1. Neurological Assessment

2. History Headache Head injury Dizziness/Vertigo Seizures Tremors
Weakness
Incoordination

4. History Cont Numbness or tingling Difficulty Swallowing
Difficulty Speaking
Environmental/occupational hazards
Past Medical History
Social History: smoking, drugs, alcohol
Medications

5. Physical Exam Mental Status, Pyschiatric Cranial Nerves Sensory exam
Motor exam

6. Mental Status Level of Consciousness Speech Orientation
Knowledge of Current events
Judgment
Abstraction
Vocabulary
Emotional responses
Memory
Calculation ability
Object recognition
Praxis

8. Facing Cranial Nerve Assessment, Barbara Bolek, American Nurse Today, November 2006

9. Cranial Nerves 1. Olfactory – have patient identify smell
2. Optic – Eye chart, visual fields
3,4,6. Oculomotor, Trochlear, Abducens – PERRLA, positions of gaze, nystagmus
5. Trigeminal Nerve: chewing muscles, facial sensation, corneal reflex
7. Facial nerve: smile, frown, close eyes, puff cheeks

10. Cranial Nerves 8. Test hearing, Weber, Rinne tests
9, 10. Glossopharyngeal and Vagus Nerves – Soft palate and uvula movement; gag reflex
11. Spinal Accessory Nerve: head movement; shrug shoulders
12. Hypoglossal – Tongue movement; “light, tight, dynamite”

11. Sensation Eyes closed Avoid leading questions
In general, if distal is intact, proximal will also be intact
Spinothalamic tract
Pain: sharp or dull
Temperature
Light touch

12. Sensation Posterior Column Tract
Vibration sense- tuning fork to bony prominence
Position- grasp toe or finger and move it up/down or side/side
Tactile discrimination- fine touch
Stereognosis- place object in hand to identify (coin or paperclip)
Graphesthesia- trace a letter or number on palm to identify
Two point discrimination
Point location

13. Motor Muscle Cerebellar Size Strength Tone Involuntary Movement
Balance:
Gait,
Tandem walking
Romberg test- have pt stand feet together arms at side eyes closed

14. Motor Cerebellar Coordination Rapid alternating movement
Knee slapping
Finger to thumb
Finger to finger
Finger to nose
Heel to shin

15. DTRs

16. Biceps – C5
The biceps reflex is elicited by placing your thumb on the biceps tendon and striking your thumb with the reflex hammer and observing the arm movement.

17. Brachioradialis – C6
The brachioradialis reflex is observed by striking the brachioradialis tendon directly with the hammer when the patient's arm is resting. Strike the tendon roughly 3 inches above the wrist. Note the reflex supination. Repeat and compare to the other arm.

18. Triceps – C7, 8
The triceps reflex is measured by striking the triceps tendon directly with the hammer while holding the patient's arm with your other hand.

19. Patellar – L3,4
With the lower leg hanging freely off the edge of the bench, the knee jerk is tested by striking the quadriceps tendon directly with the reflex hammer.

20. Achilles – S1,2
The ankle reflex is elicited by holding the relaxed foot with one hand and striking the Achilles tendon with the hammer and noting plantar flexion.

21. Babinski Reflex
The plantar reflex (Babinski) is tested by coarsely running a key or the end of the reflex hammer up the lateral aspect of the foot from heel to big toe. The normal reflex is toe flexion. If the toes extend and separate, this is an abnormal finding called a positive Babinski's sign.

22. Reflexes Deep Tendon Reflexes
Biceps, triceps, brachioradialis, patellar, achilles
Superficial Reflexes
Epigastric, abdominal, cremasteric, gluteal, plantal, bulbocavernous, superficial anal
Brain Stem Reflexes
Pupillary reaction, corneal, oculocephalic, oculovestibular, gag
Pathological Reflexes
Babinski, grasp

23. DTR Reflex Scale 0 : absent reflex
   1+: trace, or seen only with reinforcement
   2+: normal
3+: brisk
   4+: nonsustained clonus (i.e., repetitive vibratory movements)
5+: sustained clonus

24. Glasgow Coma Scale

25. Summary Neurological assessment includes: Mental status
Cognitive assessment
Cranial nerves
Motor Functions & Muscle tone
Sensory Function
Cerebellar Function
DTR & superficial cutaneous reflexes