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Neurologic Examination

This guide provides step-by-step instructions for conducting a thorough neurologic examination. It covers mental status assessment, evaluation of cranial nerves, motor function, reflexes, sensory testing, coordination, and gait assessment, including special tests. The guide also includes detailed instructions on testing cranial nerves I to XII and provides insights into motor strength assessment, reflex testing, sensory evaluation, and coordination and gait examinations. ####

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Neurologic Examination

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  1. Neurologic Examination Kefah Al-Hayek, MD Assistant Prof. of Neurology J.U.S.T ABPN, ABCNP, ABEM, ABNM

  2. Equipment Needed • Reflex Hammer • 128 and 512 (or 1024) Hz Tuning Forks • A Snellen Eye Chart or Pocket Vision Card • Pen Light or Otoscope • Wooden Handled Cotton Swabs • Paper Clips

  3. Neurologic Examination • Mental Status • Cranial Nerves • Motor • Reflexes • Sensory • Coordination and Gait • Special Tests

  4. Aphasia

  5. Cranial Nerves • I – Olfactory • Not Normally Tested • Suspected mass • c/o smell

  6. II - Optic • Optic Fundi • Visual Acuity • Visual Fields • Pupillary test • Light • accomodation

  7. III – Oculomotor, IV – Trochlear, VI - Abducens • Observe for Ptosis • Test Extraocular Movements

  8. V - Trigeminal Sensation Mastication Corneal reflex Jaw gerk

  9. VII - Facial • Observe for Any Facial Droop or Asymmetry • Ask Patient to do the following, note any lag, weakness, or assymetry: • Raise eyebrows [8] • Close both eyes to resistance • Smile • Frown • Show teeth • Puff out cheeks • UMN Vs LMN

  10. VIII - Acoustic • Screen Hearing • Lateralization (Weber( • Compare Air and Bone Conduction (Rinne) • Vestibular Function • Not Normally Tested

  11. IX – Glossopharyngeal • Afferent pathway for the gag reflex • X – Vagus • Efferent pathway for the gag reflex • Ask Patient to Swallow • Ask Patient to Say "Ah" • XI – Accessory • Shrug shoulders against resistance • Turn head against resistance

  12. XII - Hypoglossal • Observe the tongue as it lies in the mouth • Ask patient to: • Protrude tongue • Move tongue from side to side

  13. Motor • Observation • Involuntary Movements • Muscle Symmetry • Atrophy • Muscle Tone • Decreased (flaccid) or increased (rigid/spastic) tone

  14. Muscle Strength

  15. Reflexes • Deep Tendon Reflexes

  16. Deep Tendon Reflexes • Biceps (C5, C6) • Brachioradialis (C5, C6) • Triceps (C6, C7) • Knee (L2, L3, L4( • Ankle (S1, S2)

  17. Plantar Response (Babinski)

  18. Sensory • Pain & Temp • Vibration & position • Light Touch • Cortical sensory • Graphesthesia • Stereognosis • Two Point Discrimination

  19. Coordination • Rapid Alternating Movements • Point-to-Point Movements • F-N-F • H-K-S

  20. Romberg • Sensory ataxia • Gait • Walk across the room, turn and come back • Walk heel-to-toe in a straight line • Walk on their toes in a straight line • Walk on their heels in a straight line

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