Meningeal Signs

Brudzinski's Sign

Flexion of the hips and knees as you flex the neck is a positive Brudzinski's Sign

Suggests meningeal inflammation

Meningeal Signs

Kernig's Sign

Pain and increased resistance to extending the knee are a positive Kernig's sign

When bilateral, it suggests meningeal irritation

1. DON'T dialate the pupils - the single most important clue to the underlying cause of coma (structural vs. metabolic)

2. DON'T flex the neck if there is any question of trauma to the head or neck. Immobilize the C-Spine and get an x-ray 1st to rule out fractures...

3 tests of The Glascow Coma Scale

Eye Opening 1-4

Best Verbal Response 1-5

Best Motor Response 1-6

Patient's conciousness level (Total) = 3-15

What is a Lethargic patient?

What technique is used to examin a Lethargic patient?

A lethargic patient appears drowsy but opens the eyes and looks at you, responds to questions, and then falls asleep.

Speak to the patient in a loud voice

What is an Obtunded patient?

What technique is used to examin a Obtunded patient?

An obtunded patient opens the eyes and looks at you, but responds slowly and is somewhat confused. Alertness and interest in the environment are decreased.

Shake the patient gently as if awakening a sleeper.

What is an Comatose patient?

What technique is used to examin a Comatose patient?

A comatose patient remains unarousable with eyes closed. There is no evident response to inner need or external stimuli.

Apply repeated painful stimuli.

Central Nervous System

CNS

The Brain and Spinal Cord

1. cerebrum

2. diencephelon

3. brainstem

4. cerebellum

gray matter

homeostasis, temperature, heart rate, blood pressure regulation

also affects anger and sexual drive

critcal for the existance of the concious state

important for maintaining muscle tone of "antigravity muscles"

assists in regulation of breathing and heartbeat

modulates the sense of pain

cervical C1-C8

thoracic T1-T12

lumbar L1-L5

Sacral S1-S5

Coccygeal

Olfactory

Sense of Smell

Optic

Vision

Oculomotor

Pupillary constriction, opening of the eye, and most extraocular movements

Trochlear

Downward, inward movement of the eye

Abducens

Lateral Deviation of the eye

Trigeminal

Motor - Temporal and masseter muscles (jaw clenching), also lateral movement of the jaw

Sensory - facial. The nerve has 3 divisions:

1. ophthalmic

2. maxillary

3. mandibular

Facial

Motor - facial movements, including those of facial expression, closing the eye, and closing the mouth

Sensory - taste for salty, sweet, sour, and bitter substances on teh anterior 2/3 of the tounge

Vestibulocochlear or Acoustic

Hearing (cochlear division)

Balance (vestibular division)

Glossopharyngeal

Motor - pharynx

Sensory - posterior portions of the ear drum and ear canal, the pharynx, and the posterior tongue, including taste (salty, sweet, sour, bitter)

Vagus

Motor - palate, pharynx, and larynx

Sensory - pharynx and larynx

Spinal Accessory

Motor - the sternomastoid and upper portion of the trapezius

Hypoglossal

Motor - tongue

spinal reflex

ankle

S1

spinal reflex

knee

spinal reflex

brachioradialis

spinal reflex

biceps

C5, 6

spinal reflex

triceps

cutaneous reflex

upper abdominal

cutaneous reflex

lower abdominal

cutaneous reflex

plantar responses

Nerve cell bodies lie in the cerebral cortex and in several brainstem nuclei.

Axons synapse with motor nuclei in the brainstem (cranial nerves) and in the spinal cord (peripheral nerves)

OUT

Cell bodies comprise the anterior horn cell of the spinal cord.

Axons transmit impulses through anterior roots and spinal nerves into peripheral nerves, terminating at neuromuscular junction.

OUT

Mediates voluntary movement

integrates skilled, complicated, or delicate movements.

Inhibits muscle tone

CROSSES OVER IN THE BRAINSTEM (MEDULLA)

Maintains muscle tone

Controls gross automatic movements

Coordinates motor activity

Balance, equilibrium, Posture

Contain fibers conducting sensations of:

pain and temperature

Crude touch

Position and Vibration

Fine touch

General quality of sensations perceived but fine distinctions not made until sensory cortex

Band of skin innervated by the sensory of a single spinal nerve

T4 - nipples

T10 - umbilicus

1. mental status, speech, language

2. cranial nerves

3. motor system

4. sensory system

5. reflexes