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TABLE 1. AN OUTLINE OF THE
NEUROLOGICAL EXAMINATION
General Exam:
Neurological Exam:
Mental
Status Testing
Cranial
Nerves
Motor Function
Reflexes
Sensation
Coordination
Gait
Aspects of the General Exam
Measure pulse and blood pressure, supine and standing
Neck: listen for bruits; define range of movements; palpate
for tenderness
Head; note tilt or turn; measure circumference (infants);
note symmetry; palpate for tenderness and masses, listen for bruits
Back: note spinal curvatures; palpate and percuss for
tenderness; determine mobility
Mental Status Testing
Determine level of education; present and previous
employment
Alertness and attention
Orientation
Language
Memory: short-term, long-term, and fund of general knowledge
Calculations
Spatial perception
Reasoning
Cranial Nerves
CN I Smell coffee or vanilla
CN II
Visual acuity
Visual fields
Optic fundi
CN III, CN IV, CN VI
Range of movement and alignment of the visual axes
Fixation, saccades, smooth-pursuit, vestibulo-ocular reflex,
vergence
Pupils
Lids
CN V
Sensory testing of all 3 divisions
Corneal reflex
Muscles of mastication
Jaw jerk
CN VII
Facial symmetry and strength
Taste over anterior 2/3 tongue
CN VIII
Sensory threshold (compared with examiner)
Air conduction vs. bone conduction
Weber lateralization test
Vestibulo-ocular reflex
Vestibulospinal tests
CN IX, CN X
Phonation and enunciation
Symmetry of palate elevation
Gag reflex
CN XI
Sternomastoid and trapezius muscles: bulk and strength
CN XII
Tongue bulk, strength, adventitious movements
Motor Function
Pronator drift
Forearm-rolling test
Bulk
Tone
Power
Adventitious and abnormal movements
Reflexes
Muscle Stretch
Reflexes
Upper limbs: Biceps, triceps, supinator, finger jerks
Lower limbs: Patellar, ankle jerks
0 = absent
1+ = hypoactive
2+ = normal
3+ = hyperactive
4+ = hyperactive with clonus
Plantar responses (Babinski)
Also test Hoffmann's sign, grasp, snout, and palmomental
reflexes.
Sensation
Elementary Modalities:
Pain
Light touch
Vibration
Joint position sense
Thermal Sense
Discriminative Modalities:
Two point discrimination
Stereognosis
Graphesthesia
Baresthesia
Double simultaneous stimulation
Coordination
Finger to nose
Heel to shin
Rapid alternating movements
Finger and foot tapping
Gait
Stance
Arm swing
Size of
stride
Turning
Stability
Tandem gait
Heel and
toe walking
For a comprehensive discussion of the
neurologic exam,
click this link
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