NERVOUS SYSTEM

The nervous system is the part of the organism that is responsible for directing the motor elements and interpreting the senses in order to function properly. Through the nervous system, we can relate to the environment around us. It is divided into central and peripheral. The former consists of the brain and spinal cord and the latter of all the nerves and neurological cells in the body. As it plays such an important role, diseases involving the nervous system manifest themselves with very noticeable symptoms, whether they are involuntary movements or loss of muscle strength. When a person complains of some discomfort involving motor or sensory deficits, we must be vigilant as these may be some of the conditions affecting this system.

WHAT DAMAGES THE NERVOUS SYSTEM?

Conditions related to the nervous system can be traumatic, infectious, or degenerative. Traumatic injuries are quite frequent, and their consequences may be reversible in many cases but will depend on the type and mechanism of the injury. Infectious diseases can be bacterial, viral, or fungal; bacterial diseases affect children more frequently. The degenerative causes are chronic diseases, such as Alzheimer’s, Parkinson’s disease, and multiple sclerosis, which all evolve over time.

EVALUATION OF THE NERVOUS SYSTEM: HOW DO I KNOW IF THE PATIENT IS OKAY?

The physical examination involving the nervous system is one of the most fun and logical in the field of medicine. There are no tricks or ambiguities; everything is quite clear because each nerve controls a specific part of the body, and each area if the brain has specific functions. The examination of the nervous system begins, as always, with questioning. This is followed by a physical examination, which in this case involves muscle-tendon reflexes, sensitivity, and muscle strength. By simply talking to the person, we are already assessing the brain areas and their temporal and spatial orientation. Questions such as “What day is it?”, “What year is it?”, or “What is your full name?” tell us if the patient has any level of amnesia or confusion. Muscle strength is assessed by asking the patient to squeeze your hands simultaneously with full force. Lower limb strength is also tested with the patient sitting up and pushing up while you try to lower the leg. In medicine, when we examine paired organs, it’s all about comparison. The sensitivity of the skin is examined with a sharp element and a soft one (it can be a needle and a cotton ball); that way we can know if the person has lost sensitivity and to what degree.

Gadogado123, Own work, CC BY-SA 4.0

There are conditions in which the cotton ball cannot be felt but the needle stick can be felt. These changes have different interpretations. You have to be meticulous. There are professional tools, such as the neurological hammer, that come with some items to evaluate sensitivity.

With the hammer, which is actually a strong rubber mallet, you can evaluate the skin muscle reflexes. The easiest one is the knee, or patellar, reflex, and it helps us to see the proper functioning of the communication between the brain and the muscles. With the patient seated, take his or her leg behind the knee and strike the ligament between the knee and the leg with the hammer. This forces the person you are examining to kick involuntarily. My idea is not to teach you a professional neurological exam but to show you the basics so that you can make a diagnostic approach and understand how serious the situation is that you are facing.

Ali Raheem, Own work, CC BY-SA 3.0