Clinical Assessment of the Neurosurgical Patient Flashcards
(41 cards)
What is the point of doing a history/examination?
- Make a diagnosis
- Determine anatomical location of pathology
- Determine causative agent
- Effect on daily life
- Use SOCRATES and ICE
What type of neuro patients may you come across?
- Obtunded patient (history from paramedics, bystanders etc.)
- Confused/dysphasic/preverbal patient (History from notes and family)
- Awake and alert patient (history from patient)
How should an obtunded patient be assessed?
- ABC
- GCS
- Pupils
What pathology may there be in an obtunded patient?
- Cerebral perfusion/metabolic issue
- Cerebral herniation
What are the components that make up the volume of intracranial space?
- CSF volume
- Blood volume
- Brain volume
- Other volume
What is the cerebral perfusion pressure equal to?
Mean arterial pressure - intracranial pressure
CPP=MAP-ICP
How can you assess if a patient has experienced brain herniation?
- Pupillary response
- If herniated, fixed dilated pupils
How should the non-communicative patient be assessed?
- Observation – posturing, focal lack of movement, neglect, eye movements
- Assess speech
- Mini-mental score
How should the communicating patient be assessed?
- Cranial – which lobe, cerebellar, CN?
- Spinal – which level, myelopathy, radiculopathy,
- Peripheral nerve
What are the functions of the frontal lobe?
- Voluntary control of movement
- Speech
- Saccadic eye movements
- Bladder control
- Gait
- Higher order
What part of the frontal lobe is for voluntary control of movement?
Precentral gyrus
What part of the frontal lobe is responsible for speech?
- Pars opercularis
- Pars triangularis
What part of the frontal lobe is responsible for saccadic eye movements?
Frontal eye field
What part of the frontal lobe is responsible for gait?
Periventricular
What part of the frontal lobe is responsible for bladder control?
Paracentral lobule
How should the frontal lobe be examined?
-Inspection (Decorticate posture, ‘Magnetic gait’, Urinary catheter, Abulia)
-Pyramidal weakness (UMN signs – weakness, increased tone, brisk reflexes, up-going plantar
Pronator drift)
-Saccadic eye movement
-Primitive reflexes
-Speech
What is the function of the orbitofrontal cortex?
- Restraint
- Mediates empathic, civil and socially appropriate behaviour
How can the orbitofrontal cortex be examined?
- Is speech and behaviour socially appropriate?
- Go/no-go tests
- Stroop test
What is the function of the supplementary motor cortex/anterior cingulate?
Initiative
What may indicate a problem with initiative?
- Lack of motivation
- Apathy
- Abulia
- Depression
What is the function of the dorsolateral prefrontal cortex?
Order
Executive function
The integration of sensory information, the generation of a range of response alternatives to environmental challenges, the selection of the most appropriate response, maintenance of task set, sequential ordering of data, self-evaluation of performance and the selection of a replacement responses if the first applied response fails.
How can the dorsolateral prefrontal cortex be tested?
- Ability to make an appointment and keep to time
- Ability to give coherent account of history
- Spell WORLD backwards
- Say as many words as possible with a particular letter
How can language be examined?
- Fluency – Broca’s
- Nominal aphasia
- Repetition – arcuate fasciculus
- 3 step command – Wernicke’s
- ‘Baby hippopotamus’ – cerebellar speech
- Orofacial movement – ppp, ttt, mmm
- Reading
- Writing
