neurology-GCS,NEUROLOGICAL ASSESSMENT

1. ANGIOGRAPHY
BY:-Sita Pandey

2. Angiography is a test that uses an
injection of a liquid dye to make
the arteries easily visible on X-
rays.

3. When to use?
1)An angiogram is commonly used to check
the condition of Blood vessels.
2)It is used if Dr is considering surgery (it
shows the clear picture of blood vessels.
3)It revels aneurysm(Bulge on a artey)
4)It is used to look the artey of
neck,head,heart,kidney,liver,legs etc.
5)It is used to localise different tumours in
different organs.

4. How you prepare?
Usually you go to the hospital the morning of the procedure.
Your health care team will give you specific instructions and
talk to you about any medications you take. General
guidelines include:
-Don't eat or drink anything after midnight the day before your angiogram.
-Take all your medications to the hospital with you — in their original
bottles.
-If you have diabetes, ask your doctor if you should take insulin or other
oral medications before your angiogram.
-Before your angiogram procedure starts, your health care team should
review your medical history, including allergies and medications you take.
The team may perform a physical exam and check your vital signs —
blood pressure and pulse. You empty your bladder and change into a
hospital gown. You may have to remove contact lenses, eyeglasses,
jewelry and hairpins

5. How to perform?
1)You may be sedated through the IV to help you
relax,Under all aseptic condition.
2)A liquid die is inserted into the blood vessels
3)Depending on the test die is inserted with the help of
catheter in the groin or most commonly the arm.
4)Thin wire with a rounded tip is then carefully inserted
into the artery using a needle.
5)When catheter is in the correct position,the wire is
pulled out and dye is inserted through the catheter.
6)Now blood vessels can be checked in the screen.

6. Angiography set

7. Is angiography dangerous?
1)Small minority of patients are allergic to
the liquid dye.
2)Pregnant women should enquire about the
risks of the fluoroscopy
(X-ray screening)harming their baby
4)It is possible that the angiogram can
provoke a stroke,heart attack
either of which occasionally lead to death
6)There is a small risk of the catheter
damaging the blood vessels that
it was inserted through.

8. Glasgow Coma Scale (GCS)

9. GCS:-
The Glasgow Coma Scale is based on a
15 point scale for estimating and
categorizing the outcomes of brain injury.

11. GCS measures the motor response, verbal response and
eye opening response with these values:
III. Eye Opening
I. Motor Response
4 - Spontaneous eye
6 - Obeys commands fully
opening
5 - Localizes to noxious stimuli
3 - Eyes open to speech
4 - Withdraws from noxious stimuli
2 - Eyes open to pain
3 - Abnormal flexion
1 - No eye opening
2 - Extensor response
1 - No response
II. Verbal Response
5 - Alert and Oriented
4 - Confused, yet coherent, speech
3 - Inappropriate words and jumbled phrases consisting of words
2 - Incomprehensible sounds
1 - No sounds
The final score is determined by adding the
values of I+II+III.

12. This number helps medical practioners
categorize the four possible levels for
survival, with a lower number indicating a
more severe injury and a poorer prognosis:
Mild (13-15)
Moderate Disability (9-12)
Severe Disability (3-8)
Vegetative State (Less Than 3)
Persistent Vegetative State
Brain Death

13. Mild (13-15):Markely drowsy but well oriented to time place and
person.
Moderate Disability (9-12):
1) Loss of consciousness greater than 30 minutes
2) Physical or cognitive impairments which may or may resolve
3) Benefit from Rehabilitation
Severe Disability (3-8):
Coma: unconscious state. No meaningful response, no voluntary
activities
Vegetative State (Less Than 3):
Sleep wake cycles, Aruosal,but no interaction with environment
No localized response to pain

14. Persistent Vegetative State:
Vegetative state lasting longer than one month
Brain Death:
No brain function
Specific criteria needed for making this diagnosis

15. Electroencephalography

17. Electroencephalography:-
EEG refers to the recording of the brain's
spontaneous electrical activity over a short
period of time, usually 20–40 minutes, as
recorded from multiple electrodes placed
on the scalp.
The main diagnostic application of EEG is
in the case of epilepsy, as epileptic activity
can create clear abnormalities on a
standard EEG study.

18. Clinical use:-
1)To distinguish epilepsy ,seizures from
other types of spells (ie syncope,
fainting ,non-epileptic seizure)
2)To serve as a adjust test of brain death.
3)To measure ICP
4)To measure secondary brain damage(ie
subarchonoid hemorrhage)

19. Echoencephalography

20. Echoencephalography
The use of ultrasound to examine and
measure internal structures (as the
ventricles) of the skull and to
diagnose abnormalities and disease

21. Echoencephalography cont..
A diagnostic technique in which
pulses of ultrasonic waves are
beamed through the head from both
sides, and echoes from the midline
structures of the brain are recorded
graphically; shifts from any midline
may indicate a centrally placed mass.

22. Neurologic Assessment

23. Neurologic Assessment:-
Assessment that controls cognitive and
voluntary behaviral process and sub-
consious and involuntary bodily functions.

24. Components of a neurological
Assessment:
1. Interview
2. Level of Consciousness
3. Pupillary Assessment
4. Cranial Nerve Testing
5. Vital signs
6. Motor Function
7. Sensory Function
8. Tone
9. Cerebral Function

25. Interview to identify presence of:-
• headache
• difficulty with speech
• inability to read or write
• alteration in memory
• altered consciousness
• confusion or change in thinking
• disorientation
• decrease in sensation, tingling or pain
• motor weakness or decreased strength
• decreased sense of smell or taste
• change in vision or diplopia
• difficulty with swallowing
• decreased hearing
• altered gait or balance
• dizziness
• tremors, twitches or increased tone

26. Level of consciousness:-
***Consciousness is the most sensitive
indicator of neurological change**
-Consciousness can be defined as a state
of general awareness of oneself and the
environment.
-Consciousness is difficult to measure
directly but it is estimated by observing
how patients respond to certain stimuli.

27. Alert:
- awake, looks about
- responds in a meaningful manner to
verbal instructions or gestures
Drowsy:
- oriented when awake but if left alone will
sleep
Confused:
- disoriented to time, place, or person
- memory difficulty is common
- has difficulty with commands
- exhibits alteration in perception of
stimuli, may be agitated

28. Pupillary Assessment:-
-When assessing pupils (eyes) it is
important to assess the following:
- size
- shape
- reactivity to light
- comparison of one pupil to the
other

29. Cranial nerve testing:-
Olfactory I
Optic II
Oculomotor III
Trochlear IV
Trigeminal V
Abducens VI
Facial VII
Auditory (vestibulocochlear) VIII
Glossopharyngeal IX
Vagus X
Spinal Accessory XI
Hypoglossal XII

31. Vitals sign:-
-Changes in vital signs are not consistent early
warning signals. Vitals are more useful in
detecting progression to late symptom.
-Temperature
-Pulse
- Respiration
-Blood pressure

32. Motor function:-
When assessing motor function, from a
neurological perspective, the assessment
should focus on arm and leg movement.
You should consider the following:
1. muscle size
2. muscle tone
3. muscle strength
4. involuntary movements
5. posture, gait
Symmetry is the most important consideration when
identifying focal findings. Compare one side of the
body to the other when performing your assessment.

33. MotorMotor function test
function test

34. Sensory Function:-
When assessing sensory function
remember that there are three
main pathways for sensation and
they should be compared
bilaterally. temperature sensation
1. pain and
2. position sense
3. light touch

35. -Pain can be assessed using a sterile
pin
-To test position sense,grasp the
patient's index finger from the middle
joint and move it side to side and up
and down
-Light touch can be assessed with
a cotton wisp

36. Tone:-
Upper motor neuron problems (brain
and spinal cord) are associated with
increased tone. Lower motor neuron
problems are associated with
decreased tone
Reflex responses:
0 no response
1+ diminished, low normal
2+ average, normal
3+ brisker than normal
4+ very brisk, hyperactiv

37. Cerebellar Function:-
To test cerebellar function use the
following tests.
1)Finger to finger test:-Have patient touch index fingure with
index fingure several times.
2)Finger to nose test -Perform with eye open and eye closed.
3)Tandem walking -Heel to toe on a straight line.
4)Romberg test:-stand with feet together and arms at their
sides. Have patient close his/her eyes and maintain this
position for 10 seconds.If the patient begins to sway.have them
open their eyes.If swaying continues,the test is positive or
suggestive of cerebellum problems.

38. Finger to nose test
Finger to fingure test

39. Tandem walking
Romberg test

40. THANK
YOU 