The human nervous system ensures the regulation of the functioning of organs and tissues, and also helps to adapt the body to certain conditions. It depends on it the work of the organism as a whole, as well as the interaction of man with the environment. It is very important for each doctor to be able to determine neurological status the patient. What is it, and how is its study going on, we’ll talk about this later.
Why status is important
First of all, when communicating with the patient, the doctor should pay attention to his behavior, reaction and general mental state. Especially if the patient was admitted with any kind of trauma or emergency care was called by relatives. The doctor determines, first of all, the state of the brain, since the therapy prescribed in the future largely depends on this. Examining the patient’s neurological status, the doctor allows himself to prescribe a treatment that will improve brain functionality and increase the chances of a positive treatment outcome.
The reaction of the pupils to the light is not enough to establish a neurological status. Currently, a scheme has been developed that evaluates the functioning of the brain based on some neurological symptoms. You can establish the status by contacting a specialized diagnostic center. Let’s further consider how status is established.
Primary patient survey
The main condition for a proper study of neurological status is the doctor’s ability to compare symptoms and signs with certain areas of the nervous system.
At a general examination, the doctor should be proactive and find out the following:
- establish patient data: name, position;
- listen to patient complaints;
- establish whether fainting or epileptic seizures have occurred;
- complaints of frequent headaches and their nature, where they are localized, find out what triggered the pain, what were the accompanying symptoms;
- it is necessary to find out in what sequence pain or an attack develops, what is a stimulant;
- find out what treatment was carried out earlier, what drugs were used and how they acted on the patient.
Also, the writing of the neurological status will include gender, previous infectious diseases, features of the perinatal period and what other hereditary diseases of the nervous system are.
General examination of the patient
To establish neurological status, it is necessary not only to interview the patient, but also to examine him carefully. For this patient, it is necessary to strip to underwear.
Then assess the condition of the skin, their color. Measure body temperature. To note the presence of scars, traces of injections. It is necessary to determine what type the patient belongs to: asthenic, hypersthenic, normastenic. Is there obesity or excessive thinness.
Next, a visual and palpation examination of the head is performed. Its shape, symmetry, and also the presence of abrasions are noted. It is necessary to pay attention to seals, painful foci. To feel the temporal arteries, assess their condition. Assess eyeballs and discharge from nose and ears, if any.
Examination of the cervical spine
When examining the neck, pay attention to the position and mobility of the head and neck. The thyroid gland, carotid arteries, lymph nodes are examined by palpation. Carotid arteries and subclavian are examined by auscultation. The tone of the occipital muscles is determined if there is a Lermitt symptom. Next, an examination of the chest and abdominal cavity is performed.
A thorough examination of the spine is very important. They pay attention to various kinds of spinal deformities, assess the mobility of the vertebrae by tilting the patient in different directions, determine the degree of tension of the back muscles and their pain, as well as the condition of the lumbar vertebrae.
Brain functions and examination of the cranial nerves
In the study of neurological status, it is very important to evaluate brain functions. It is necessary to distinguish the violation from pathologies in the work. To do this, evaluate the following criteria:
- consciousness;
- ability to navigate;
- find out how developed attention, memory;
- determine how a person makes contact, what kind of speech he has;
- find out if the patient is able to follow the sequence;
- check for signs of agnosia.
The description of the neurological status cannot bypass the analysis of the cranial nerves. There are only 12 pairs.
Each of them is responsible for one or another function. Sensitive nerves (1, 2, 8 pairs) are responsible for the sensitivity of the skin of the face, eyes, mouth, nasopharynx. Motor 3, 4, 6, 7, 11, 12 pairs are responsible for the movement of the eyeballs, muscles of the face, tongue, palate, and also the larynx. Mixed 5, 9, 10 pairs of nerves are responsible for motor and sensory functions. This is the trigeminal nerve, glossopharyngeal and vagus nerves.
There are special tests that check how the cranial nerves function.
Assessment of motor functions and reflexes
It is important to evaluate muscle performance. It is necessary to examine the muscles of the lower leg and shoulder girdle, to determine the tone and symmetry of muscle contractions, how developed the muscles are.
In this case, several tests are performed to evaluate the motor reaction in order to examine the neurological status. Example: in the supine position, the patient raises his knee, while it is necessary to observe the movement of the foot. Muscle weakness of the lower extremities is determined by bending the leg at the knee and by extending the thumb. In a standing position with the patient's eyes tightly closed, they are asked to raise their hands with their palms up. Muscle strength can be checked by asking the patient to walk on the heels and fingers.
A study of neurological status cannot do without evaluating patient coordination. According to the patient’s gait, his coordination and motor functions are evaluated. They use a good test: the patient needs to touch the tip of the nose and fingertips with the greatest accuracy.
All actions need to be done quickly. If at the same time there is a trembling of hands or not hitting the target, this is an anomaly.
Evaluating reflexes is also necessary. They are divided into deep tendon and regressive.
The asymmetry of reflex reactions or their suppression indicates damage to the nerve roots or peripheral nerves. In the future, by visiting the diagnostic center, this can be confirmed by conducting an instrumental examination.
Sensitivity assessment and assessment of the autonomic nervous system
Sensory perception is evaluated by finding out the following facts:
- are there any pain;
- nature of pain;
- localization and duration;
- what symptoms accompany pain and what actions weaken it;
- actions that gave rise to pain attacks.
They also conduct tests to determine sensitivity. Sensitivity is checked necessarily at symmetrical points on the right and on the left. For a deeper examination, the state of deep and superficial receptors is assessed.
The assessment of autonomic functions is partially carried out during a patient survey, based on his complaints. In order to make a deeper analysis of the vegetative system, carry out the following actions:
- measure blood pressure in the supine position, after 3 minutes standing;
- measure heart rate;
- conduct tests with deep breathing;
- conduct a test for reactivity with pressure on the eyeballs;
- feel the skin, determining sweating, iodine can be used if necessary;
- if urination is impaired, they feel the stomach, if necessary, conduct an instrumental examination.
Study of a patient in a coma
It is much more difficult to assess the neurological status of the patient if he is in a coma. In this case, it is necessary to pay attention to the following factors: to assess the functioning of the respiratory system and blood circulation, to determine the depth of coma and the reason for getting into such a state, to examine the patient for injuries, to check reflexes.
All actions of the doctor should be aimed at saving the patient’s life, therefore, when assessing the neurological status, actions are taken together that are aimed at eliminating life-threatening conditions. In such cases, it is better to send the patient to the center of neurology. They will conduct a full examination.
Neurological status of the child
A feature of assessing the neurological status of a child is that he is not able to perform some tests and answer questions. But the doctor will be able to give a correct assessment, observing the behavior of the baby, from the words of the mother and through appropriate tests for movement and reflexes.
Attention should be paid to the symmetry of the limbs, the shape and size of the skull, and skin color. It is important to evaluate congenital reflex reactions. When they appeared and how expressed, since these reactions characterize the development and condition of the child. In case of deviations from the norm when establishing a neurological status in a child, he can be sent for further examination to the center of neurology.
The nervous system is the main command point in the body, the state of a person depends on its functioning, therefore it is necessary to take all necessary measures to maintain its normal functioning.