Overview of the Neurological Exam Quiz

PDF page 662: The neurological exam is a clinical assessment tool used to determine what specific parts of the CNS are affected by damage or disease. It can be performed in a short time—sometimes as quickly as 5 minutes—to establish neurological function. In the emergency department, this rapid assessment can make the difference with respect to proper treatment and the extent of recovery that is possible. The exam is a series of subtests separated into five major sections. The first of these is the mental status exam, which assesses the higher cognitive functions such as memory, orientation, and language. Then there is the cranial nerve exam, which tests the function of the 12 cranial nerves and, therefore, the central and peripheral structures associated with them. The cranial nerve exam tests the sensory and motor functions of each of the nerves, as applicable. Two major sections, the sensory exam and the motor exam, test the sensory and motor functions associated with spinal nerves. Finally, the coordination exam tests the ability to perform complex and coordinated movements. The gait exam, which is often considered a sixth major exam, specifically assesses the motor function of walking and can be considered part of the coordination exam because walking is a coordinated movement.

PDF page 662: The neurological exam is a clinical assessment tool used to determine what specific parts of the CNS are affected by damage or disease. It can be performed in a short time—sometimes as quickly as 5 minutes—to establish neurological function. In the emergency department, this rapid assessment can make the difference with respect to proper treatment and the extent of recovery that is possible. The exam is a series of subtests separated into five major sections. The first of these is the mental status exam, which assesses the higher cognitive functions such as memory, orientation, and language. Then there is the cranial nerve exam, which tests the function of the 12 cranial nerves and, therefore, the central and peripheral structures associated with them. The cranial nerve exam tests the sensory and motor functions of each of the nerves, as applicable. Two major sections, the sensory exam and the motor exam, test the sensory and motor functions associated with spinal nerves. Finally, the coordination exam tests the ability to perform complex and coordinated movements. The gait exam, which is often considered a sixth major exam, specifically assesses the motor function of walking and can be considered part of the coordination exam because walking is a coordinated movement.

PDF page 662: The neurological exam is a clinical assessment tool used to determine what specific parts of the CNS are affected by damage or disease. It can be performed in a short time—sometimes as quickly as 5 minutes—to establish neurological function. In the emergency department, this rapid assessment can make the difference with respect to proper treatment and the extent of recovery that is possible. The exam is a series of subtests separated into five major sections. The first of these is the mental status exam, which assesses the higher cognitive functions such as memory, orientation, and language. Then there is the cranial nerve exam, which tests the function of the 12 cranial nerves and, therefore, the central and peripheral structures associated with them. The cranial nerve exam tests the sensory and motor functions of each of the nerves, as applicable. Two major sections, the sensory exam and the motor exam, test the sensory and motor functions associated with spinal nerves. Finally, the coordination exam tests the ability to perform complex and coordinated movements. The gait exam, which is often considered a sixth major exam, specifically assesses the motor function of walking and can be considered part of the coordination exam because walking is a coordinated movement.

PDF page 662: The neurological exam is a clinical assessment tool used to determine what specific parts of the CNS are affected by damage or disease. It can be performed in a short time—sometimes as quickly as 5 minutes—to establish neurological function. In the emergency department, this rapid assessment can make the difference with respect to proper treatment and the extent of recovery that is possible. The exam is a series of subtests separated into five major sections. The first of these is the mental status exam, which assesses the higher cognitive functions such as memory, orientation, and language. Then there is the cranial nerve exam, which tests the function of the 12 cranial nerves and, therefore, the central and peripheral structures associated with them. The cranial nerve exam tests the sensory and motor functions of each of the nerves, as applicable. Two major sections, the sensory exam and the motor exam, test the sensory and motor functions associated with spinal nerves. Finally, the coordination exam tests the ability to perform complex and coordinated movements. The gait exam, which is often considered a sixth major exam, specifically assesses the motor function of walking and can be considered part of the coordination exam because walking is a coordinated movement.

PDF page 662: Localization of function is the concept that circumscribed locations are responsible for specific functions. The neurological exam highlights this relationship. For example, the cognitive functions that are assessed in the mental status exam are based on functions in the cerebrum, mostly in the cerebral cortex. Several of the subtests examine language function. Deficits in neurological function uncovered by these examinations usually point to damage to the left cerebral cortex. In the majority

PDF page 663: of individuals, language function is localized to the left hemisphere between the superior temporal lobe and the posterior frontal lobe, including the intervening connections through the inferior parietal lobe. The five major sections of the neurological exam are related to the major regions of the CNS (Figure 16.2). The mental status exam assesses functions related to the cerebrum. The cranial nerve exam is for the nerves that connect to the diencephalon and brain stem (as well as the olfactory connections to the forebrain). The coordination exam and the related gait exam primarily assess the functions of the cerebellum. The motor and sensory exams are associated with the spinal cord and its connections through the spinal nerves.

PDF page 663: of individuals, language function is localized to the left hemisphere between the superior temporal lobe and the posterior frontal lobe, including the intervening connections through the inferior parietal lobe. The five major sections of the neurological exam are related to the major regions of the CNS (Figure 16.2). The mental status exam assesses functions related to the cerebrum. The cranial nerve exam is for the nerves that connect to the diencephalon and brain stem (as well as the olfactory connections to the forebrain). The coordination exam and the related gait exam primarily assess the functions of the cerebellum. The motor and sensory exams are associated with the spinal cord and its connections through the spinal nerves.

PDF page 663: of individuals, language function is localized to the left hemisphere between the superior temporal lobe and the posterior frontal lobe, including the intervening connections through the inferior parietal lobe. The five major sections of the neurological exam are related to the major regions of the CNS (Figure 16.2). The mental status exam assesses functions related to the cerebrum. The cranial nerve exam is for the nerves that connect to the diencephalon and brain stem (as well as the olfactory connections to the forebrain). The coordination exam and the related gait exam primarily assess the functions of the cerebellum. The motor and sensory exams are associated with the spinal cord and its connections through the spinal nerves.

PDF page 664: Damage to the nervous system can be limited to individual structures or can be distributed across broad areas of the brain and spinal cord. Localized, limited injury to the nervous system is most often the result of circulatory problems. Neurons are very sensitive to oxygen deprivation and will start to deteriorate within 1 or 2 minutes, and permanent damage (cell death) could result within a few hours. The loss of blood flow to part of the brain is known as a stroke, or a cerebrovascular accident (CVA). There are two main types of stroke, depending on how the blood supply is compromised: ischemic and hemorrhagic. An ischemic stroke is the loss of blood flow to an area because vessels are blocked or narrowed. This is often caused by an embolus, which may be a blood clot or fat deposit. Ischemia may also be the result of thickening of the blood vessel wall, or a drop in blood volume in the brain known as hypovolemia. A related type of CVA is known as a transient ischemic attack (TIA), which is similar to a stroke although it does not last as long. The diagnostic definition of a stroke includes effects that last at least 24 hours. Any stroke symptoms that are resolved within a 24-hour period because of restoration of adequate blood flow are classified as a TIA. A hemorrhagic stroke is bleeding into the brain because of a damaged blood vessel. Accumulated blood fills a region of the cranial vault and presses against the tissue in the brain (Figure 16.3). Physical pressure on the brain can cause the loss of function, as well as the squeezing of local arteries resulting in compromised blood flow beyond the site of the hemorrhage. As blood pools in the nervous tissue and the vasculature is damaged, the blood-brain barrier can break down and allow additional fluid to accumulate in the region, which is known as edema.

PDF page 664: Damage to the nervous system can be limited to individual structures or can be distributed across broad areas of the brain and spinal cord. Localized, limited injury to the nervous system is most often the result of circulatory problems. Neurons are very sensitive to oxygen deprivation and will start to deteriorate within 1 or 2 minutes, and permanent damage (cell death) could result within a few hours. The loss of blood flow to part of the brain is known as a stroke, or a cerebrovascular accident (CVA). There are two main types of stroke, depending on how the blood supply is compromised: ischemic and hemorrhagic. An ischemic stroke is the loss of blood flow to an area because vessels are blocked or narrowed. This is often caused by an embolus, which may be a blood clot or fat deposit. Ischemia may also be the result of thickening of the blood vessel wall, or a drop in blood volume in the brain known as hypovolemia. A related type of CVA is known as a transient ischemic attack (TIA), which is similar to a stroke although it does not last as long. The diagnostic definition of a stroke includes effects that last at least 24 hours. Any stroke symptoms that are resolved within a 24-hour period because of restoration of adequate blood flow are classified as a TIA. A hemorrhagic stroke is bleeding into the brain because of a damaged blood vessel. Accumulated blood fills a region of the cranial vault and presses against the tissue in the brain (Figure 16.3). Physical pressure on the brain can cause the loss of function, as well as the squeezing of local arteries resulting in compromised blood flow beyond the site of the hemorrhage. As blood pools in the nervous tissue and the vasculature is damaged, the blood-brain barrier can break down and allow additional fluid to accumulate in the region, which is known as edema.

PDF page 664: Damage to the nervous system can be limited to individual structures or can be distributed across broad areas of the brain and spinal cord. Localized, limited injury to the nervous system is most often the result of circulatory problems. Neurons are very sensitive to oxygen deprivation and will start to deteriorate within 1 or 2 minutes, and permanent damage (cell death) could result within a few hours. The loss of blood flow to part of the brain is known as a stroke, or a cerebrovascular accident (CVA). There are two main types of stroke, depending on how the blood supply is compromised: ischemic and hemorrhagic. An ischemic stroke is the loss of blood flow to an area because vessels are blocked or narrowed. This is often caused by an embolus, which may be a blood clot or fat deposit. Ischemia may also be the result of thickening of the blood vessel wall, or a drop in blood volume in the brain known as hypovolemia. A related type of CVA is known as a transient ischemic attack (TIA), which is similar to a stroke although it does not last as long. The diagnostic definition of a stroke includes effects that last at least 24 hours. Any stroke symptoms that are resolved within a 24-hour period because of restoration of adequate blood flow are classified as a TIA. A hemorrhagic stroke is bleeding into the brain because of a damaged blood vessel. Accumulated blood fills a region of the cranial vault and presses against the tissue in the brain (Figure 16.3). Physical pressure on the brain can cause the loss of function, as well as the squeezing of local arteries resulting in compromised blood flow beyond the site of the hemorrhage. As blood pools in the nervous tissue and the vasculature is damaged, the blood-brain barrier can break down and allow additional fluid to accumulate in the region, which is known as edema.

PDF page 664: Damage to the nervous system can be limited to individual structures or can be distributed across broad areas of the brain and spinal cord. Localized, limited injury to the nervous system is most often the result of circulatory problems. Neurons are very sensitive to oxygen deprivation and will start to deteriorate within 1 or 2 minutes, and permanent damage (cell death) could result within a few hours. The loss of blood flow to part of the brain is known as a stroke, or a cerebrovascular accident (CVA). There are two main types of stroke, depending on how the blood supply is compromised: ischemic and hemorrhagic. An ischemic stroke is the loss of blood flow to an area because vessels are blocked or narrowed. This is often caused by an embolus, which may be a blood clot or fat deposit. Ischemia may also be the result of thickening of the blood vessel wall, or a drop in blood volume in the brain known as hypovolemia. A related type of CVA is known as a transient ischemic attack (TIA), which is similar to a stroke although it does not last as long. The diagnostic definition of a stroke includes effects that last at least 24 hours. Any stroke symptoms that are resolved within a 24-hour period because of restoration of adequate blood flow are classified as a TIA. A hemorrhagic stroke is bleeding into the brain because of a damaged blood vessel. Accumulated blood fills a region of the cranial vault and presses against the tissue in the brain (Figure 16.3). Physical pressure on the brain can cause the loss of function, as well as the squeezing of local arteries resulting in compromised blood flow beyond the site of the hemorrhage. As blood pools in the nervous tissue and the vasculature is damaged, the blood-brain barrier can break down and allow additional fluid to accumulate in the region, which is known as edema.