Neurological systems review, and quick tests

Neurological systems review
Things to ask
• Presenting Problem
o Symptoms R/V Qs – ask patient to answer yes/no
• Seizures/fits – have you ever experienced any fits/faints/ funny turns?
• Fainting
• Dizziness/vertigo – head spins (dizziness), room spins (vertigo)
• Headache LOC (loss of consciousness), blackout
• Meningism – neck stickness
• Visual disturbance – do you see stars/flashes? Any changes in vision?
• Weakness – in muscles – dropping things easily, clumsiness
• Movt problems – unusual twitches/ move of your muscles
• Parasthesia – pins and needles (odd sensations)
• Anaesthesia - numbness
• Bladder/bowel – do you have ever accidents? Lost control of your water works?
• Risk factors
o Smoking
o Diabetes
o Alcoholism
o Diet/metabolism
o Drugs/chemical exposure
• Past Hx
• Family Hx
• Social
o Diet
o Exercise
• Meds/allergies
• All other systems r/v qs
• + risk factors
Things to test
* The movements and reactions of the eye.
* An examination of the eye using an ophthalmoscope. (not applicable in this case)
* A test of smell, of each nostril. This is particularly important in concussion cases, as a compromised sense of smell can be an indicator of frontal lobe damage. Sadly, this is the part of the test most often neglected.
* The patient should be asked to whistle, smile and clenching his teeth.
* Hearing should be tested.
* The muscles required to move the head around should be palpatated.
* Then the patient is asked to do the classic hand and arm movements, in order to elicit evidence of tremors, unilateral or bilateral motor weakness and to evaluate coordination and position sense.

Check each of the cranial nerves briefly
* I. Olfactory - Smell.
* II. Optic - Vision.
* III. Oculomotor - Eye movement.
* IV. Trochlear - Eye movement.
* V. Trigeminal - Controls the muscle and senses of the face.
* VI. Abducens - Eye movement.
* VII. Facial - Taste, expression and facial and scalp movements.
* VIII. Vestibulolocochlear - Hearing and vestibular system.
* IX. Glassopharyngeal - Gag reflex, taste, throat and sinus reflex.
* X. Vagus - throat, voice, gag reflex, coughing, dilations of the stomach.
* XI. Accessory - rotate head, shrug shoulder, raising chin.
* XII. Hypoglossal - muscles of the tongue.

References
Tutorial 2008 – Neurological systems review
neurologicalexam.com