Anatomy of Nervous System. Neurological Assessment. Brain. Brain. Spinal Cord. Spinal Cord 03/23/2010. Central. Peripheral
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1 Anatomy of Nervous System Neurological Assessment Central Brain Spinal cord Peripheral Spinal Nerves Brain Cerebral cortex ( rind ) gray matter Frontal Parietal Temporal Occipital Wernicke s area receptive aphasia Broca s area expressive aphasia Brain Basal ganglia: motor function Thalamus: relay station Hypothalamus: HR, BP, sleep, etc. Cerebellum: motor coordination Brain stem Midbrain Pons Medulla: respiration, heart, GI function, CN 8-12 Spinal Cord Nerve cell bodies arranged in horns Nerve pathways cross in the spinal cord Eg. Sensation of the left side of the body enters the left dorsal horn, and crosses to the right ventral horn and travels to right hemisphere Sensation Spinothalamic tract: pain, temperature, crude and light touch Posterior columms: does not cross sides; position, vibration, finely localized touch Motor pathways Spinal Cord Corticospinal (Pyramidal) tract: All go through the medulla s pyramid Crossed Uncrossed Finer body movements Extrapyramidal Cruder movement (walking) Upper vs Lower motor neurons 1
2 Peripheral Nervous System Reflex arc Deep tendon reflexes: requires Intact sensory nerve Functional synapse Motor Nerve Competent Muscle Superficial corneal, abdominal Visceral Pupillary light, accommodation Pathologic Mnemonic: Oh Oh Oh, To Taste And Feel Very Good Veal Simply Heaven Cervical 8 Thoracic 12 Lumbar 5 Sacral 5 1 Coccygeal Spinal Nerves Sensory in dorsal horns; motor in ventral Dermatome Functional Divisions Autonomic vs. Somatic Nervous System Sympathetic vs. Parasympathetic Primary sympathetic neurotransmitter is Norepinephrine, so sympathetic system is called adrenergic Primary sympathetic neurotransmitter is Acetylycholine, so parasympathetic system is called cholinergic Headache Head injury Dizziness/Vertigo Seizures Tremors Weakness Incoordination History History Cont Numbness or tingling Difficulty Swallowing Difficulty Speaking Environmental/occupational hazards Past Medical History Social History: smoking, drugs, alcohol Medications 2
3 Anticholinergic Symptoms Mydriasis Dry, flushed skin Hallucinations Agitation Hyperthermia Urinary retention Delayed intestinal motility (constipation) Tachycardia Seizure Anticholinergic Mnemonic Blind as a bat Dry as a bone Red as a beet Mad as a hatter Hot as a hare Drugs with Anticholinergic Effects Physical Exam Atropine (100% of maximal anticholinergic effect) Scopolamine Tolterodine Hyoscyamine Cholinergic Parkinsonism agents Prednisone (55%) Diphenhydramine (Benadryl) Amitriptyline (Elavil) Digoxin Nifedipine Phenobarbital Oxybutynin (20%) Isosorbide dinitrate Hydroxyzine Warfarin Dipyridamole Codeine Ranitidine (10%) Dyazide Furosemide (Lasix) Nortriptyline (3%) Mental Status, Pyschiatric Sensory exam Motor exam Mental Status Level of Consciousness Speech Orientation Knowledge of Current events Judgment Abstraction Vocabulary Emotional responses Memory Calculation ability Object recognition Praxis 1. Olfactory have patient identify smell 2. Optic Eye chart, visual fields, fundus 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 3
4 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 Eyes closed Sensation Avoid leading questions In general, if distal is intact, proximal will also be intact Spinothalamic tract Pain: sharp or dull Temperature Light touch Sensation Posterior Column Tract Vibration sense Position Tactile discrimination Stereognosis Graphesthesia Two point discrimination Extinction Point location Muscle Size Strength Tone Involuntary Movement Cerebellar Balance: Gait, Tandem walking Romberg, One legged squat Motor Cerebellar Coordination Motor Rapid alternating movement Knee slapping Finger to thumb Finger to finger Finger to nose Heel to shin Deep Tendon Reflexes Tests sensory and motor function Biceps Brachiradialis Triceps Quadriceps (patellar) Achilles 4
5 Clonus Superficial reflexes Abdominal Cremasteric Plantar reflexes Additional Tests 5
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