The human nervous system regulates the work of organs and tissues, and also contributes to the adaptation of the body to certain conditions. The work of the organism as a whole, as well as the interaction of a person with the environment, depends on it. It is very important for every doctor to be able to determine the neurological status of the patient. What it is and how it is being researched, we will talk about this later.
Why status is important
First of all, when communicating with a patient, the doctor must pay attention to his behavior, reaction and general mental state. Especially if the patient was admitted with some kind of injury 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. It is by examining the neurological status of the patient that the doctor allows himself to prescribe a treatment that will improve the functionality of the brain and increase the chances of a positive outcome of the treatment.
Pupillary response to light is not enough to establish a neurological status. Currently, a scheme has been developed that evaluates the work of the brain, based on some neurologicalsymptoms. You can set the status by contacting a specialized diagnostic center. Let's see how the status is set next.
Initial patient interview
The main condition for a correct examination of the neurological status is the doctor's ability to compare symptoms and signs with certain parts of the nervous system.
During a general examination, the doctor should take an active position and find out the following:
- set patient data: full name, position;
- listen to patient complaints;
- determine whether there have been fainting or epileptic seizures;
- complaints of frequent headaches and what they are, where they are localized, find out what provoked the pain, what were the accompanying symptoms;
- need to find out in what sequence the pain or attack develops, what is the stimulant;
- find out what treatment was given earlier, what drugs were used and how they affected the patient.
Also, the writing of the neurological status will include gender, past infectious diseases, features of the perinatal period, and also what hereditary diseases of the nervous system are.
General examination of the patient
To establish the neurological status, it is necessary not only to interview the patient, but also to carefully examine him. For this, the patient must be stripped down to underwear.
Then assess the condition of the skin, their color. Measure body temperature. Note the presence of scarsinjection marks. It is necessary to determine what type the patient belongs to: asthenic, hypersthenic, normasthenic. Is there obesity or excessive thinness.
Next, a visual and palpation examination of the head is carried out. Note its shape, symmetry, as well as the presence of abrasions. It is necessary to pay attention to seals, painful foci. Feel the temporal arteries, assess their condition. Assess eyeballs and nasal and ear discharge, if present.
Examination of the cervical spine and 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. The carotid and subclavian arteries are examined by auscultation. Determine the tone of the occipital muscles, whether there is a symptom of Lermitte. Next, the chest and abdomen are examined.
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 in the back muscles and their soreness, as well as the condition of the lumbar vertebrae.
Brain functions and cranial nerve examination
It is very important in the study of neurological status to evaluate brain functions. It is necessary to distinguish violation from pathologies at work. To do this, you need to evaluate the following criteria:
- consciousness;
- the ability to navigate;
- find out how developed attention, memory;
- determine how a person makes contact, what kind of speech he has;
- to find out if the patient is able to follow the sequence;
- check for signs of agnosia.
Description of neurological status cannot bypass the analysis of cranial nerves. There are only 12 pairs.
Each of them is responsible for a particular function. Sensory 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, facial muscles, tongue, palate, and larynx. Mixed 5, 9, 10 pairs of nerves are responsible for motor and sensory functions. These are the trigeminal, 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 the work of the muscles. It is necessary to examine the muscles of the lower leg and shoulder girdle, determine the tone and symmetry of muscle contractions, how developed the muscles are.
In this case, several motor response tests are performed to examine the neurological status. Example: in the supine position, the patient raises the knee, while observing the movement of the foot. Muscular weakness of the lower extremities is determined by bending the leg at the knee and by extending the thumb. In a standing position with eyes tightly closed, the patient is asked to raise their hands, palms up. Muscle strength can be tested by asking the patient to walk on heels and toes.
Research of the neurological status cannot do without evaluation of the patient's coordination. According to the patient's gait, his coordination and motor functions are assessed. This uses a good test: the patient needs to touch the tip of the nose and fingertips with the greatest accuracy.
All actions must be done quickly. If at the same time hand trembling or not hitting the target appears, this is an anomaly.
Evaluate reflexes is also necessary. They are divided into deep tendon and regressive.
The asymmetry of reflex reactions or their inhibition 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 and Autonomic Nervous System Assessment
Sensory perception is assessed by finding out the following facts:
- is there pain;
- character of pain;
- localization and duration;
- what symptoms accompany the pain and what actions ease it;
- actions that gave rise to attacks of pain.
Also conduct tests to determine the sensitivity. Sensitivity must be checked at symmetrical points on the right and left. For a deeper examination, the state of deep and superficial receptors is assessed.
Assessment of autonomic functions is partly carried out during the patient's interview, based on his complaints. In order to make a deeper analysis of the vegetative system, conductfollowing steps:
- measure blood pressure in the supine position, after 3 minutes standing;
- measure heart rate;
- do deep breathing tests;
- perform test for reactivity with pressure on the eyeballs;
- feel the skin, determining sweating, you can use iodine if necessary;
- if urination is disturbed, they feel the stomach, if necessary, conduct an instrumental examination.
Examination of a patient in a coma
It is much more difficult to assess the neurological status of a patient if he is in a coma. In this case, it is necessary to pay attention to the following factors: assess the work of the respiratory system and blood circulation, determine the depth of the coma and the reason for getting into such a state, examine the patient for injuries, check reflexes.
All doctor's actions should be aimed at saving the patient's life, therefore, when assessing the neurological status, actions are jointly carried out that are aimed at eliminating life-threatening conditions. In such cases, it is better to send the patient to the neurology center. They will conduct a full examination there.
Child's neurological status
The peculiarity 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 the correct assessment by observing the behavior of the baby, according to the mother and through appropriate tests for movement and reflexes.
You should pay attention to the symmetry of the limbs, the shape and size of the skull, skin color. It is important to assess the innate 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 determining the neurological status of the child, he may be sent for further examination to the neurology center.
The nervous system is the main command post 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 operation.
