NEUROLOGICAL ASSESSMENT

A. Neurological History

- Always confirm at the very beginning of your interview if the patient is mentally sound to provide correct and
rational information regarding his/her health. Check if the patient can cognitively recall.

HISTORY OF PRESENT HEALTH CONCERNS

1. Headache – increased intracranial pressure (caused of icp: abnormal buildup of cerebrospinal fluid, swelling in
the brain)

2. Seizures – Epilepsy, head injury loss of consciousness due to involuntary muscle movement and sensory
disturbance because of abnormal firing of neuron.

- What to ask if the patient experienced head injury/nabagok: Nagsuka ba? Saan banda yung tama sa
ulo, Nawalan ba ng malay, nangisay/seizure.

3. Dizziness or lightheadedness – Carotid artery disease

4. Numbness or tingling- Brain, spinal cord, or peripheral nerve damage

5. Any decrease in ability to smell or taste

6. Problems with communication – injury to the cerebral cortex, nabulol ang patient

7. Lost bowel or bladder control –spinal cord injury or tumors, biglang naihi.

8. Dysphagia- difficulty in swallowing. Cerebrovascular accident (stroke)

9. Muscle weakness or any loss of movements – Stroke, spinal cord compression, any neurological diseases.

NEUROLOGICAL ILLNESS

1. Parkinson’s Disease

- Long term degenerative central nervous system disorder (lost of dopamine in the midbrain.)

- Affects the motor system.

- Symptoms: Shuffling gait or baby steps, trembling of legs or extremities, rigidity

2. Myasthenia Gravis

- long term neuromuscular disease that causes skeletal muscle weakness.

- facial asymmetry

- difficulty in talking and trouble walking, double vision.

3. Guillain-Barre Syndrome (GBS)

- Autoimmune disorder that attacks the myelin sheath.

- Symptoms: weakness, numbness, and tingling, and even paralysis.

4. Multiple Sclerosis

- Autoimmune disease that attacks the myelin sheath

 - Symptoms: one-sided numbness or weakness in one or more limbs, lhermitte sign- sudden electrical
shock sensation in the neck and spine, tremor of coordination or unsteady gait that is why they need
assistance.

5. Tourette’s Syndrome

- involves involuntary repetitive movements or uncontrollable sounds (tics)

6. Huntington’s Chorea

- Inherited progressive neuro disorder

- Symptoms: uncoordinated gait, jerky body movements, and dementia

7. Cerebral Palsy

- Disorder of movement, muscle tone or posture

- Caused by damage to immature, developing brain before birth

- Congenital illness and they have very poor prognosis that some of them do not reach adulthood
because of the paralysis that starts from the foot and as it reaches cervical spine, it creates problem in
breathing.

- Symptoms: poor coordination, weak muscles, and tremors. Problems with sensation, vision, hearing,
swallowing, and speaking may also be present.

8. Korsakoff’s Syndrome

- Sobra sa walwal

- Amnestic disorder caused by thiamine

- Caused by prolonged ingestion of alcohol

- Solution: uminom ng vitamin b

HISTORY OF PRESENT ILLNESS IF:

1. Repetitive involuntary trembling, quivering, shaking, or other movements.

- Motor neuron disease, tourette’s syndrome

2. Memory loss (dementia)

PAST HEALTH HISTORY

1. Any type of head injury with or without loss of consciousness

2. Meningitis

3. Encephalitis

- Inflammation of the brain

- Usually happen sa baby

- Most common cause is virus

 - Symptoms: Flu-like symptoms, seizure

- How to differentiate encephalitis and hydrocephalus (Malaki ulo ng patient)

 HYDROCEPHALUS – maraming water sa brain, get a flashlight, itutok sa ulo(bunbunan) ng patient

and if umilaw, that is not inflammation. That is fluid.

4. Spinal cord injury

6. CVA/Cerebrovascular Accident (Stroke)

- Can be caused by a clot (ischemic stroke), bleeding (hemorrhagic stroke)

 Ischemic Stroke – Deprived of blood, blood clot blocks the blood flow
 Hemorrhagic Stroke – Bleeding, blood spills out from break in blood vessels in brain

- Symptoms: facial asymmetry, arm weakness, and slurred speech

- STROKE ASSESSMENT: BEFAST

1. Balance – loss of balance, headache or dizziness

2. Eyes – blurred vision
3. Face – one side of the face is dropping, facial asymmetry.
4. Arms – Arm or leg weakness; pataasin ang kamay for 10secs
5. Speech – Speech difficulty
6. Time – Time to call for ambulance immediately

FAMILY HISTORY

1. Hypertension

- Number one culprit for stroke

2. Cerebrovascular Accident (CVA)

- If there is a history of CVA, there is an exponential risk of stroke to reoccur

3. Alzheimer’s Disease

- Inherited

- Progressive neurologic disease with gradual worsening dementia

-The brain is shrinking

4. Epilepsy

-Inherited

5. Brain Cancer

6. Huntington’s Chorea
LIFESTYLE AND HEALTH PRACTICES

1. Medications, alcohol, or recreational drugs

- Tremors, altered LOC, dizziness, mood changes

2. Smoking habits

- Vasoconstriction

3. Safety Practices

- Seatbelts, protective headgear for biking or sports

4. Diet

- Low fat diet, low cholesterol, low salt is important for neuro because it prevents the occurrence of
hypertension. Dapat rich in vitamin b complex

- Peripheral neuropathy: vitamin B3, B9, B12 deficiency

5. Exposure to lead, insecticides, pollutants, or other chemicals

- Altered LOC

6. Any heavy lifting or repetitive motion

- There may be spinal cord injury or peripheral nerve injuries, and symptoms.

B. Neurological Examination

1. Mental Status Exam and Level of Consciousness (LOC)

- MSE assess the highest level of cerebral integration

- MSE must be performed at the beginning of the head-to-toe exam to ensure that the patient
is mentally sound/validity of client’s response.

- When assessing the elderly, make sure that the elderly can read and listen/check the vision
and hearing.

- SOME of the Components of MSE: LOC, Posture, gait, body movements, speech, mood, etc.,
 A. Mini-mental State Exam (MMSE) aka FOLSTEIN TEST

- Short version of MSE

- Tool to assess mental status

- Tests five areas of cognitive function: 1. Orientation 2. Registration 3. Attention & Calculation
4. Recall 5. Language

- greater than or equal to 24 points (out of 30) indicates normal

- severe = less than 9 points,

- moderate = 10-18 pts.,

- mild= 19-23 pts

LEVEL OF CONSCIOUSNESS

1. Alert – awake and able to answer questions

2. Lethargy – opens eyes, answers questions, and falls back to sleep

3. Obtunded- Opens eyes to loud voice, responds slowly with confusion, and seem unaware of the environment

4. Stupor – Awakens to vigorous shake or painful stimuli but returns to unresponsive sleep

5. Coma – client remains unresponsive to all stimuli; eyes stay closed.

GLASGOW COMA SCALE (GCS)

- Tool for assessment of impairment LOC in response to defined stimuli.

- Originally, it was used to assess for acute brain injury

- Eye = 4, Verbal=5, Motor= 6, maximum of perfect number is 15, minimum is 3

- 3=deep coma, 8 below=coma

 Eye Opening Response

- 4 = pagpasok ng room, napansin ka ng patient
-3 = Tulog ang patient, you greeted, “good morning” nagising siya
-2 = Tulog ang patient, you greeted and hindi pa rin nagising. Shinake mo siya para magising, nagising
-1 = “good morning” shinake na rin, ayaw gumising pero buhay pa.

 Verbal Response
- If the patient’s score is 4 or 3, proceed to verbal response. 2 below for eye response, automatic 1
- 5 = ask for time, place, and person (sino kasama niyo, nasaan kayo, anong araw)
- 4 = kung may mali na isa sa tanong, kung hindi niya alam kung nasaan siya as long as he/she
understood the questions.
- 3 = Inappropriate response, mga sagot na walang kinalaman sa tanong (ex. Bigla kang minura)
- 2 = hindi words ang sinagot (ex. Growl or umubo lang)
- 1 = no response. Applicable sa naka-intubate (kapag nod, 1 lang)

 Motor Response
- If the patient is oriented, proceed to motor response
- 6 = kapag nasunod yung pinagawa (pinataas yung kamay)
- 5 =kinurot mo si patient, pinigilan ka niya
- 4 = kinurot mo, nagtago lang or withdraws from pain
- 3 = kinurot, nag decorticate lang meaning nag curl inward ang kamay
- 2 = kinurot, nag decerebrate meaning nag curl outward ang kamay
- 1 = no reaction
Pain Stimulation
1. Fingertip Pressure – itutusok yung kuko sa pinky finger
2. Trapezius Pinch – Pinch yung sa may bandang collarbone
3. Supraorbital notch – sa may noo, above the nose

Test for sensation

 To test light touch sensation = use a wisp of cotton to touch the patient
 To test pain sensation = use a safety pin or paper clip
 To test temperature sensation = use test tubes filled with hot and cold water but it is not recommended
 NORMAL: client correctly identifies sensation

Deep Tendon Reflexed Test

 Muscle group to be tested must be in a neutral position

 Strike tendon with a single, brisk, stroke, with a reflex hammer.
 While it is done firmly, it should not elicit pain. Perform tests on both sides


2. Motor and cerebellar Exams

3. Sensory and reflex exams

4. Cranial Nerve Exams

Equipment:

 Mental Status Exam and LOC

- MSE questionnaire, pen light, pen/pencil
 Sensory and reflex exams
- Cotton, safety pin/paper clip, test tube with hot and cold water, reflex hammer
 Motor and cerebellar exams
- Tape measure
 Cranial nerve exams
- Op