Neuro Assessment Study Guide.

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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.
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Glascow Coma Scale Assessment Criteria for Brain Death

Best eye opening (spontaneous, to speech, to pain, none) General: Date, time, blood pressure (SBP < 90 mmHg), and body temp (above 32 degrees)
Best verbal response (oriented, confused, inappropriate words, Responsiveness/movement: No responsiveness to noxious stimuli, no movement, spinal
incomprehensible words, no sounds with painful stimuli) reflexes such as Babinksi are not indicative of brainstem function.
Best motor response (Obeys commands, localizes pain, flexion Evidence of absence of brainstem fxn: Absent papillary light reflex; absent corneal, gag,
withdrawal, decorticate, decerebrate, none) cough reflexes; absent oculocephalic reflex (Doll’s Eyes); absent oculovestibular reflex (ice
water in ear, eyes should track toward ear); apnea test.
15 points possible

FOUR Score Scale Balance Tests (Cerebellar Function)

Eye Response: Romberg Test: Have patient balance with eyes closed. Make sure you hold your arms out s
Eyelids open or opened, tracking or blinking to command 4 you can catch them if they teeter.
Eyelids open but not tracking 3 Heal-to-Toe Walking: Self explanatory (not sure if it’s eyes closed or not)
Eyelids closed but opens to loud voice 2 Rapid Alternating Movements: Have pt turn hands palm-side up and palm-side down really
Eyelids closed but open to pain 1 really fast.
Eyelids remain closed with pain 0

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
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Thought Process/Mental Status Level of Consciousness

Orientation: person, place, time. Person is the last thing to go. Fully Awake: self explanatory
Abstract Thinking: understanding idioms such as “that person is out to lunch.” Alert:
Ability to Solve Problems/Concentrate: give pt some easy math problems Lethargic: still oriented, but have to call their name to get
(use paper and pencil). their attention.
Memory (immediate, recent and remote): Say 3 unrelated words and have the pt Stuporous (Semi-Comatose): Patient responds when you
repeat them; Ask pt what they had for the dinner or breakfast; Ask pt when they shake them and yell louder.
graduated from high school. Comatose: Not waking up.
Judgment: If this room were on fire, what would you do?

Methods to Elicit Response Responses to Painful Stimuli Muscle Tone

Central Methods: Trapezius squeeze, supraorbital Normal: Pt shouts, pulls away Normal: Self explanatory
pressure, sternal rub, mandibular pressure. Flexion: Decorticate posturing indicates lesions of deep Flaccid: If you take the pt’s arm and pick it up
hemispheric areas of pons (could be one side only) and let it drop...it drops. No tone at all!
Peripheral Methods: Pencil across nail beds, Extension: Decerebrate posturing indicates lesions Rigidity: Not a contracture. You can straighten it.
achilles tendon squeeze. between pons and mid-brain Spasticity: Twitching. This is a sign that the pt is
recovering some muscle tone.

Sensory Function Tests Neurovascular Checks of Extremities

Light touch sensation: Touch pt lightly in various places. Hand/Motor Radial Nerve: Pt hyperextends thumb or wrist (hitchhiker thumb)
Sharp versus dull: Paperclip point vs. dull end. Medial Nerve: Pt opposes thumb and little finger, flexes wrist
Stereognosis (object recognition): Place a familiar Ulnar Nerve: Pt abducts all fingers
object in the pt’s hand and have them identify it.
Temperature recognition: Warm and cold test tubes. Hand/Sensory Radial Nerve: Prick web space between thumb and index finger
Sense of position (proprioception): Move fingers up/dwn Medial Nerve: Prick distal surface of the index finger
Graphesthesia: Draw a letter or number on pt’s skin. Ulnar Nerve: Prick distal end of small finger
Two-point discrimination: Gets harder to discriminate as
the two points get closer together. Lwr Extmty/M Peroneal Nerve: Dorsiflex ankle; extend toes
Tibial Nerve: Plantar flex ankle and flex toes

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.