ASSESSMENT OF NEUROPSYCHIC FUNCTION
I. INTRODUCTION
The neurological examination must be part of the clinical examination of any patient who presents for a general medical consultation.
A minimum examination ordered will make it possible to detect any neurological abnormality and to order the first additional examinations appropriately.
II. ANATOMY AND PHYSIOLOGY
- The entire nervous tissue of man is called the nervous system.
- The nervous system is used for the capture, processing, storage and sending of information.
- It helps regulate the functioning of all organs, and therefore adapt to the external environment.
Depending on their functions, we differentiate:
- The voluntary nervous system which directs processes under the control of consciousness and will (e.g. muscle contraction, etc.).
- The autonomic nervous system which directs the functions of the internal organs (e.g. breathing, digestion, etc.).
The nervous system is divided into:
-Central nervous system including the brain (intellectual faculties, will), the cerebellum (balance), the medulla oblongata (vital functions), the spinal cord. All protected by the meninges, the CSF (cerebrospinal fluid), the bone structures.
-Peripheral nervous system comprising all the nerves connecting the periphery with the central nervous system.
III . CLINICAL EXAMINATION
The neurological examination is one of the key elements of diagnosis in neurology which is also based on questioning the patient.
The interview is the crucial time with which the consultation begins in neurology but also in general medicine.
The neurological examination itself constitutes the second step of reasoning in neurology.
This neurological examination includes different tests and maneuvers that the doctor will have the patient perform. For this, he needs a minimum of equipment, namely
- A reflex hammer .
- A foam tip.
- A piece of cotton or gauze.
- A pin.
- A tuning fork .
1°Assessment of consciousness => Glasgow scale.
2° Evaluation of pupils
- Pupil diameter
- Symmetry of the two eyes
- Reaction to light
3° Search for paralysis ( The driving force)
- Hemiplegia
- Paraplegia
- Tetraplegia
- Facial paralysis
4° Search for a language disorder
- Aphasia
- Dysarthria
5. Reflexes: patellar and Achilles; Plantar cutaneous reflex
6. Search for sensitivity disorders
7. examination of the different cranial nerves
8. Behavior assessment: Calm or agitated
9. Assessment of orientation
In time and space
10. Memory assessment.
- Glasgow Coma Scale
Opening the eyes
- 4 Spontaneous
- 3 To the voice
- 2 To the pain
- 1 None
Verbal response
- 5 Oriented
- 4 Confused
- 3 Inappropriate
- 2 Incomprehensible
- 1 Zero
Motor response
- 6 Obey
- 5 Oriented
- 4 Avoidance
- 3 Flexion
- 2 Extension
- 1None
ASSESSMENT OF NEUROPSYCHIC FUNCTION
VI. ADDITIONAL EXAMINATIONS
Depending on the results of the examination and the diagnostic hypotheses made by the practitioner, additional examinations such as a brain scan or MRI , an electroencephalogram , a blood test or many other examinations may be carried out.
- exploration of the parenchyma (scanner, MRI, EEG),
- exploration of vessels (angiography, Doppler),
- exploration of peripheral nerves and muscles (electromyogram, evoked potential, muscle biopsy).
A ° Parenchyma examinations
- The scanner:
- The goal is to make a thin, precise cut centered on the brain.
- Dense areas are light, less dense areas are dark.
Indications: Stroke and cerebral infarction.
2) Magnetic Resonance Imaging
- The magnetic properties of materials are used (in the presence of a magnetic field, hydrogen emits radio waves). These emissions are captured and interpreted into an image.
- This is a second-line test.
- Contraindication: wearing a metal device (pacemaker, prosthesis), pregnancy, obesity.
3) Electroencephalogram
- It records the electrical activities of the brain using electrodes. The recording is done on a graph paper.
- A flat line is diagnostic of brain death.
- The patient should not take any sedatives or stimulants.
- Do not fast (risk of hypoglycemia).
- Indications: epilepsy, sleep disorder, dementia.
ASSESSMENT OF NEUROPSYCHIC FUNCTION
B ° Examinations exploring the vessels
- Angiography, arteriography:
It is the radiological study of the vessels of the brain after injection of radiopaque products.
Indications: aneurysms, angiomas, arterial malformations, tumors , embolizations.
- Doppler
It is the ultrasound examination of the vessels which makes it possible to determine their permeability (extra and intracerebral) as well as the speed of the blood circulating there.
This provides information on speed, flow rate, detection of leaks and narrowing, stenoses, thromboses.
C°Examinations exploring peripheral nerves and muscles
- Evoked potential
It is the recording of the electrical activity of the brain in correlation with sensory stimulations (visual, auditory, etc.). This is to evaluate the conduction of nerve impulses on the sensory pathways and to detect the delay in the transmission of the message.
Indications: Multiple sclerosis.
- Electromyogram
- It is the study of the electrical activity of the peripheral nervous system (neuro-muscular junctions, muscles and nerves). The collection is done using electrodes inserted into the muscles.
-measurement of motor and sensory nerve conduction by electrical stimulation of the nerves and collection of responses remotely,
-recording of spontaneous electrical activities of the muscle.
- Indications: Myopathy, myasthenia gravis, amyotrophic lateral sclerosis, polyradiculoneuritis.
- Muscle biopsy
- It is the removal of a fragment of muscle and/or nerves and/or fascia after an incision. There is local anesthesia and suture.
ASSESSMENT OF NEUROPSYCHIC FUNCTION
V. CONCLUSION
It is interesting to note that despite the progress made over the last 10 years in terms of additional examinations, neurology is above all a medical specialty based on the clinic, that is to say the questioning and examination of the patient.
ASSESSMENT OF NEUROPSYCHIC FUNCTION
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