Assessing the nervous system requires a structured approach to interpret clinical signs accurately. Nurses must correlate patient complaints with underlying anatomical structures. Symptomatology often points directly to localized brain, spinal cord, or peripheral nerve pathology. A thorough baseline assessment guides future evaluations and detects rapid clinical deterioration.
Consciousness relies on the intact functioning of the cerebral hemispheres and the reticular activating system. Disruptions manifest across a continuum from mild confusion to deep coma.
Motor pathways control voluntary muscle movement through upper and lower motor neurons. Damage anywhere along this pathway alters muscle tone and strength.
Sensory pathways transmit tactile, thermal, and nociceptive signals to the somatosensory cortex. Lesions in these pathways distort perception.
The twelve cranial nerves manage special senses, facial movements, and parasympathetic functions. Dysfunction reveals precise locations of brainstem or neural compression. Pupillary changes, such as unilateral dilation sluggish to light, signal dangerous oculomotor nerve compromise. Visual field cuts point toward optic tract or occipital lobe lesions.
Smooth, purposeful movement requires the integration of the cerebellum, basal ganglia, and vestibular systems. Cerebellar dysfunction manifests as ataxia, an unsteady, uncoordinated gait resembling that of an intoxicated person. Tremors during intentional movement also point to cerebellar disorders, whereas resting tremors suggest basal ganglia pathology.
The skull is a rigid box containing brain tissue, blood, and cerebrospinal fluid. An increase in any of these components raises intracranial pressure. Early signs include subtle behavioral changes and headache. Late signs include Cushing's triad: widening pulse pressure, bradycardia, and irregular respirations.
Autonomic instability results from hypothalamic or brainstem dysfunction, leading to erratic blood pressure, sweating abnormalities, and body temperature fluctuations. Seizures represent uncontrolled electrical discharges in the brain. They range from generalized tonic-clonic activity with loss of consciousness to focal seizures causing localized sensory or motor symptoms.