Transcript Neurology Evaluation in the ED

Neurology Evaluation
in the ED
Nicholas Cascone, PA-C
Components of Neuro
Evaluation in ED

Mental Status – emotional and intellectual
function
– Thought process
– Mood
– Insight
– Sensorium
– Attention
– Memory, short and long-term
Components of Neuro
Evaluation in ED

Glasgow Coma Scale – measure of
sensorium/consciousness
– Eye opening:
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4
3
2
1
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spontaneous
opens to speech
opens to pain
none
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5
4
3
2
1
=
=
=
=
=
alert, oriented
disoriented but verbal
nonsensical
moans/unintelligible speech
none
– Verbal response:
Components of Neuro
Evaluation in ED

Glasgow Coma Scale (cont’d)
– Motor response
6
5
4
3
2
1
=
=
=
=
=
=
follows commands
localizes pain
withdraws from pain
decorticate – flexion
decerebrate – extension
none
Components of Neuro
Evaluation in ED

Higher cerebral function
– Language
 Dysarthria – mechanical disorder of speech from
weakness of facial/oral muscles
 Dysphasia – problem with language of
cortical/subcortical origin
– Fluent (Wernicke’s) or nonfluent (Broca’s)
– Comprehension – tested by ability to follow commands
Components of Neuro
Evaluation in ED

Cranial nerves
– I – rarely tested
– II/III – direct/indirect pupillary response
– III/IV/VI – extraocular muscle movements
– V/VII – corneal reflex
– VIII – hearing, balance
– IX/X – gag reflex
– XI – shoulder shrug
– XII – tongue protrusion
Components of Neuro
Evaluation in ED

Sensory exam
– Touch in all extremities
– If negative, test proprioception or vibration
sense
– Further investigation involves testing
individual dermatomes to localize lesions
Components of Neuro
Evaluation in ED

Motor system
– Muscle tone – passive movement of muscle
groups with patient not resisting
– Muscle bulk – atrophy, wasting
– Muscle strength – 0-4 scale, 0=complete
paresis, 1=minimal contraction, 2=active
movement when gravity counteracted,
3=movement against gravity only,
4=movement against resistance
– Reflexes, Babinski response
Components of Neuro
Evaluation in ED

Cerebellar testing
– Posture, truncal movements test central
cerebellum
– Appendicular movements test lateral
cerebellum
– Dysdiadokokinesis – inability to execute
rapidly alternating movements
Components of Neuro
Evaluation in ED

Gait and station
– Most important neurological test
– Watch as patient sits upright, rises, stands, walks,
turns, heel walks, toe walks
– Gait disturbance examples
 Ataxic – wide-based, unsteady, irregular steps, inability to
negotiate barriers; cerebellar lesions
 Apraxic – cannot initiate gait; nondominant hemispheric
lesions
 Equine – high step present due to foot drop; peroneal muscle
weakness
 Festination – narrow-based, shuffling; Parkinsonism
 Waddling – weakness of lower trunk/pelvic girdle