Neuro Assessment
Neuro Assessment
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I On Olfactory Some Sensory Sense of smell Have pt hold one nostril closed and pass a
familiar smelling item under the nostril (coffee,
orange, peppermint, vanilla)
II Occasion Optic Say Sensory Sense of vision Block one eye at a time and have pt read
something. If can’t read, then hold up fingers and
ask how many fingers you’re showing.
III Our Oculomotor Marry Motor Moves 4 of muscles of eye, raises eyelid, Constricting pupils with a light. Opening eyelid,
papillary constriction and lens moving eye superiorly, medially and diagonally..
accomodation (with 4, 6…make big movements with hand and
have them follow it with their eyes only)
IV Trusty Trochlear Money Motor Superior oblique eye muscles Move eye down and laterally (with 3, 6)
V Truck Trigeminal But Sensory, Sensation over face Touch cornea lightly with cotton wisp, check for
Motor Muscles of mastication blink. Chewing, jaw opening and clenching.
Touch three areas on the face with light cotton
(near temple, at cheek and next to mouth)
VI Acts Abducens My Motor Moves eye laterally Moving eye laterally (with 3, 4)
VII Funny Facial Brother Sensory, Controls the muscles of facial expression, Closing eyes, closing mouth, moving lips and
Motor and taste to the anterior two-thirds of the other muscles of facial expression (have pt
tongue smile); salivation and lacrimation.
VIII Amazingly Acoustic Believes it’s Sensory, Hearing and equilibrium Whisper a word in the pt’s ear from 1-2 feet
Motor away. A better method is to use tuning fork.
IX Good Glassopharyngeal Bad Sensory, Sense from pharynx and taste on posterior Swallowing, gag sensation, secretion of saliva.
Motor 1/3 of tongue; Tasting on posterior tongue (place sugar, salt,
Swallowing, parotid salivary gland etc…on tongue)
X Vehicle Vagus Business to Sensory, Proprioception from pharynx, larynx. Speaking and swallowing (test motor fxn of
Motor Pharyngeal and laryngeal muscles. palate, pharynx, larynx).
Have pt say “L, N, T”, have them swallow, have
them say “aaaah” and watch for uvula going up.
XI Any Accessory Marry Motor Pharyngeal, laryngeal and soft palate Put hands on shoulders and have the pt shrug
muscles, trapezius and against your hands. Can also put hand on cheek
sternocleidomastoid. and have them turn head against your hand.
XII How Hypoglossal Money Motor Intrinsic and extrinsic muscles of tongue. Have pt stick out tongue, it should be medial.
Have pt push tongue into each cheek…if they
can only do one side, this is bad news.
Neuro Assessment Study Guide.doc
Motor Response:
Thumbs up, first or peace sign to command 4
Additional Checks and Reflexes
Localizes to pain 3 Chvostek’s Sign: This is a spasm of the facial muscle elicited by tapping the facial nerve in
Flexion response to pain 2 the region of the parotid gland. If positive this is a sign of hypocalcemia.
Extensor posturing 1 Babinski: Move finer along lateral side of foot and across the top….normal in babies but
No response to pain or abnormal otherwise. The toes flare and flex.
generalized myoclonus status epilepticus 0 Patellar: Use hammer. Hv pt clench hands if it is difficult to elicit a response.
Pronator Drift: Have pt hold arms up with palms upward. Close eyes. If one arm drifts down
Brainstem Reflexes and pronates, this is a positive sign for pronator drift (and stroke!)
Pupil and corneal reflexes present 4
One pupil wide and fixed 3
Pupil or corneal reflexes absent 2 Cushing’s Triad
Pupil and corneal reflexes absent 1
Hypertension, irregular respirations and bradycardia.
Respiration
Not intubated, regular breathing pattern 4 This is a sign of increased intracranial pressure which
Not intubated, Cheyne-Stokes breathing pattern 3 is never a good thing.
Not intubated, irregular breathing pattern 2
Breathes above ventilator rate 1
Breathes at ventilator rate or apnea 0
Neuro Assessment Study Guide.doc
Lower Extmty/S Peroneal Nerve: Prick lateral surface of great toe and medial surface of second toe
Tibial Nerve: Prick medial and lateral surfaces of sole of foot.