Neurological Question #10
The nurse is performing an assessment on a client with an intracranial hematoma. Which assessment finding is most important?
- Increased muscular pain, especially during sleep.
- Cogwheel rigidity.
- Tingling to extremities and inability to ambulate.
- Hamstring and spinal pain when the hip and knee is flexed then extended.
Hamstring pain when the hip and knee is flexed then extended is an example of positive Kernig’s sign and may occur with intracranial hematomas. In Kernig’s, the client is supine and when examiner passively straightens the leg at the knee (after flexion to 90 degrees), the client may experience pain along the spine which prevents or limits passive extension of the knee. Pain associated with intracranial bleeding is not isolated to nighttime only. If present, it may indicate increased pressure and may be severe and persistent. Cogwheel rigidity (answer B) is found in clients with Parkinson’s characterized by muscular rigidity in which passive movements of the limbs elicit ratchet-like start-and-stop movements through range of motion of joints.