Overview of Trauma Neurological Exam
The nervous system contains important organs located within and outside the skull and the main framework of the body (the axial skeleton). These organs are arranged in such a way that they get different levels of protection. Injuries or accidents can have a wide range of impacts on the nervous system. These impacts could be minor and immediate or severe and long-term, affecting both brain function and emotional health. Quick identification, proper treatment, and full-scale rehabilitation are important for improving the results of treatment and encouraging recovery in people affected by such injuries.
A systematic way of examining the nervous system makes sure that all aspects of brain function are thoroughly checked, reducing the chance that any significant findings are missed. Being consistent in the methods used for the assessment can help make sure the examination is done accurately. This is important as it allows for consistent results across different doctors and clinics.
Anatomy and Physiology of Trauma Neurological Exam
The nervous system can be divided into two major parts: the central nervous system (CNS) and the peripheral nervous system (PNS). The CNS is made up of the brain and the spinal cord, which are essential for our survival. The PNS, on the other hand, includes nerves and specific cells that send signals to and from the CNS.
The most important unit of the nervous system is the neuron, or nerve cell, whose job is to transmit information quickly. Neurons communicate with each other using both chemical and electrical signals. They have branch-like structures called dendrites and axons, which send and receive signals. Some axons are wrapped in a fatty substance called myelin that helps speed up these signals. Neurons are also supported by special cells known as neuroglia, including cells called oligodendria, astrocytes, ependymal cells, and microglia. Ependymal cells are in charge of producing cerebrospinal fluid (CSF), a liquid that protects the brain and spinal cord.
The CNS is protected by a layer of tissue called the meninges, which consists of three parts: the dura, arachnoid, and pia mater. The brain is organized into three main parts: the forebrain, midbrain, and hindbrain. The forebrain includes parts like the cerebral cortex (that helps in thinking and consciousness), thalamus (that relays signals), limbic system (involved in emotions), and basal ganglia (that helps in controlling movement). The midbrain connects the forebrain and hindbrain, while the hindbrain includes the pons, cerebellum, and medulla oblongata. The brain also has cranial nerves that send signals to and from the different parts of the body.
The spinal cord starts from the medulla oblongata, runs through the bones of the neck and back, and ends near the top of the lower back. It’s in charge of sending signals between the brain and the rest of the body. The spinal cord has special regions that control the arms and the legs. The spinal cord also has fibers known as dorsal and ventral roots that help in carrying signals to and from the body.
The PNS consists of nerves that connect the CNS to the rest of the body. It is divided into the somatic nervous system (SNS) and the autonomic nervous system (ANS). The SNS helps in controlling voluntary movements, while the ANS controls involuntary responses, like heart rate and digestion. The ANS can be further divided into the sympathetic and parasympathetic divisions, which help the body react to different situations, like stressful events or rest.
Finally, dermatomes are areas of skin controlled by a single nerve. They send sensory information such as touch, temperature, and pain from the skin to the brain. Testing dermatomes can help doctors understand nerve injuries or neurological symptoms.
The organization of the nervous system helps doctors identify and understand neurological issues or injuries. It’s critical for doctors to be able to examine the nervous system accurately, especially in emergency situations or continuous patient care, without the need for diagnostic tests.
Why do People Need Trauma Neurological Exam
If a person has been in an accident or suffered physical harm, there may be a need for a check-up focused on the brain and nervous system, this is called a neurologic examination. There are several reasons this might be necessary:
- High-speed car accidents, sharp injuries, or falls from great heights can often injure the nervous system.
- If the person seems unusually sleepy or confused, this test may be needed to figure out why.
- A head, spine or limb injury can also involve damage to the nerves.
- If the person reports symptoms related to brain and nerve function, such as weakness, numbness, or problems with speech or vision, a neurologic examination may be necessary.
- If symptoms get worse following an injury, the examination should be done.
- If the person has more than one injury, a neurologic examination might be necessary to check for possible nerve damage.
The decision to perform a neurologic examination on a person who has experienced physical trauma is based on various factors. These include the type and cause of the injury, the symptoms the person is showing, and any risks of their nervous system being affected.
Equipment used for Trauma Neurological Exam
A standard nervous system check-up requires certain tools. However, the doctor’s knowledge and interaction with you are very crucial for a precise evaluation. Depending on the place of study, the people involved, and the symptoms you might present, the tools the doctors may need can vary.
These tools can include:
- Snellen card or chart: A tool used for eye exams
- Ophthalmoscope: A device for checking the health of your eye
- Tongue depressor: A tool for keeping your tongue down so the doctor can examine your throat
- Small flashlight: Used to help the doctor see better while examining you
- Reflex hammer: Used to test your body’s reflexes
- Disposable safety pin: Often used in nerve sensitivity tests
- Small cotton wool pledget: Used for a variety of purposes, like dabbing a small amount of medication
- 128- and 256-Hz tuning forks: Used for hearing tests
- Samples of coffee or mint: Maybe used for smell tests
- Paper and pen: Often used for writing notes and observations
- Compass with 2 blunt tips: Used in sensory exams
- Coins: These can be used in various tests, including sensory ones
- Small common objects like screws: These might serve in a variety of tests
How is Trauma Neurological Exam performed
Generally, for a neurological examination to be most effective, the patient should be fully awake, well-supplied with oxygen, and maintain normal blood pressure and blood sugar levels. This is because things like sedation, lack of oxygen, low blood pressure, and low blood sugar can affect nerve function and make the examination results less accurate.
A full neurological check-up includes examining a patient’s mental state, cranial nerves, sensory function, motor function, and reflexes. However, these examinations might not be possible for unresponsive or unconscious patients. But, even in these cases, careful observation can give doctors some information about the patient’s neurological health. For example, one can still test reflexes in patients who are in a coma.
One commonly used method to assess a patient’s consciousness level is the Glasgow Coma Scale (GCS). This helps determine how serious a patient’s traumatic brain injury is and it’s simple enough to be performed by less experienced caregivers both in and outside of hospital settings. The GCS looks at how a patient responds in three areas: eye opening, verbal function, and motor function.
The GCS scoring system works as follows:
Eye opening
- Opens eyes spontaneously: score of 4
- Opens eyes in response to speech or sound: score of 3
- Opens eyes in response to pain: score of 2
- No response: score of 1
Verbal function
- Alert and oriented: score of 5
- Confused/disoriented: score of 4
- Uses inappropriate words: score of 3
- Makes incomprehensible sounds: score of 2
- No response or patient is intubated: score of 1
Motor function
- Follows commands: score of 6
- Responds to painful stimuli: score of 5
- Withdraws from pain: score of 4
- Abnormal flexing (decorticate posture): score of 3
- Abnormal extending (decerebrate posture): score of 2
- No response: score of 1
The combined GCS scores range from 3 to 15, with a lower score indicating more severe neurological dysfunction. Some doctors prefer to report the scores for each category rather than a total score to provide a more detailed view of the patient’s mental state.
A crucial part of a neurological examination is to assess the patient’s mental status. This pertains to how well the patient is aware of their internal and external environments. Basically, a person with normal consciousness should be easily awakened, able to respond appropriately to visual or verbal cues, and be aware of their identity, location, situation, and the current time. Abnormal consciousness exists on a spectrum that ranges from mild sleepiness to being unresponsive (coma).
A patient’s cranial nerves can also be examined. Of the twelve cranial nerves, the olfactory nerve (used for smelling) is usually not checked during a trauma neurologic assessment. Damage to the brainstem and central brain lesions can manifest in cranial nerve weakness.
Thus, the neurological examination provides a detailed insight into the patient’s neurological health and can be extremely useful in trauma settings.
What Else Should I Know About Trauma Neurological Exam?
When someone is unconscious, it could be due to damage to a part of the brain called the brainstem. But other factors like alcohol intake and low blood sugar can also cause unconsciousness, so these need to be ruled out in patients who have suffered from trauma and are not fully conscious.
There’s a system used to measure the severity of a brain injury. It’s called the Glasgow Coma Scale (GCS), and the scores can range from 3 (most severe) to 15 (least severe). Injury severity is categorized as severe, moderate, or mild.
A concussion, also known as a mild brain injury, is a temporary condition that can cause a brief loss of consciousness, seeing stars, or symptoms like headaches, dizziness, nausea, and vomiting. In some cases, a person could even develop a condition called post-concussive syndrome, which can cause ongoing symptoms long after the injury has happened.
When talking about brain injuries in general, it can happen in different ways, such as from a blow to the head or a blast injury. The GCS score can be used to classify if it’s mild, moderate, or severe. It’s important to note that one assessment isn’t enough; doing multiple tests over time can give doctors a better idea of possible outcomes. For example, constantly low or dropping scores indicate a poorer outlook than steadily high or improving scores.
Examination of your cranial nerves, which are 12 pairs of nerves that originate from the brain, can provide insights into any potential injury. Any anomalies in vision, pupil response, eye movement, corneal reflex, hearing, gag reflex, or muscle strength could indicate damage to these nerves.
Damage to the spinal cord can result in a condition called spinal shock, which can cause paralysis, loss of deep tendon reflexes (DTRs), reduced sympathetic activity, and absent sphincter reflexes. This condition can last from weeks to months, after which, some reflexes may return, although they might not be under voluntary control.
