1. Neurological Assessment
Mental Status and
Neurological Assessment
L / Hanaa Eisa

2. Learning outcome
At the end of this Lesson the study p will be able to:
Discuss the divisions of the nervous system and
their functions.
Relate blood flow to the brain to the functional area
supplied.
Describe the characteristics of the most common
neurological complaints.
Perform a mental status assessment and document
the results.

3. Learning outcome cont’d
Explain the pathophysiology of any abnormal
results obtained.
Document a complete health history as it relates to
the neurological system.

4. Introduction The nervous system consists of :
The central nervous system (CNS)
The peripheral nervous system
The autonomic nervous system.
Together these three components integrate all physical, emotional, and intellectual activities.

5. Nervous System Anatomy
Central Nervous System
Brain
Spinal cord
Peripheral Nervous System
Cranial nerves
Spinal nerves

6. Central nervous system-spinal cord

7. Peripheral Nervous System-12 Pairs of Cranial Nerves
Originate in the brain
Control many activities in the body
Take impulses to and from the brain

8. Cranial nerves and their target regions Sensory nerves are shown in blue motor nerves shown in red8

9. Anatomy and physiology
Protective layers
Scalp
Skull
Meninges
Dura mater (الأم الجافية)
Arachnoid mater (أم عنكبوتية )
Pia mater (الأم الحنون)

10. Central nervous system
Brain
Cerebrum: right and left hemispheres
Cerebral cortex
Memory storage and recall
Sensation
Vision, hearing, motor function

11. Lobes of the Cerebrum Parietal Somatic sensory Frontal
Higher intellectual function
Speech production
Psilateral motor control

12. Lobes of the Cerebrum Temporal Hearing Memory Speech perception
Occipital
Vision
Limbic
Emotion

13. Brain Diencephalon: Body temperature regulation
pituitary hormone control
autonomic nervous system responses
Cerebellum
Maintains posture and equilibrium
Brain stem
Respiratory and cardiac regulation, level of awareness, reticular activating system

14. Spinal cord
Gray matter
White matter
Dorsal horn
Ventral horn

15. Blood supply Circle of Willis Carotid arteries Cerebral arteries
Basilar artery
Cerebellar arteries

16. Cranial nerves Motor, sensory, or both Olfactory (I) Optic (II)
Oculomotor (III)
Trochlear (IV)
Trigeminal (V)
Abducens (VI)
Facial (VII)
Acoustic (VIII)
Glossopharyngeal (IX)
Vagus (X)
Spinal accessory (XI)
Hypoglossal (XII)

17. Reflexes Specific response to adequate stimulus Monosynaptic
Polysynaptic
Classes
Muscle strength or deep tendon
Superficial
Pathological

18. Reflexes Deep tendon Grading scale 0 – 4+ Compare right to left
Biceps, triceps, patellar
Superficial
Abdominal, bulbocavernosus
Pathological

19. Health History Age Early adult , Middle adult , Older adult Gender
Female or Male
Race
African, American

20. Common chief Characteristics of chief complaints Quality Quantity
Associated manifestations
Aggravating factors
Alleviating factors
Setting
Timing
Common chief complaints
Seizure , Syncope , Pain
Paresthesia , Disturbances in gait
Visual changes
Vertigo
Memory disorders
Difficulty with swallowing or speech

21. Past health history Medical Injuries and accidents Neurologic specific
Non-neurologic specific
Surgical
Medications
Communicable diseases
Injuries and accidents
Family health history
Social history
Alcohol, tobacco, drug use
Sexual practices
Work and home environment
Health maintenance activities

22. Motor System
Extra pyramidal rigidity
Coordination
Gait
Station

23. Gerontological variations
Increased risk for ischemic brain injuries
Decreased rate of nerve conduction
Decreased number of neurons
Decreased neurotransmitter production
Sensory alterations
Cognitive changes

24. Spinal nerves Dermatome: Band of skin innervated by the sensory
Root of a single spinal nerve

25. Physical assessment of the neurologic system
Testing cranial nerves
Testing Motor function
Testing Sensory function
Testing Reflexes (Always consider left to right symmetry)

26. Areas of the neurologic system assessment
Testing cranial nerves I to XII
I . Olfactory: smell
ll. Optic: vision

27. Eyes – techniques of examination
Visual acuity
Near vision: Use (Jaeger or Rosenbaum chart (hand-held card).
Can also use to test visual acuity at the bedside , hold 14 inches
(about 30 cm) from patient’s eyes
Jaeger chart
Rosenbaum chart

28. III. Oculomotor , IV. Trochlear ,VI. Abducens
Test Extraocular Movements
Test pupillary reaction to light

29. CN V. Trigeminal examine for motor and sense

30. VIII. Acoustic Weber Test (by using a tuning fork).
Rinne test: to compares air and bone conduction
Romberg test: Ask the patient to remain still and close their eyes (for about 20 seconds).

31. Areas of the neurologic system assessment
Motor function
Observation of gait and balance
Administration of the Romberg test
Administration of the finger-to-nose test
Observation of rapid alternating action movements

32. Areas of the neurologic system assessment
Sensory function
Observation of light touch identification
Sharp, dull determination
Graphesthesia (Number identification)

33. Areas of the neurologic system assessment
Reflexes :
Stimulus-response activities of the body.
Biceps
Triceps
Patellar (knee)
Abdominal

34. Level of consciousness(LOC)
LOC state continuum from alertness to coma.
Fully alert client responds to questions spontaneously. Comatose client may not respond to verbal stimuli.
The LOC was tests in three major areas
Eye response , motor response and verbal response .
An assessed totaling 15 points indicates client is alert and completely oriented .
A comatose client scores 7 or less.

35. Glasgow coma scale

36. Thank you