NEUROLOGICAL EXAMINATION

 

  • Mental Status

    • Level of consciousness
    • Orientation (person, place, time, situation)
    • Affect and mood
    • Behavior
    • Attitude
    • Language (Naming, Fluency, Comprehension, Reading, Writing)
    • Memory (e.g. 3 words)
    • Attention (e.g. D-L-R-O-W, serial 7's)

 

  • Cranial nerves

    • CN 2

      • Acuity (Snellen card)
      • Visual fields
      • Fundoscopic
      • Pupils (below)
      • Swinging flashlight

    • CN3

      • Pupils

        • size/shape
        • direct and indirect light response
      • ptosis
      • medial rectus, inferior oblique, superior rectus, inferior rectus

    • CN4

      • Superior oblique

    • CN5

      • Muscles of mastication
      • Facial sensation

    • CN6

      • Lateral rectus

    • CN7

      • Facial motor power (upper and lower face)

    • CN8

      • Hearing
      • Weber, Rinne

    • CN9/10

      • Palate elevation
      • Gag

    • CN11

      • Head turn, shoulder shrug

    • CN12

      • Tongue protrusion

 

  • Motor

    • Bulk

    • Power

      • Rating

        • 5 = patient can maintain full power against resistance
        • 4 = patient cannot fully overcome examiner's resistance
        • 3 = patient cannot overcome any of examiner's reistance
        • 2 = patient cannot overcome gravity
        • 1 = trace, flicker of movement
        • 0 = no movement
      • Compare right and left, proximal and distal arm and leg
    • Drift
    • Tone
    • Speed of movement
    • Abnormal movements

    • Frontal release signs

      • Myerson's sign
      • Snout
      • Grasp response

 

  • Sensation

    • Primary modalities (Compare right and left, proximal and distal arm and leg, body)

      • Temperature
      • "Pinprick"
      • Position
      • Vibration

    • Other

      • Stereognosis
      • Graphesthesia
      • Extinction
      • Romberg

 

  • Reflexes

    • Deep tendon reflexes

      • Rating system

        • ++++ ("4+") = clonus
        • +++ ("3+") = pathologic spread, pathologically brisk
        • ++ ("2+") = normal
        • + ("1+") = present but hypoactive
        • 0 = absent
      • biceps
      • triceps
      • brachioradialis
      • patella
      • ankle
    • Plantar (e.g. Babinski maneuver)

 

  • Coordination

    • Finger-to-noise
    • Heel-to-shin
    • Rapid alternating movements

 

  • Gait

    • Station
    • Base
    • Stride
    • Arm swing
    • Turning
    • Tandem
    • Heel walking
    • Toe walking