2. Anatomy and physiology of nervous system
• The nervous system is a complex network of nerves
and nerve cells (neurons) that carry signals or
messages to and from the brain and spinal cord to
different parts of the body.
• It is made up of the central nervous system (brain
and spinal cord) and the peripheral nervous system
(nerves and ganglia).
4. Anatomy and physiology of nervous system
• Controls most body functions, including
awareness, movements, sensations, thoughts,
speech, memory and balance.
5. Elements of Neurologic System Examination
• Mental status testing
• Higher cerebral functions
• Cranial nerves
• Sensory examination
• Motor system
• Cerebellar testing
• Gait and station
6. Mental Status Examination (MSE)
• The MSE is a method used to document an
individual’s basic cognitive, emotional, and
behavioral functioning at a given point in time
7. The Domains Included in the MSE: 14
• Level of consciousness
– This refers to the client’s level of alertness and responsiveness to
questions or other stimuli.
– Awareness of date/time, current location, and current situation (e.g.,
reason for appointment).
• Gross/fine motor movement
– The client’s gait, posture, manual dexterity, etc.
• Dress/grooming and hygiene
– Is the client neatly dressed or more disheveled? Neatly or poorly
groomed? Are they attending to personal hygiene?
8. The Domains Included in the MSE: 14
• Sensory function
– Can the client hear well enough to understand questions
and see well enough to complete forms or visual tests?
– A client’s speech pattern is typically described in terms of
fluency (the ease or flow), rate (from slow to rapid to
pressured), volume (from soft to loud), and intonation
(from normal to flat or monotone, as well as any odd
tonality, such as in foreign accent syndrome (Kurowski,
Blumstein, & Alexander, 1996).
9. The Domains Included in the MSE: 14
– A client’s range of emotional expression, based on their speech,
facial expressions, or other behaviors.
– What the client reports about their internal mood state,
especially as concerns any depressive or anxious symptoms.
• Attention/working memory
– Ability to focus on tasks (attention) and briefly hold information
in mind (working memory) before using it. This domain is based
on examiner observations, client self-report, or brief tests such
as counting backward from 100 by 7s.
10. The Domains Included in the MSE: 14
– Ability to recall information, based on examiner observations, client self-
report, or brief tests, such as short-term recall of three objects stated to them.
• Thought process
– The flow and coherence of thoughts, inferred from a client’s observable
behaviors, especially speech. For example, if the client’s speech is rambling
and disorganized, the examiner may infer that their thinking is also
• Thought content
– Thought content can be inferred from spontaneous speech and direct
questioning by the examiner. For example, the examiner might ask, “Have you
ever heard things other people don’t hear or seen things other people don’t
see?” An answer of “yes” to such questions raises the possibility of
hallucinatory thought content.
11. The Domains Included in the MSE: 14
– How aware is the client of their own strengths and
• Strengths and limitations
– Traditional forms of the MSE have been designed
to record any cognitive, emotional, or behavioral
13. What is the Glasgow Coma Scale?
• The Glasgow Coma Scale (GCS) is a system to
“score” or measure how conscious you are.
• It does that by giving numbered scores for
how awake you are, your level of awareness
and how you respond to basic instructions.
15. What is consciousness?
• In the medical context, consciousness has three
requirements. To be conscious, you have to be:
• Awake: This includes whether or not you have the
ability to wake up because of voice or touch. That’s
what makes a coma different from just being asleep.
• Alert: This is how responsive you are to people talking
to you and if you’re able to understand what’s
happening in your immediate surroundings.
• Oriented: This means you know who you are, where
you’re at, what day it is and other details related to the
here and now.
16. What does the Glasgow Coma Scale measure?
• Eye response: This relates to how awake and alert
• Motor response: This part is about how well your
brain can control muscle movement. It can also show
if there are any issues with the connections between
your brain and the rest of your body.
• Verbal response: This tests how well certain brain
abilities work, including thinking, memory, attention
span and awareness of your surroundings.
18. What does the Glasgow Coma Scale measure?
• In 2018, a team of experts — including one of the original creators of the
GCS — published an updated version of the GCS called the “GCS-P.” The P
stands for “pupil,” as in the pupil of the eye.
• This is a fourth number that providers subtract from the standard GCS
• Pupil reaction is important because it’s an indicator of your brain function.
• When your pupils don’t react to light, it’s a sign that a serious problem or
injury is affecting your brain. The pupil score ranges from 0 to 2.
• The pupil scores mean:
– 2: Neither pupil reacts to light.
– 1: One pupil doesn’t react to light.
– 0: Both pupils react to light.
19. What does the Glasgow Coma Scale measure?
• Subtracting the pupil reaction score from the GCS
score means that the GCS-P score can range from 1
• The GCS-P score still uses a score of 8 or fewer to
mean a coma.
• A GCS score of 3 and a pupil score of 2 is a GCS-P
score of 1.
• That means a very deep coma and no pupil reaction
in both eyes.
20. Common Diagnostic Methods
• CT scan: This imaging test uses a combination of X-
rays and computer technology to create detailed
images of any part of the body, including bones,
muscles, fat, and organs.
• CT scans are more detailed than general X-rays.
• They are used to diagnose disorders of the brain,
spine, or other parts of the nervous system.
21. Common Diagnostic Methods
• Electroencephalogram (EEG): This test records the
brain's continuous electrical activity through
electrodes attached to the scalp.
• MRI: This test uses a combination of large magnets,
radio waves, and a computer to make detailed
images of organs and structures within the body.
• MRI creates images with much more detail than CT
scan without radiation.
22. Common Diagnostic Methods
• Electro diagnostic tests, such as electromyography
(EMG) and nerve conduction velocity (NCV): These
tests evaluate and diagnose disorders of the muscles
and motor neurons.
• Electrodes are inserted into the muscle or placed on
the skin overlying a muscle or muscle group.
• Electrical activity and muscle response are recorded.
23. Common Diagnostic Methods
• Positron emission tomography (PET): This test uses a
small amount of radioactive material, a camera, and
a computer to see how well organs and tissues are
• This test may see the early onset of disease before
imaging tests can.
• Arteriogram (angiogram): This X-ray of the arteries
and veins detects blockage or narrowing of the blood
24. Common Diagnostic Methods
• Spinal tap (lumbar puncture): During this test, a
special needle is placed into the lower back, into the
• This is the area around the spinal cord and nerves.
The pressure in the spinal canal and brain can then
• A small amount of cerebrospinal fluid (CSF) can be
removed and sent for testing to find out if there is an
infection or other problems.
• CSF is the fluid that bathes the brain and spinal cord.
25. Common Diagnostic Methods
• Evoked potentials: This test records the brain's electrical
response to visual, auditory, and sensory stimuli.
• Myelogram: This test uses dye injected into the spinal
canal to make the structure clearly visible on X-rays and
used less commonly because MRI is widely available.
• Neurosonography: This test uses ultra-high-frequency
sound waves and allows the healthcare provider to
analyze blood flow in cases of possible stroke.
• Ultrasound (sonography): This imaging test uses high-
frequency sound waves and a computer to make images of
blood vessels, tissues, and organs. Ultrasounds are used to
view internal organs as they function. They also assess
blood flow through various vessels.
26. Epidemiology and Burdens
• Globally, in 2016, neurological disorders were the leading
cause of DALYs 276 million and second leading cause of
deaths 9·0 million. (DALY-Disability adjusted life year)
• The absolute number of deaths and DALYs from all
neurological disorders combined increased by 39% and
DALYs by 15%.
• The only neurological disorders that had a decrease in rates
and absolute numbers of deaths and DALYs were tetanus,
meningitis, and encephalitis.
• The four largest contributors of neurological DALYs were
stroke 42·2%, migraine16·3%, Alzheimer's 10.4% and
meningitis 7·9% . WHO(2016). Neurological Disorders, pp,
• A headache is a pain in head or face that’s often
described as a pressure that’s throbbing, constant,
sharp or dull.
• Headaches can differ greatly in regard to pain type,
severity, location and frequency.
• Headaches are a very common condition that most
people will experience many times during their lives.
• They’re the most common form of pain and are a
major reason cited for days missed at work or school,
as well as visits to healthcare providers.
• While most headaches aren’t dangerous, certain types
can be a sign of a more serious condition.
28. What are the types of headaches? (>150)
• Primary headaches
• Dysfunction or over-activity of pain-sensitive features in your head cause primary
headaches. They’re not a symptom of or caused by an underlying medical
condition. Some people may have genes that make them more likely to develop
• Types of primary headaches include:
– Tension-type headaches (most common type of headache).
– Migraine headaches
– Cluster headaches
– New daily persistent headaches (NDPH)
• Some primary headaches can be triggered by lifestyle factors or situations,
– Alcohol, particularly red wine.
– Certain foods, such as processed meats that contain nitrates (food-triggered headaches).
– Consuming nicotine (nicotine headache).
– Changes in sleep or lack of sleep.
– Physical activity, such as exercise (exertion headaches).
– Skipped meals (hunger headache).
– Coughing, sneezing, blowing your nose, straining (such as when having a bowel movement), or
laughing or crying vigorously (primary cough headaches).
29. Secondary headaches
• An underlying medical condition causes secondary headaches. They’re
considered a symptom or sign of a condition.
• Types of secondary headaches that aren’t necessarily dangerous and
resolve once the underlying condition is treated include:
– Dehydration headache
– Sinus headaches
– Medication overuse headaches
• Types of secondary headaches that can be a sign of a serious or potentially
life-threatening condition include:
– Spinal headaches
– Thunderclap headaches: A thunderclap headache is an extremely painful
headache that comes on suddenly, like a clap of thunder. This type of
headache reaches its most intense pain within one minute and lasts at least
– Head injury
– Brain bleed
30. What’s the difference between a headache and a
• A migraine is a type of primary headache disorder.
• A migraine is a common neurological condition that
causes a variety of symptoms, most notably a
throbbing headache on one side of head.
• Migraines often get worse with physical activity,
lights, sounds or smells.
• They usually last at least four hours or even days.
31. Who do headaches affect?
• Anyone can have a headache, including
children, adolescents and adults.
• About 96% of people experience a headache
at least once in their life.
• About 40% of people across the world have
tension-type headaches and about 10% have
32. • Sign and symptoms of headache?
• Diagnostic method?
• Medical management?
• Non pharmacological management?