Running head: NEUROLOGICAL ASSESSMENT 1

Neurological Assessment

Briana G. Inestroza

Brigham Young University – Idaho

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Neurological Assessment

The nervous system is a complex component of the body that controls much of what the

human body does and is capable of. It contains the central nervous system (CNS) and the

peripheral nervous system (PNS). The CNS is what is more commonly known amongst people,

and it includes the brain and spinal cord. The PNS contains nerve fibers that connect the CNS to

the rest of the body by extending out to the limbs and organs. The nervous system is responsible

for muscle movement, sensations, pain, and much more. When intact, the nervous system makes

living effortless. However, when the nervous system is altered it can lead to everyday

complications and altered body functions.

Multiple Sclerosis

Multiple Sclerosis (MS) is a chronic-inflammatory disease that disables the CNS and

limits its effectiveness. The severity of MS is different in every person because of how it

progresses differently in everyone. This makes the disease unpredictable and means that there is

no one specific care plan for everyone. There are different factors that contribute to MS

including: immune, environmental, and infectious. In MS, the body’s own immune system

begins attacking the nerves, brain, and spinal cord, making them ineffective. This impairs the

body’s ability to send signals to the limbs and organs and vice versa. Research shows that the

disease is more prominent in Northern Europeans and Northern Americans of higher latitudes. It

is least common amongst Japanese people and American Indians (Zawanda & Campanella,

2013). Zawanda and Campanella report that Epstein-Barr virus and human herpesvirus 6 (HPV-

6) are more than likely involved in the onset of MS (2013). When assessing for MS, it is

important to ask about the common symptoms such as: tingling/numbness, fatigue/walking and

gait difficulties, dizziness and vertigo, bowel/bladder problems, depression, and pain. The
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numbness and tingling seen in MS should be further evaluated so that it is not mistaken with the

early symptoms of peripheral neuropathy. Asking about symptoms will give an insight on how

MS is developing in that specific person. It’s also important to ask questions such as, “What are

your diet and exercise patterns?” in order to learn about the patient and to help lead them in a

direction that is beneficial for those with MS. To help a patient learn more about their condition,

a good and brief description is given in the following website:

https://www.youtube.com/watch?v=QpUMT-SA75Q#action=share. For those living in

Charlotte, NC, there is a local group that meets for those who have recently been diagnosed with

multiple sclerosis that provides support and teaches about self-care. More information about this

group can be found at: https://www.nationalmssociety.org/Chapters/NCT/Groups-and-

Discussions/Programs/Minimally-Impaired-Newly-Diagnosed-Self-Help-Group.

Meningitis

Similar to multiple sclerosis, meningitis is a neurological disorder pertaining to the brain

and spinal cord. However, unlike MS, meningitis is inflammation of the protective membranes

(meninges) of the brain and spinal cord, typically caused by a bacterial or viral infection. These

bacterial infections can lead to “cerebrospinal fluid pleocytosis, cochlear damage, cerebral

edema, hydrocephalus, and cerebrovascular complications” (Mook-Kanamori, Geldhoff, Van der

Poll, & Van de Beek, 2011). This type of meningitis spreads through airborne droplets, so it is

possible to get it from someone who already has this infection. Adolescents are at most risk for

acquiring meningitis. Meningitis can also come from other factors, such as: injuries, cancers, and

drugs. This type of meningitis is not transmissible. How meningitis is treated depends on how it

is acquired and how severe it is, ranging anywhere from minor to life-threatening. Meningitis

presents itself with the following symptoms: fever, vomiting, headaches, stiff neck, rashes,
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photophobia, confusion, delirium, and seizures. One of the most important things to talk to the

patient about is questions that can help rule out injuries or trauma such as, “have you recently

had any head injuries or brain surgeries?” The patient should also be asked about any neck

stiffness along with its onset, severity and any sudden onsets of fever. To help the patient learn

more about meningitis, especially a young patient who may not want to read through articles,

refer them to the following website: https://www.meningitisb.com/index.html.

Encephalitis

Encephalitis is inflammation of the brain itself, making it different from other

neurological disorders like meningitis and multiple sclerosis. Similar to meningitis, viral

infections tend to be the main cause of encephalitis. In 1937, encephalitis was linked to the

contact of ticks and has since then been proven to be one of its most likely causes (Petruševski,

2017). Even though viral infections are the most common contributor of encephalitis, it can come

from faulty immune system reactions to infections that originated elsewhere. The virus and

inflammation of the brain can cause symptoms anywhere from mild to severe. Some symptoms

include: flu-like symptoms (headaches, fever, fatigue), confusion, seizures, problems with senses

and movement. Common symptoms in infants are irritability, poor-feeding, and bulging in the

soft spots of the infant’s skull. Anyone with a weakened immune system such as young children,

older adults, or people with HIV are at greater risks for acquiring encephalitis. Even though

encephalitis is rarely life-threatening, it is important to assess for it carefully if there are any

suspicions. Questions to ask the patient could include “Have you recently traveled to any humid,

marshy areas where you could have been exposed to ticks and mosquitos?” Patients should also

be asked about any behavioral changes or any problems with movement. To help give the patient
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a brief overview of what encephalitis is, the brochure found in the link would be beneficial:

http://encephalitisglobal.org/wp-content/uploads/2015/07/Encephalitis-Global-Brochure.pdf.

Peripheral Neuropathy

Neuropathy is the word used to describe nerve damage or disease. Peripheral neuropathy

is damage to the nerves affecting the body, bust mostly the hands and feet. Peripheral neuropathy

can be attributed to many factors such as trauma/injury, disease/disorders, or exposure to toxins.

Traumas that sever the spinal cord or the nerves can lead to the impairment of sensations.

Uncontrolled diabetes can lead to peripheral neuropathy and is known as “diabetic neuropathy”.

Shingles, Guillain-Barre syndrome, and heavy alcohol consumptions are known contributors to

the development of peripheral neuropathy. Like seen in MS, Epstein-Barr virus can lead to nerve

disorder with undesirable effects. Neuropathy first appears as tingling, prickling, or burning

sensations in some part of the body, usually the extremities (Saunders, 2013). As the disorder

progresses, the symptoms become more severe. Not only is there decreased sensation, but also

heat intolerance, loss of bladder/bowel control, orthostatic hypotension, fasciculation, and

muscle atrophy (National Institute of Neurological Disorders and Stroke, 2017). Diminished

sensations can be painful and dangerous if not taken care of or watched carefully. Patients should

be asked if they have noticed any signs of tingling, prickling, or burning. Patients should also be

advised to take it slowly when getting up, due to the changes in blood pressure. Treatment varies

depending on how the disorder progresses in the individual. The different causes of the

neuropathy will also have an effect on how treatment should be handled. For more education on

treatment and maintenance options, the patient should be referred to:

https://www.foundationforpn.org/living-well/.
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Bell’s Palsy

Bell’s palsy is a neurological disorder pertaining to the cranial nerve. More specifically,

cranial nerve VII, also known as the facial nerve. The damage to the cranial nerve is associated

with herpes-simplex, flu-like illnesses, chronic middle-ear infections, high blood pressure,

diabetes, sarcoidosis, tumors, and trauma. An uncommon but still possible contributor to Bell’s

Palsy, like encephalitis, is the acquiring of the disorder through mosquitos or ticks (Lyme’s

Disease). These conditions lead the muscles to either become swollen, inflamed, or compressed,

which further leads to pressure in the fallopian canal, causing ischemia (National Institute of

Neurological Disorders and Stroke, 2017). Due to the nerve becoming impaired, the facial

muscles become weak and the face becomes temporarily paralyzed. This disorder presents itself

as facial drooping, usually on one side. The eye and mouth on the affected side become

impaired, making it difficult to close the eye or mouth. During the assessment, the patient should

be asked, “Have you noticed agitation or dryness in your eyes?” Asking this question determines

how much the eye is being affected and potential need for artificial teardrops. Also asking the

patient, “Have you had any impairment of taste?” is important to grasp an idea of how much the

cranial nerve is being affected. Some resources that can be beneficial for a patient experiencing

Bell’s Palsy can be found in the following websites:

 http://www.educatehealth.ca/media/475531/bell%E2%80%99s%20palsy-brochure.pdf

 http://bellspalsy.org.uk/exercises1.pdf

Conclusion

The nervous system is made of many components, leaving room for many unique

disorders and diseases. The Neurological disorders come in many forms and no two are exactly
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alike. While there may be similarities, it is important to know which specific disorder is being

dealt with in order to have specific patient-centered care.

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References

Mook-Kanamori, B. B., Geldhoff, M., Van der Poll, T., & Van de Beek, D. (2011). Pathogenesis

and Pathophysiology of Pneumococcal Meningitis. American Society for Microbiology,

volume 23. doi: 10.1128/CMR.00008-11

National Institute of Neurological Disorders and Stroke. (2017, May 10). Bell’s Palsy Fact

Sheet. Retrieved from https://www.ninds.nih.gov/Disorders/Patient-Caregiver-

Education/Fact-Sheets/Bells-Palsy-Fact-Sheet

National Institute of Neurological Disorders and Stroke. (2017, May 9). Peripheral Neuropathy

Fact Sheet. Retrieved from https://www.ninds.nih.gov/Disorders/Patient-Caregiver-

Education/Fact-Sheets/Peripheral-Neuropathy-Fact-Sheet

Petruševski, A. B. (2017). History of development of inflammatory diseases of the nervous

system - meningitis and encephalitis. Vojnosanitetski Pregled: Military Medical &

Pharmaceutical Journal Of Serbia, 74(6), 599-605. doi:10.2298/VSP151218250P

Saunders, D. P. (2013). Neuralgia, neuritis, and neuropathy. Magill’S Medical Guide (Online

Edition)

Zawada, W. P., & Campanella, J. P. (2013). Multiple sclerosis. Magill’S Medical Guide (Online

Edition)