Interactive Guide to Physical Examination
Neurological

The Neurologic Exam

Objectives:

After completing this module the student should be able to describe:

  • Relevant neuroanatomy.
  • The component parts of the neurologic exam.
  • Examination techniques used to assess cranial nerve function.
  • Examination techniques used to assess motor function.
  • Examination techniques used to assess sensory function.
  • Examination techniques used to elicit and evaluate reflexes.
  • Examination techniques used to evaluate mental status.

Module navigation:

Ideally, the student should progress through the module by using the menu of options on the side. Additional cues to access the glossary, video clips, or interactive portions of the module can be found within the text.

Equipment needed:

  • Ophthalmoscope
  • Penlight or other light source
  • Tongue blade
  • 256 Hz and 512 Hz tuning forks
  • Reflex hammer
  • Cotton tipped wooden swab
  • Disposable sharp object such as safety pin, or sharp wooden stick

General approach:

The neurologic exam is complex and therefore can be intimidating for students. Learning the basic skills needed to uncover the signs of neurologic disease will help students feel more comfortable with this portion of the physical exam. The detail of the neurologic exam may vary extensively, and depends upon the patient's symptoms, cooperation, level of consciousness and concurrent illnesses. This module will review examination techniques needed for a fairly thorough exam.

Neurologic assessment can be broken down into five categories: mental status and speech, cranial nerves, the motor system, the sensory system and reflexes. It may not be necessary to perform all portions of the exam on each patient. In fact, in many healthy patients your neurologic exam may be quite abbreviated. Remember to use the patient as his/her own control, comparing right and left sided findings. If an abnormality is found, determine if the lesion is in the central or peripheral nervous system.

The exam itself can be integrated with other portions of the exam in a "regional" approach (assessing cranial nerves during the head and neck examination for example), or may proceed in a "top-down" fashion (starting with mental status and moving down the body). Lastly, keep in mind that in some rapidly evolving diseases, exam findings can dramatically change in a short period of time. Therefore, repeating your exam may be necessary and provide important new information.