FONTANILLA, YZZA AVRILL P.

NEUROLOGICAL HEALTH ASSESSMENT

Neurologic system is responsible for coordinating and regulating all body functions.
TWO STRUCTURAL COMPONENTS:
1. Central nervous system (CNS)
➢ Brain: Receives and processes sensory information, initiates responses, stores memories, generate thoughts and
emotion
➢ Spinal Cord: Conducts signals to and from the brain, control reflexes activities
2. Peripheral nervous system (PNS)
➢ Autonomic nervous system: controls involuntary responses
o Sympathetic division: “fight or flight”
o Parasympathetic division: “rest or digest”
➢ Somatic nervous system: controls voluntary movements
CRANIAL NERVES SPINAL NERVES

Name Nerve type Function

I Olfactory Sensory Smell
II Optic Sensory Vision
III Oculomotor Motor Most eye movement
IV Trochlear Motor Moves eye to look at nose
V Trigeminal Both Face sensation, mastication
VI Abducens Motor Abducts the eye
VII Facial Both Facial expression, taste

VIII Vestibulocochlear Sensory Hearing, balance

IX Glossopharyngeal Both Taste, gag reflex
X Vagus Both Gag reflex, parasympathetic innervation

XI Accessory Motor Shoulder shrug

XII Hypoglossal Motor Swallowing, speech

Neurons are the fundamental units of the brain and nervous system. Consists of AXON, DENDRITES and CELL
BODY
 1. Health history
o Past
o Present
2. Family history
3. Lifestyle and health practices
4. Physical examination
o Mental status
o Cranial nerves
o Motor and cerebral system
o Sensory system
o Reflexes

PHYSICAL EXAMINATION
1. MENTAL STATUS AND LEVEL OF CONSCIOUSNESS
*Orientation to place, person, date
Glass-gow coma scale
• Severe: GCS 3-8
• Moderate: GCS 9-12
 • Mild: GCS 13-14
• Fully awake: 15

MANIFESTATIONS OF BRAIN INJURY

o Decorticate posturing
o Decerebrate posturing

2. CRANIAL NERVE EVALUATION

I. OLFACTORY

Cranial Nerve Assessment Normal Response Documentation

Ask the client to smell and identify Client is able to identify different Client was able to describe the odor
the smell of cologne with each nostril smell with each nostril separately and of the materials used.
separately and with the eyes closed. with eyes closed unless such
condition like colds is present.
o Inability to smell (neurogenic anosmia) or identify the correct scent may indicate olfactory tract lesion or
tumor or lesion of the frontal lobe. Loss of smell may also be congenital or due to other causes such as nasal or
sinus problems. It may also be caused by injury of nerve tissue at the top of the nose or the higher smell pathways
in the brain due to viral upper respiratory infection. Smoking and use of cocaine may also impair one’s sense of
smell.
II. OPTIC
Cranial nerve Normal response Documentation Abnormal response
assessment
>Use a Snellen chart >Client has 20/20 Client was able >Abnormal findings include difficulty reading Snellen
to assess vision in vision OD (right to read with chart, missing letters, and squinting.
each eye eye) and OS (left each eye and
>Ask the client to eye). both eyes >Client reads print by holding closer than 14 inches or
read a newspaper or >Client reads print holds print farther away as in presbyopia, which
magazine paragraph at 14 inches without occurs with aging.
to assess near >Loss of visual fields may be seen in retinal damage
difficulty.
vision. or detachment, with lesions of the optic nerve, or with
>Full visual fields
>Assess visual
>Round red reflex is lesions of the parietal cortex
fields of each eye by
present, optic disc is >Papilledema (swelling of the optic nerve) results in
confrontation.
>Use an 1.5 mm, round or blurred optic disc margins and dilated, pulsating veins.
ophthalmoscope to slightly oval, well- Papilledema occurs with increased intracranial
view the retina defined margins, pressure from intracranial hemorrhage or a brain
and optic disc of creamy pink with tumor. Optic atrophy occurs with brain tumors
each eye. paler physiologic
cup. Retina is pink
 III. OCULOMOTOR

Cranial Nerve Assessment Normal Response Documentation

Reaction to light: Illuminated and non-illuminated PERRLA (pupils equally round and
pupil should constrict. reactive to light and accommodation)

Reaction to accommodation: Pupils constrict when looking at a PERRLA (pupils equally round and
near object, dilate when looking at a reactive to light and accommodation)
distant object, converge when near
object is moved towards the nose.

ABNORMAL RESPONSE:
o Dilated pupils 6-7mm: oculomotor nerve paralysis
o Argyll Robertson pupils: CNS syphilis, meningitis, brain tumor, alcoholism
o Constricted, fixed pupils: narcotic abuse or damaged to pons
o UNILATERALLY DILATED PUPIL UNRESPONSIVE to light or accommodation: damage to cranial nerve
III (oculomotor)
o CONSTRICTED PUPIL UNRESPONSIVE TO LIGHT OR accommodation: lesions of the sympathetic
nervous system.
IV: TROCHLEAR & VI ABDUCENS

Cranial Nerve Assessment Normal Response Documentation

Hold a penlight 1 ft. in front of the client’s eyes. Ask the client Client’s eyes should be Both eyes are able to move
to follow the movements of the penlight with the eyes only. able to follow the as necessary.
Move the penlight upward, downward, sideward and diagonally. penlight as it moves.
ABNORMAL RESPONSE:
o NYSTAGMUS (RHYTHMIC OSCILLATION OF THE eyes: cerebellar disorders.
o LIMITED EYE MOVEMENT THROUGH THE SIX cardinal fields of gaze: increased intracranial pressure.
PARALYTIC STRABISMUS: paralysis of the oculomotor, trochlear, or abducens nerves
V: TRIGEMINAL

Cranial Nerve Assessment Normal Response Documentation

Test motor function. Ask the client to clench the Temporal and masseter muscles Temporal and masseter
teeth while you palpate the temporal and masseter contract bilaterally. muscles contract bilaterally.
muscles for contraction
ABNORMAL RESPONSE:
o Decreased contraction in one of both sides. Asymmetric strength in moving the jaw may be seen with lesion or
injury of the 5th cranial nerve. Pain occurs with clenching of the teeth.
o Trigeminal neuralgia is sudden, severe facial pain. It's often described as a sharp shooting pain or like having
an electric shock in the jaw, teeth or gums. It usually happens in short, unpredictable attacks that can last from
a few seconds to about 2 minutes. The attacks stop as suddenly as they start
VII: FACIAL
Assessment Technique Normal Response Documentation
Ask client to smile, raise the eyebrows, Client should be able to smile, raise Client performed various facial
frown, and puff out cheeks, close eyes eyebrows, and puff out cheeks and expressions without any difficulty
tightly. Ask client to identify various close eyes without any difficulty. The and able to distinguish varied tastes.
tastes placed on the tip and sides of client should also be able to
tongue. distinguish different tastes.
ABNORMAL RESPONSE:
o Inability to close eyes, wrinkle forehead, or raise forehead along with paralysis of the lower part of the face on
the affected side is seen with Bell’s palsy (a peripheral injury to cranial nerve VII [facial]). Paralysis of the
lower part of the face on the opposite side affected may be seen with a central lesion that affects the upper motor
neurons, such as from stroke.
o Inability to identify correct flavor on anterior two-thirds of the tongue suggests impairment of cranial nerve VII
(facial).
 VIII: VESTIBULOCOCHLEAR

Cranial Nerve Assessment Normal Response Documentation

Test the client’s hearing ability in each ear She/he can hear your whisper
using whisper test Weber test: Vibration heard equally well
and perform the Weber and Rinne tests to in
assess the cochlear (auditory) component of both ears.
cranial nerve VIII Rinne test: AC > BC (air conduction is
twice as long as bone conduction).
Ask the client to walk across the room and The client should have upright posture The client was able to
back and assess the client’s gait. and steady gait and able to maintain stand and walk in an
Perform the Romberg test. This tests the balance. upright position and
client’s equilibrium. Ask the client to stand Client maintains position for 20 seconds able to maintain
with feet together, arms at sides, and eyes without swaying or with minimal balance.
open, then with the eyes closed. swaying.
When performing this test, put your arms
around the client without touching him or her
to prevent falls.
ABNORMAL RESPONSE:
o conductive hearing loss, the client reports lateralization of sound to the poor ear—that is, the client “hears” the
sounds in the poor ear. The good ear is distracted by background noise and conducted air, which the poor ear
has trouble hearing. Thus, The poor ear receives most of the sound conducted by bone vibration. (BC > AC)
o sensorineural hearing loss, the client reports lateralization of sound to the good ear. This is because of limited
perception of the sound due to nerve damage in the bad ear, making sound seem louder in the unaffected ear
(AC > BC)
o Client moves feet apart to prevent falls or starts to fall from loss of balance. This may indicate a vestibular
disorder.
IX-X: GLOSSOPHARYNGEAL& VAGUS
Cranial Nerve Assessment Normal Response Documentation
Test motor function. Client should be able to elicit gag reflex Client was able to elicit
and swallow without any difficulty. gag reflex and able to
swallow without
difficulty.
Elicit gag response. by touching the
posterior pharynx with the tongue
depressor.
Note ability to swallow. by giving the client
a drink of water. Note the quality of voice

ABNORMAL RESPONSE:
o An absent gag reflex may be seen with lesions of cranial nerve IX (glossopharyngeal) or X (vagus).
o Dysphagia or hoarseness may indicate a lesion of cranial nerve IX (glossopharyngeal) or X (vagus) or other
neurologic disorder.
XI: ACCESSORY
Cranial Nerve Assessment Normal Response Documentation

Ask client to shrug shoulders against resistance Client should be able to shrug shoulders Client was able to
from your hands and turn head to side against and turn head from side to side. shrug his shoulders and
resistance from your hand (repeat for other turn his head from one
side) to assess trapezius muscle side to the other.

ABNORMAL RESPONSE:
o Asymmetric muscle contraction or drooping of the shoulder may be seen with paralysis or muscle weakness
due to neck injury or torticollis.
 XII: HYPOGLOSSAL
Cranial Nerve Assessment Normal Response Documentation
Ask client to protrude tongue at The client should be able to move The client was able to move tongue
midline and then move it side to side. tongue without any difficulty. in different directions.
ABNORMAL RESPONSE:
o Fasciculations and atrophy of the tongue may be seen with peripheral nerve disease. Deviation to the affected
side is seen with a unilateral lesion.
3. MOTOR AND CEREBERRAL SYSTEM
A. Assess condition and movement of muscles. Assess the size and symmetry of all muscle groups
NORMAL FINDINGS:
o Muscles are fully developed and symmetric in size (bilateral sides may vary 1 cm from each other).
o OLDER ADULT CONSIDERATIONS: Some older clients may have reduced muscle mass from degeneration
of muscle fibers
ABNORMAL:
o Muscle atrophy may be seen in diseases of the lower motor neurons or muscle disorders
o Injury of the central spinal cord is associated with extremity weakness.
o Loss of motor function, pain and temperature seen in anterior cord syndrome.
o Loss of proprioception seen in posterior cord syndrome. A loss of strength, proprioception, pain and temperature
is seen in Brown-Séquard syndrome
B. Assess the strength and tone of all muscle groups. Note any unusual involuntary movements such as fasciculations,
tics, or tremors.
NORMAL:
o Relaxed muscles contract voluntarily and show mild, smooth resistance to passive movement.
o No fasciculations, tics, or tremors are noted.
o OLDER ADULT CONSIDERATIONS: Some older clients may normally have hand or head tremors or
dyskinesia (repetitive movements of the lips, jaw, or tongue).
ABNORMAL:
o Soft, limp, flaccid muscles are seen with lower motor neuron involvement. Spastic muscle tone is noted with
involvement of the corticospinal motor tract. Rigid muscles that resist passive movement are seen with
abnormalities of the extrapyramidal tract.
o Fasciculation (rapid twitching of resting muscle) seen in lower motor neuron disease or fatigue.
o Tic (twitch of the face, head, or shoulder) from stress or neurologic disorder. Unusual, bizarre face, tongue, jaw,
or lip movements from chronic psychosis or long-term use of psychotropic drugs. Tremors (rhythmic, oscillating
movements) from Parkinson’s disease, cerebellar disease, multiple sclerosis (with movement),
hyperthyroidism, or anxiety.
o Slow, twisting movements in the extremities and face from cerebral palsy.
o Brief, rapid, irregular, jerky movements (at rest) from Huntington’s chorea.
o Slower twisting movements associated with spasticity (athetosis) seen with cerebral palsy.
C. Evaluate gait and balance.
NORMAL: Gait is steady; opposite arm swings.
ABNORMAL: Gait and balance can be affected by disorders of the motor, sensory, vestibular, and cerebellar systems.
Unsteady gait

D. Stand on one foot.

NORMAL: Bends knee while standing on one foot; hops on each foot without losing balance.
ABNORMAL: Inability to stand or hop on one foot is seen with muscle weakness or disease of the cerebellum.

E. Assess coordination. Demonstrate the finger-to-nose test to assess accuracy of movements

NORMAL: Client touches finger to nose with smooth, accurate movements, with little hesitation.
ABNORMAL: Uncoordinated, jerky movements and inability to touch the nose may be seen with cerebellar disease.

F. Assess rapid alternating movements

NORMAL: Client touches each finger to the thumb rapidly.
ABNORMAL: Inability to perform rapid alternating movements may be seen with cerebellar disease, upper motor
neuron weakness, or extrapyramidal disease.
G. Perform the heel-to-shin test. Ask the client to lie down (supine position) and to slide the heel of the right foot
down the left shin. Repeat with the other heel and shin.
NORMAL: Client is able to run each heel smoothly down each shin.
ABNORMAL: Deviation of heel to one side or the other may be seen in cerebellar disease.

4. SENSORY SYSTEM
A. Assess light touch, pain, and temperature sensations.
o To test light touch sensation, use a wisp of cotton to touch the client
o To test pain sensation, use the blunt and sharp ends of a safety pin or paper clip.
o To test temperature sensation, use test tubes filled with hot and cold water.
NORMAL:
o Client correctly identifies light touch. OLDER ADULT CONSIDERATIONS: in some older clients, light touch
and pain sensations may be decreased.
o Client correctly differentiates between dull and sharp sensations and hot and cold temperatures over various
body parts.
ABNORMAL:
o Anesthesia (absence of touch sensation)
o Hypesthesia (decreased sensitivity to touch)
o Hyperesthesia (increased sensitivity to touch)
o Analgesia (absence of pain sensation)
o Hypalgesia (decreased sensitivity to pain)
o Hyperalgesia (increased sensitivity to pain)
B. Test vibratory sensation.
NORMAL: Vibratory sensation at the ankles may decrease after age 70 (Willacy, 2011), but vibration sense is more
likely to be absent at the great toe and preserved at the ankle bones (Gilman, 2002).
ABNORMAL: Inability to sense vibrations may be seen in posterior column disease or peripheral neuropathy (e.g., as
seen with diabetes or chronic alcohol abuse).

C. Test sensitivity to position. If position sense is intact distally, then it is intact proximally.
NORMAL: Client correctly identifies directions of movements.
ABNORMAL: Inability to identify the directions of the movements may be seen in posterior column disease or
peripheral neuropathy (e.g., as seen with diabetes or chronic alcohol abuse).

D. Assess tactile discrimination (fine touch). To test point localization, briefly touch the client and ask the client to
identify the points touched. To test graphesthesia, use a blunt instrument to write a number, such as 2, 3, or 5, on the
palm of the client’s hand. Ask the client to identify the number.
NORMAL: Client correctly identifies object, area touched, number written.
ABNORMAL: Inability to correctly identify objects (astereognosis), area touched, number written in hand; to
discriminate between two points; or identify areas simultaneously touched may be seen in lesions of the sensory cortex.

5. REFLEXES
The reflex (or percussion) hammer is used to elicit deep tendon reflexes. Proceed as follows to elicit a deep tendon
reflex:
Encourage the client to relax because tenseness can inhibit a normal response. Position the client properly. Hold the
handle of the reflex hammer between your thumb and index finger so it swings freely. Palpate the tendon that you will
need to strike to elicit the reflex. Using a rapid wrist movement, briskly strike the tendon. Observe the response. Avoid
a slow or weak movement for striking. Compare the response of one side with the other.
To prevent pain, use the pointed end to strike a small area, and the wider, blunt (flat) end to strike a wider or more tender
area.
• Use a reinforcement technique, which causes other muscles to contract and thus increases reflex activity, to
assist in eliciting a response if no response can be elicited.
• For arm reflexes, ask the client to clench the jaw or to squeeze one thigh with the opposite hand, then
immediately strike the tendon. For leg reflexes, ask the client to lock the fingers of both hands and pull them
against each other, then immediately strike the tendon.
 • Rate and document reflexes using the following scale and figure.
GRADE 4+ Hyperactive, very brisk, rhythmic oscillations (clonus); abnormal and indicative of disorder
GRADE 3+ More brisk or active than normal, but not indicative of a disorder
GRADE 2+ Normal, usual response
GRADE 1+ Decreased, less active than normal
GRADE O NO RESPONSE

A. Test deep tendon reflexes. Position client in a comfortable sitting position. Use the reflex hammer to elicit reflexes
NORMAL: Normal reflex scores range from 1+ (present but decreased) to 2+ (normal) to 3+(increased or brisk, but
not pathologic).
ABNORMAL: Absent or markedly decreased (hyporeflexia) deep tendon reflexes (rated 0) occur when a component
of the lower motor neurons or reflex arc is impaired; this may be seen with spinal cord injuries. Markedly hyperactive
(hyperreflexia) deep tendon reflexes (rated 4+) may be seen with lesions of the upper motor neurons and when the higher
cortical levels are impaired.

B. Test biceps reflex. Ask the client to partially bend arm at elbow with palm up. Place your thumb over the biceps
tendon and strike your thumb with the pointed side of the reflex hammer Repeat on the other side. (This evaluates the
function of spinal levels C5 and C6.)
NORMAL: Elbow flexes and contraction of the biceps muscle is seen or felt. Ranges from 1+ to 3+. Forearm flexes
and supinates. Ranges from 1+ to 3+.
ABNORMAL: No response or an exaggerated response is abnormal.

C. Assess brachioradialis reflex. Ask the client to flex elbow with palm down and hand resting on the abdomen or lap.
Use the flat side of the reflex hammer to tap the tendon at the radius about 2 inches above the wrist Repeat on other side.
(This evaluates the function of spinal levels C5 and C6.)
NORMAL: Elbow extends, triceps contracts. Ranges from 1+ to 3+.
ABNORMAL: No response or an exaggerated response is abnormal.

D. Test triceps reflex. Ask the client to hang the arm freely (“limp, like it is hanging from a clothesline to dry”) while
you support it with your nondominant hand. With the elbow flexed, use the flat side of the reflex hammer to tap the
tendon above the olecranon process Repeat on the other side. This evaluates the function of spinal levels C6, C7, and
C8.
NORMAL: Elbow extends, triceps muscle contracts. Ranges from 1+ to 3+.
ABNORMAL: No response or exaggerated response

E. Assess patellar reflex. Ask the client to let both legs hang freely off the side of the examination table. Using the flat
side of the reflex hammer, tap the patellar tendon, which is located just below the patella. Repeat on the other side. For
the client who cannot sit up, gently flex the knee and strike the patella. This evaluates the function of spinal levels L2,
L3, and L4
NORMAL: Normal response is plantarflexion of the foot. Ranges from 1+ to 3+.
ABNORMAL: No response or an exaggerated response is abnormal.

F. Test Achilles reflex. With the client’s leg still hanging freely, dorsiflex the foot. Tap the Achilles tendon with the flat
side of the reflex hammer. Repeat on the other side. For assessing the reflex in the client who cannot sit up, have the
client flex one knee and support that leg against the other leg. Dorsiflex the foot and tap the tendon using the flat side
of the reflex hammer. This evaluates the function of spinal levels S1 and S2.
NORMAL: Normal response is plantarflexion of the foot. Ranges from 1+ to 3
ABNORMAL: No response or an exaggerated response is abnormal.

G. Test ankle clonus when the other reflexes tested have been hyperactive. Place one hand under the knee to support
the leg, then briskly dorsiflex the foot toward the client’s head. Repeat on the other side.
NORMAL: No rapid contractions or oscillations (clonus) of the ankle are elicited.
ABNORMAL: Repeated rapid contractions or oscillations of the ankle and calf muscle are seen with
lesions of the upper motor neurons.
H. Assess plantar reflex. Use the handle end of the reflex hammer to elicit superficial reflexes, whose receptors are in
the skin rather than the muscles. With the end of the reflex hammer, stroke the lateral aspect of the sole from the heel to
the ball of the foot, curving medially across the ball. Repeat on the other side. This evaluates the function of spinal levels
L4, L5, S1, and S2.
NORMAL: Flexion of the toes occurs
ABNORMAL: The toes will fan out for abnormal (positive Babinski response). Except in infancy, extension
(dorsiflexion) of the big toe and fanning of all toes (positive Babinski response) are seen with lesions of upper motor
neurons. Unconscious states resulting from drug and alcohol intoxication, brain injury, or subsequent to an epileptic
seizure may also cause it.

I. Test abdominal reflex. Lightly stroke the abdomen on each side, above and below the umbilicus. This evaluates the
function of spinal levels T8, T9, and T10 with the upper abdominal reflex and spinal levels T10, T11, and T12 with the
lower abdominal reflex.
NORMAL: Abdominal muscles contract; the umbilicus deviates toward the side being stimulated. The abdominal reflex
may be concealed because of obesity or muscular stretching from pregnancies. This is not an abnormality.
ABNORMAL: Superficial reflexes may be absent with lower or upper motor neuron lesions.

J. Test cremasteric reflex in male clients. Lightly stroke the inner aspect of the upper thigh. This evaluates the function
of spinal levels T12, L1, and L2.
NORMAL: Scrotum elevates on stimulated side.
ABNORMAL: Absence of reflex may indicate motor neuron disorder.

6. TESTS FOR MENINGEAL IRRITATION OR INFLAMMATION

✓ If you suspect that the client has meningeal irritation or inflammation from infection or subarachnoid
hemorrhage, assess the client’s neck mobility. First, make sure that there is no injury to the cervical vertebrae
or cervical cord. Then, with the client supine, place your hands behind the patient’s head and flex the neck
forward until the chin touches the chest if possible.
A. Test for Brudzinski’s sign. As you flex the neck, watch the hips and knees in reaction to your maneuver. Test for
Kernig’s sign. Flex the client’s leg at both the hip and the knee, then straighten the knee.
NORMAL: Hips and knees remain relaxed and motion-less. No pain is felt. Discomfort behind the knee during full
extension occurs in many normal people.
ABNORMAL: Pain and flexion of the hips and knees are positive Brudzinski’s signs, suggesting meningeal
inflammation. Pain and increased resistance to extending the knee are a positive Kernig’s sign. When Kernig’s sign is
bilateral, the examiner suspects meningeal irritation.

• ASSESSMENT
• VALIDATE AND DOCUMENTING FINDINGS
CLINICAL TIP: When documenting your assessment findings, it is better to describe the client’s response than
to label the behavior.

• Nursing Diagnosis
❑ Health Promotion Diagnoses
• READINESS FOR ENHANCED COMMUNICATION
• READINESS FOR ENHANCED SPIRITUAL WELL-BEING
❑ Risk Diagnoses
• RISK FOR INJURY RELATED TO DISTURBED SENSORY-PERCEPTUAL PATTERNS
• RISK FOR ASPIRATION RELATED TO IMPAIRED GAG REFLEX
• RISK FOR SELF-DIRECTED 6VOLENCE, RELATED TO DEPRESSION, SUICIDAL TENDENCIES,
DEVELOPMENTAL CRISIS, LACK OF SUPPORT SYSTEMS, LOSS OF SIGNIFICANT OTHERS, POOR
COPING MECHANISMS AND BEHAVIORS
❑ Actual Diagnoses
• IMPAIRED VERBAL COMMUNICATION RELATED TO APHASIA, PSYCHOLOGICAL IMPAIRMENT,
OR ORGANIC BRAIN DISORDER
• ACUTE OR CHRONIC CONFUSION RELATED TO DEMENTIA, HEAD INJURY, STROKE, OR
ALCOHOL OR DRUG ABUSE
• IMPAIRED MEMORY RELATED TO DEMENTIA, STROKE, HEAD INJURY, OR ALCOHOL OR DRUG
ABUSE
• INEFFECTIVE IMPULSE CONTROL RELATED TO SUBSTANCE ABUSE, CO-DEPENDENCY,
DEVELOPMENTAL DISORDER, OR ORGANIC BRAIN DISORDERS
• IMPAIRED SWALLOWING RELATED TO ABSENT GAG REFLEX OR DECREASED MUSCLE
STRENGTH FOR MASTICATION, OR FACIAL PARALYSIS

❑ SELECTED COLLABORATIVE PROBLEMS

• RC: INCREASED INTRACRANIAL PRESSURE
• RC: STROKE
• RC: SEIZURES
• RC: SPINAL CORD COMPRESSION
• RC: MENINGITIS
• RC: CRANIAL NERVE IMPAIRMENT
• RC: PARALYSIS
• RC: PERIPHERAL NERVE IMPAIRMENT
• RC: INCREASED INTRAOCULAR PRESSURE
❑ REFER TO PRIMARY CARE PROVIDER