16 Chapter 16 The Neurological Exam
By Krishnan Prabhakaran
Motivation.
Head trauma and concussions can happen to adults and children alike. There are countless different ways in which traumatic brain injuries can occur: a direct physical blow to the head, falling on the ground, or a car accident – among many other possibilities.
However, concussions can also happen even when there is no direct blow to the head. In some cases, a concussion can even happen with simple sudden movements or jolts, and these “minor” concussions often go undetected and undiagnosed. Even when caused by a direct blow to the head, most concussions don’t lead to a loss of consciousness and are left untreated.
Each concussion is different, and not everyone exhibits the same symptoms. The best way to recognize and assess the extent of a concussion is to get a neurological exam by a clinical neuroscience practitioner. Here is what you can expect.
There are many types of neurological assessments that licensed practitioners will do with their patients. Neurological assessments are the most effective way of recognizing and analyzing concussions. In most cases, doctors will use a special brain imaging techniques like CT or MRI scans to look for brain abnormalities.
Unfortunately, CT & MRI scans are often ineffective in recognizing concussions because most lesions in the brain caused by a head trauma are too small to be identified by these types of scans. This is why neurological assessments are a fundamental tool in understanding the effects of a head trauma as a whole and can evaluate just how extensive the damage is.
Common neurological assessments include:
- Assessing mental capacity & status
- Pupil size assessment
- Sensory exams
- Pupil reactivity assessment
- Blood pressure measurement
- Handgrip strength assessment
- Motor function & balance exercises
- Pulse measurements
- Respiration assessment
In most cases, these neurological assessments last around an hour. They are non-invasive and don’t involve any brain stimulants. Sometimes people might not feel any initial symptoms after a traumatic brain injury. This is why it’s generally a good idea to visit a practitioner and go through the examination to make sure everything is in good order.
Learning Objectives
Upon completion of the work in this chapter students should be able to:
- Describe the mental status exam and perform simple tests to determine brain function
- Perform sensory and motor exams (e.g. sight, eye movement) to determine cranial nerve function
- Utilize sensory and motor exams to determine the health of spinal cord functions
- Perform coordination and gait exams as indicators of cerebellar integration of neuronal function
Background.
A. Overview of the Neurological Exam
The neurological exam is a clinical assessment tool used to rapidly determine which specific parts of the CNS are affected by damage or disease. The exam can be broken down into the following subsets:
- Mental Status Exam = assesses the hi