Hazards: Neurological Disorders Blood Brain Barrier Essential barrier to provide the best environment for the neurons Certain substances can not enter, or enter very slowly – many medications are not able to pass this barrier Neurological Assessment Health History Current health, symptoms Major illnesses, medication Family history Psychosocial history Education Level of performance Personality or behavior changes Smoking, drug use/abuse Physical Examination Physical Examination Looking for abnormalities, so understanding “normal” is essential Vitals Mental status Head, neck, back Cranial nerves Motor function Sensory function Reflexes Initial Physical Examination Level of Consciousness Glasgow Coma Scale 1-15 (used for unconscious states) Best Eye Opening Best Motor Response- how to elicit?? Best Verbal Response Orientation- What year is this? Memory- Family or home Affect, mood Communication  Judgment Neuro Checks in Acute Care Will depend on level of injury  LOC (orientation X4) The most important indicator of neurologic function** Vital signs Pupils (PERLA) Muscle strength (movement against resistance) Sensory assessment (dull v. sharp) Head, Neck, Back Inspect head for size, shape, lesions, eye position, drainage Wounds, asymmetry  Palpate head, neck, back for lesions, fractures, pain Percuss gently over spine for pain Auscultate for carotid bruit Cranial Nerve Assessment Cranial Nerves Olfactory – smell Optic – visual acuity, peripheral vision, eye position Occulomotor, trochlear, abducens – shape, size of pupils, nystagmus, reaction to light & accommodation Trigeminal- face sensation, chewing, jaw muscles Facial – taste, frown, smile, eyebrow movement, corneal reflex Cranial Nerves continued Acoustic – whisper test, watch tick Glossopharyngeal – gag, say ah Vagus – check voice for hoarseness, swallow reflex Spinal accessory – shrug shoulders, turn head, move head against resistance Hypoglossal – deviation of tongue, asymmetry How to Memorize Cranial Nerves  Olfactory, Optic, Oculomotor, Trochlear, Trigeminal, Abducens, Facial, Acoustic, Glossopharyngeal, Vagus, Spinal Accessory, HypoglossalO n Old Olympus Towering Tops, A Fin And German Viewed Some HopsS ome Say Marry Money, But My Bother Says Bad Business Marries Money S= Sensory only M= Motor only B= Both Sensory and Motor Motor Assessment Muscle size Muscle strength 5 point scale 0/5= contraction, movement absent 1/5= trace of contraction 2/5= movement with gravity only 3/5= movement against gravity 4/5= full ROM but with some weakness 5/5= Full ROM, normal strength Motor Assessment continued Muscle tone Flaccid or spastic Tremors, fasciculations  Coordination Rapid alternating movement Point-to-point Truncal balance – sitting, standing Gait- proprioception- sense of body position Types of Gait Disturbances Ataxic – staggering Dystonic – irregular, poor direction Dystrophic – broad based – waddling Equine – high steps (like a show horse) Festinating – on toes fast pace Hemiplegic – one arm and leg swing wide with each step Parkinsonian, short shuffling, leaning forward Scissor steps- slow, short steps, with legs crossing Steppage – foot and toes high, foot slaps down (similar to equine) Sensory Assessment Touch, vibration, pain, proprioception, discrimination (sharp/dull) Hearing, vision, smell, taste Test with eyes closed  Always compare sides Think about the dermatomes Sensory Assessment Terms Stereognosis- ability to feel a familiar object without looking Absence is astereognosis Graphesthesia- ability to recognize a written symbol - agraphesthesia Extinction- simultaneous stimulation 2-point stimulation- ability to differentiate 2 pin pricks from 1 Abnormal Sensations Paresthesia- distorted sensation Light touch feels like burning pain Dysesthesia – localized, irritating sensation Prickly, crawling Hypoesthesia- reduced sensation Hyperesthesia- abnormal excessive sensation Response to Painful Stimulation Localization- push away source of pain Flexion withdrawal- move s purpose Abnormal Flexion  Decorticate posturing Response to Pain Abnormal Extension  Decerebrate posturing No response- flaccid Superficial Reflexes Corneal- touch cornea Pharyngeal- touch posterior pharynx with cotton tip applicator Abdominal- stroke skin at umbilicus Plantar- stroke sole of foot Deep Tendon Reflexes Causes the muscle to stretch Bicep jerk Tricep jerk Brachioradial jerk Knee jerk Ankle jerk Abnormal Reflexes Babinski Snout- tap around mouth, pursing Rooting- stroke side of face, mouth opens & head turns toward stim. Sucking- touch lips, lips tongue and jaw move forward Rooting & sucking normal in infants, abnormal in adults Diagnostic Testing for Neurologic System Skull & Spine X-ray- fractures CT scan- edema, space-occupying lesions, intracranial bleeds If contrast used – allergy to shellfish Important for traumas  MRI- cerebral infarction, demyelinization Remove all metal Caution with aneurysm clips, some orthopedic hardware* More Neuro Tests PET (positron emission tomography) Blood flow to a specific area Adequacy of nutrients, oxygen Mapping of receptors May require 4 hour fast Electorencephalogram (EEG) Measures electrical activity in cortex For seizures, assess for brain death Antidepressants, tranquilizers, stimulants should be avoided for 24-48 hours Central Neurologic Disorders Coma Sustained unconsciousness No response to verbal stimuli Varying response to painful stimuli No voluntary movement Often altered respirations Often altered pupil response No blinking**Consciousness = wakefulness PLUS aware of self/surroundings Causes of Coma Lesion putting pressure on brain stem, especially the RAS Gunshot wound, Auto accident or head trauma leading to bleeding, tumors Symptoms generally unilateral Metabolic disorders, which affect the brains supply of glucose or oxygen Hypoxia, blood loss, ischemia from cardiac condition, diabetes Symptoms usually