OUTLINE OF A SCREENING NEUROLOGIC EXAMINATION
Performing this examination should take no more than 5 minutes when you are familiar with it. Note that this is sufficient only for screening; additional examination of specific regions or with specific tests is usually indicated if a specific neurologic condition is suspected.
There is no rigidly standardized order in which to perform the neurologic examination. However, while learning it, it is most useful to perform it in a consistent logical manner. It is generally considered to contain the five parts listed below. To avoid getting confused or forgetting portions, complete one part before going on to the next; complete the mental status first, then cranial nerves, then motor, then sensory, then coordination. Use the hints in parentheses to help organize each portion.
Mental Status:
(this may be sufficiently examined while taking the history from the patient)
orientation, memory, speech, praxis
Cranial Nerves:
(start at the top of the face with the eyes and work to the bottom or you may go numerically by cranial nerve number; starting with II)
extraocular muscles (EOM), visual fields (VF), pupils, fundus
facial symmetry, strength and sensation
tongue and palate symmetry and strength
sternocleidomastoid strength
Motor:
(work from proximal to distal or both arms then both legs)
bulk, tone and strength in arms and legs
deep tendon reflexes (DTRs)
pathologic reflexes (Babinski)
Sensory:
(test at least one area in each limb)
at least one of the following to test spinothalamic pathway-
temperature, pin prick, light touch
at least one of the following to test dorsal column pathway-
vibration, proprioception
Coordination:
upper extremity - finger to nose, rapid alternating movements
lower extremity - heel-to-knee-to-shin, parallel and heel-to-toe gait