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Assessing Neurologic Function

A. Health assessment: Subjective data


a. Questions about present health status include
b. Tremors, problems with coordination or balance
c. Loss of movement of any part of the body
d. Difficulty with speaking or senses
e. Information about memory
f. Feeling state, e.g. anxius, depressed
g. Ability to perform self- care and ADL
h. Sexual activity
i. Weight changes
j. Prescribed and over the counter medications, frequency of use and duration
k. Prescribed and over the counter medications, frequency of use and duration
l. Seizures, fainting, dizziness, headaches
B. Physical assessment to collect objective data
1. Mental status assessment with abnormal findings
a. Unilateral neglect: strokes involving middle cerebral artery
b. Poor hygiene and grooming: dementing disorders
c. Abnormal gait and posture: transient ischemic attacks (TIAs), strokes,
Parkinsons disease
d. Emotional swings, personality changes: strokes of anterior cerebral artery
e. Masklike appearance on face: Parkinsons disease
f. Apathy: dementing disease
g. Aphasia ( demeting disease
h. Dysphonia ( change in tone of voice) : strokes of posterior inferior cerebral artery,
paralysis of vocal cords, cranial nerve X
i. Dysathria ( difficulty in speaking): strokes involving anterior inferior and superior
cerebral arteries, lesions involving UMN,LMN, cerebellum, extrapyramidal tract
j. Decreased level of consciousness: brain trauma, infections, TIAs, stroke, brain
tumors
k. Confusion, coma: strokes affecting bvertebralbasilar arteries
2. Cognitive function assessment with abnormal findings
a. Disorientation to time and place: stroke of right cerebral hemisphere
b. Memory deficits: anterior cerebral artery and vertebralbasilar artery
c. Perceptual deficits: strokes of middle cerebral artery, brain trauma, dementing
conditions
d. Impaired cognition: strokes of middle cerebral artery, vertebral trauma, brain
tumors

3. Cranial nerve assessment with abnormal findings
a. CN 1 (Olfactory) Anosmia ( inability to smell)
1. Lesions of frontal lobe
2. Impaired blood flow to middle cerebral artery
b. CN II ( optic)
1. Blindness in one eye: strokes of internal carotid artery,TIAs
2. Homonymous hemianopia (impaired vision/blindness in one side of both eyes):
blockage of posterior cerebral artery
3. Impaired vision: strokes of anterior cerebral artery, brain tumors
4. Blindness,double vision: involvement of vertebralbasilar arteries;double or blurred
vision may occur with TIAs
5. Papilledema ( swelling of optic nerve): increased intracranial pressure
c. CN III, IV, VI ( oculomotor, trochlear, abducens)
1. Nystagmus ( involuntary eye movement): strokes of anterior, inferior, superior
cerebellar arteries
2. Constricted pupils: may signify impaired blood flow to vertebralbasilar arteries
3. Ptosis: strokes posterior inferior cerebellar artery, myasthenia gravis, palsy of CN III
d. CN V ( trigeminal) : Changes in facial sensations; impaired blood flow to carotid artery
1. Decreased sensation to face and cornea on same side of body: strokes of posterior
inferior cerebral artery
2. Lip and mouth numbness: strokes of vertebralbailar artery
3. Loss of facial sensation, contraction of masseter and temporal muscles; lesions of
CNV
4. Severe facial pain: trigeminal neuralgia (tic douloureux)
e. CN VII ( Facial)
1. Loss of ability to taste: brain tumors, nerve impairement
2. Decreased movement of facial muscles: lesions of UMN,LMN
3. Inability to close eyes, flat nasolabial fold, paralysis of lower face, inability to
wrinkle forehead: paralysis of LMN
4. Eyelid weakness, paralysis of lower face: paralysis of upper motor neuron
5. Pain, paralysis, sagging of facial muscles: affected side in Bells palsy
f. CN VIII ( acoustic): decreased hearing or deafness: strokes of vertebralbasilar arteries or
tumors of CN VII
g. CN IX and X ( glossopharyngeal, vagus)
1. Dysphagia ( difficulty in swallowing): impaired blood flow to vertebralbasilar
arteries, posterior or anterior inferior or superior cerebellar arteries
2. Unilateral loss of gag reflex: lesions of CN IX and X
h. CN XI ( Spinal accessory)
1. Muscle weakness: LMN
2. Contraleteral hemiparesis: strokes affecting middle cerebral artery and internal
carotid artery
i. CN XII ( hypoglossal)
1. Atrophy, fasciculations ( twitches): LMN disease
2. Tongue deviation toward involved side of body

Assessment of Eye
a. Health assessment : subjective data
1. During interview, note nonverbal behaviors such as squinting or abnormal eye
movements
2. Explore watery, irritated yes, or changes in vision
3. Use of eyewear, care of eyeglasses or contact lenses
b. Physical assessment: objective data
1. Vision assessment with abnormal findings
a. Vision acuity is assessed with Snelen chart or E chart for testing distance vision;
Rosenbaum chart for testing near vision
b. Myopia or nearsightedness
1. Reading of 20/100 using Snellen or E chart
2. Impaired ability with near vision
3. Presbyopia in clients age > 45;loss of elasticity of lens
4. Hyperopia in clients younger than 45
2. Eye movement and alignment with abnormal findings
a. Failure of eyes to converge equally on an approaching object may indicate
neuromuscular disoreder or improper eye alignment
b. Failure of one or both eyes to follow an object in any given direction may indicate
extraocular muscles weakness or cranial nerve dysfunction
c. Involuntary rhythmic movement of eyes ( nystagmus): associated with use of
medications
d. Unequal corneal light reflex reveals improper alignment
3. Papillary assessment with abnormal finding
a. Pupils with unequal size may indicate severe neurologic problems including
increased intracranial pressure
b. Failure of pupils to respond to light may indicate retinal degeneration or
destruction to optic nerve
c. Client who has one dilated and one unresponsive pupil may have paralysis of one
oculomotor nerve.
d. Unequal dilation, constriction or inequality of pupil size may be caused by some
eye medications
1. Morphine and narcotics: small, unresponsive pupils
2. Anticholinergic drugs: dilated unresponsive pupils
e. Failure of eyes to accommodate with lack of papillary response to light may
indicate neurologic problem
f. Pupils that do not respond to light but accommodate properly is seen in clients
with diabetes
4 Extrenal eye assessment with abnormal finding
a. Unusual redness or discharge indicates inflammatory state due to trauma, allergies, or
infection
b. Drooping of one eyelid, ptosis, may result from stroke, neuromuscular disorder, or
congenital
c. Unusual widening of lids may be due to exopthalmus ( protrusion of eyeball due to
increase in intraocular volume) is often associated with hypethyroid conditions
d. Yellow plaques noted on lid margins ( xanthelasma) may indicate high lipid levels
e. Acute localized inflammation of hair follicle known as hordeolum (sty) often caused by
staphylococcal organisms
f. Chalazion is infection or retention cyst of meibomian glands
g. Conjunctiva
1. Increased erythema, presence of exudates indicates acute conjunctivitis
2. Cobblestone appearance associated with allergies
3. Fold in conjunctiva (pterygium) is clouded area that is seen as clouded area over
cornea ( may interfere with vision if covering pupil)
h. Sclera
1. Unusual redness indicates inflammatory state resulting from trauma, allergies, or
infection
2. Yellow discoloration occurs with jaundice involving liver conditions
3. Bright red areas are subconjunctival hemorrhages and may indicate trauma or
bleeding disorders; may occur spontaneously
i. Cornea
1. Dullness, opacities, irregularities
2. Absence of blink reflex may indicate neurologic disorder
j. Iris
1. Lack of clarity may indicate cloudiness in cornea
2. Constriction of pupil accompanied by pain and circorneal redness indicates acute
iritis.

5 Internal eye assessment with abnormal findings: Opthalmoscopic examination
a. Absence of red reflex may indicate total opacity of pupil by cataract or hemorrhage
into vitreous humor
b. Dark shadow visualized is cataract ( opacity of lens) due to aging, trauma, diabetes,
or congenital defect
c. On retinal exam, areas of hemorrhage, exudates, white patches are found with
diabetes or long- standing HPT
d. Loss of optic disc as well as increase in size of physiologic cup results from
papilledema that occurs with increased intracranial pressure
e. Blood vessels of retina
1. Displacement of blood vessels from center of optic disc occurs with increased
intraocular pressure as with glaucoma
2. Apparent narrowing of vein where an arteriole crosses over occurs with HPT
3. Engorged veins occur with diabetes, atherosclerosis, blood disorders
f. Variations in color of pale color in retinal background indicates disease
g. Upon inspection of macula, absence of fovea centralis may indicate macular
degeneration
h. Tenderness over lacrimal glands, puncta, masolacrimal duct or drainage may indicate
infection
i. Excessive tearing may indicate blockage of nasolacrimal duct.

Assessment of Ear
a. Health assessment: subjective data
1. Be aware of nonverbal behaviors ( inappropriate answers, asking for statements to be
repeated suggest altered hearing function)
2. Explore with client
a. Changes in hearing
b. Ringing in ears ( tinnitus)
c. Ear pain
d. Drainage from ears
e. Use of hearing aids
b. Physical assessment of ears and hearing

1. Hearing test with abnormal findings
a. Weber test
1. Tunning fork placed on midline vertex of head
2. If sound is heard in or lateralized to one ear, indicative of conductive hearing
loss I that ear or sensorineural loss in other.
b. Rinne test
1. Vibrating tuning fork placed on clients mastoid bone and client identifies
when sound no longer heard
2. Fork moved in front of clients ear close to ear canal, and client identifies
when sound no longer heard
3. Sound should be heard twice as long by air conduction than by bone
conduction
4. Bone conduction is greater than air conduction with a conductive hearing loss
c. Whisper test: rough estimate that hearing loss exists

2 external ear assessment with abnormal findings
a. Unusual redness or drainage around auricle indicates inflammatory response to infection
or trauma
b. Scales or skin lesions around the rim may indicate skin cancer
c. Small, raised lesions around rim of ear are tophi and indicate gout
d. Unusual redness, lesion, or purulent drainage of external auditory canal indicates
infection
e. Hardened, dry, or foul-smelling cerumen in ear canal indicates infection or impaction of
cerumen
f. Inspection of tympanic membrane
1. Inconsistent texture and colr occur with scarring from previous perforation caused by
infection, allergies, or trauma
2. Bulging membranes ( loss of bony landmarks, distorted light reflex) indicate otitis
media or malfunctioning of auditory tubes
3. Retracted membranes with accentuated bony landmarks and distorted light reflex
occurs with obstructed auditory tube
g. Tenderness, swelling or nodules over auricles and mastoid process indicate inflammation
of external auditory canal or mastoiditis.