Comprehensive Neurological Assessment Tool

A. MENTAL STATUS Consciousness:            conscious      lethargic         obtunded           stupurous          comatous Coherence: Orientation:            time            person          place Memory: Note: client’s dress, grooming and personal hygiene, facial expression, manner and affect,               manner of speech B. CRANIAL NERVES I. Olfactory             decrease/loss of smell       both nostril       right nostril        left nostril II. Optic           Visual acuity _____/______            blindness            presbyopia           Visual field defect _______________            corrected by glasses III, IV, & VI. Oculomotor, Trochlear, & Abducens            Pupillary size  Right_____mm    Left_____ mm             brisk          sluggish         nonreactive            Accommodation:   equal       unequal              nystagmus         ptosis            defect in extraoccuiar movements V. Trigeminal            Strength : temporal muscle                            masseter muscle                             paralysis        paresis           Facial Sensation:     decreased          loss           Corneal Reflex:       present               absent VII. Facial             symmetry           assymetry             weakness             tics                     facial droop          loss of secretions                                                                                      (mandibuiar,submandibular,lacriomal)             loss of   taste in anterior 2/3 of tongue VIII. Acoustic (Vestibulocochlear)            hearing loss        Left           Right            (+)Rinne's test                conduction HL (AC<BC)            (+)Rinne's test NORMAL                sensoryneural HL (AC>BC)             (-)Weber's test - unilateral conduction HL (heard in impaired ear)            (-) Weber's test - unilateral sensoryneural HL (sound heard in good ear)            (+) Weber's test (equally heard on both ears) IX & X. Glossopharyngeal & Vagus             hoarseness of voice             uvula deviated/asymmetrical             Palatal movement             present          absent            Gag Reflex                        present          absent            dysphagia      difficulty swallowing             loss of sensation of posterior 1/3 of tongue XI. Spinal Accessory              paralysis                       atrophy             fasciculations             sternocleidomastoid             trapezius XII. Hypoglossal             tongue deviation             atrophy             fasciculations C. MOTOR SYSTEM Gait & Porture           Coordination (rapid & point to point movement)             coordinated              uncoordinated             ataxia                       stagerring                    Parkinsonian             involuntary movements(tremors, tics, chorea, athetosis, myoclonus, etc.)            (+) Romberg's sign Sensory Function:             hypalgesia                hyperalgesia               graphestisia Muscle size:             symmetrical             asymmetrical              atrophy Muscle Tone:            flaccid                      spastic                         rigid Muscle Strength:           Right                   Elbow: flexion_______     extension_______                         Wrist______         Grip______                      Hip: flexion______           extension______                           Hip: abduction______      adduction______                          Knee: flexion______         extension______                           Dorsiflexion______          Plantar flexion______             Left                   Elbow: flexion_______     extension_______                         Wrist______         Grip______                      Hip: flexion______           extension______                           Hip: abduction______      adduction______                          Knee: flexion______         extension______                           Dorsiflexion______          Plantar flexion______             Arms & Legs:         coordinated             uncoordinated             Grading :                          0         no muscular contractions                          1         barely detectable flicker                          2         active movement w/o gravity                          3         active movement w/ gravity                          4          active movement w/ gravity some resistance                          5          active movement w/ gravity full resistance REFLEXES Right Left Bicepts Tricepts Brachioradialis Knee Jerk Babinski/Plantar  present  present             Grading:                       4+        very brisk, hyper,repetitive,clonus                       3+        brisker than average, may be normal for some                       2+        average/Normal                       1 +       diminished response or low Normal                       0          no response  MENINGEAL SIGNS             Nuccal Rigidity             Brudzinski's Sign (flexion of hip & knee w/ neck)            Kernig's (resistance to full extension of leg at knee when sitting) GLASGOW COMA SCALE Parameter Response Best Eye Opening Response          (put “C” if eyes are closed due to swelling) Spontaneously            4 To speech 3 To pain 2 No response 1 Best Motor Response                        (record best upper limb response to painful stimuli)           Obeys verbal command 6 Localizes pain 5 Flexion-withdrawal 4 Flexion-abnormal 3 Extension-abnormal         2 No response       1 Best Verbal Response (put “E” if with ET or “T” if with T-tube) Conversation – oriented x3 Conversation – confused Speech – inappropriate Sounds – incomprehensible No response TOTAL                       Total Score            Interpretation                   15                     Normal                13-15                  Minor head injury                  9-12                  Moderate head injury                  3-8                    Severe head injury                  ­< 7                    Coma                    0                     Deep coma/brain death