An injury to the head such as a concussion requires a full neurological assessment. Such assessment is necessary to determine the extent of the injury. Once the assessment is complete and a diagnosis is made, the condition of the patient needs to be monitored by neuro checks. These checks provide a means of evaluating a patient's ongoing status, generally over the first 24 hours.
Frequency and Duration
The frequency of neuro exams depend upon the initial assessment. Normally the treating physician establishes a schedule based upon the initial findings The schedule will also indicate particular areas of concern. For example, a patient with a grade 3 concussion, meaning loss of consciousness, needs neuro checks for at least the first 24 hours. A neuro check that uncovers a substantial change in condition may dictate a change to the frequency and duration.
The initial assessment determines the level of consciousness (LOC). The levels range from full consciousness to a coma. For neuro checks, the purpose is to compare the current level with the initial level to determine if the patient is progressing, regressing or holding his own. Check mental condition and patterns of speech, if the patient is able to communicate. The ability to speak clearly is a good indicator for a neuro check.
Every neuro check involves an assessment of the patient's ability to move. Movement also includes an evaluation of strength. Once again the neuro check is comparing the patient's ability at the initial assessment to the current condition. Watch for any decrease in strength or lack of mobility. Observe the patient walk if able to spot any balance problems. Any abnormal behavior requires notifying the treating physician.
An eye examination that focuses upon the pupils is part of a neuro check. The initial assessment should have noted the patient's ability to see, visual field and the reaction to light as measured by the pupils. Neuro checks follow up on the pupils' reactions to light to determine any change in condition, as well as confirming no change in the ability to see.