an isotope, the isotope emits activity (positrons) which are scanned and converted to a color image by the computer, the more aciteve a given part of the brain the more glucose uptake

• -no caffeine, ETOH, tobacco 24 hrs before test
• -NPO for 4-12 hrs prior, if pt. is diabetic do not give insulin before test
• -do not give glucose sln or other drugs that alter glucose metabolism
• -IV line established
• -client may be asked to perform functions such as counting, test takes 2-3 hrs
• -icr. fluid intake after exam, no special urine precautions