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Comprehensive Neuro Exam Guide for Healthcare Professionals

A detailed guide on conducting and documenting a thorough neuro exam, covering mental status, language, cranial nerves, motor function, reflexes, sensory perception, cerebellar assessment, gait analysis, and essential tips for a neuro rotation. Learn how to assess and report various components effectively.

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Comprehensive Neuro Exam Guide for Healthcare Professionals

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  1. The Neuro Exam Yes, you really do have to wake them up and do this Last Updated by Lindsay Pagano Summer 2013

  2. What are the components and how do I document them? Neuro: • Mental Status • Language, Speech • Cranial Nerves • Motor • Reflexes • Sensory • Cerebellar • Gait

  3. What are we checking and how? Mental Status • What? • Level of alertness, awareness • Degree of interaction • Orientation • Following commands • Older children: naming objects, simple calculations, extinction, neglect, fund of knowledge • Difference from baseline • How?

  4. Language, Speech • Language • comprehension • spontaneous, fluent • appropriate content • other things you can check: repetition, naming objects, reading, writing • Speech • prosody • volume • rate • dysarthria

  5. Cranial Nerves • CN 1: Olfactory…yeah, we don’t check that either • CN 2: Optic • Visual acuity • Visual fields • Fundus • CN 3: Oculomotor • Pupil reactivity to light (direct and consensual) and accomadation • Extraocular eye movements (superior, medial and inferior recti; inferior oblique) • CN 4: Trochlear • Extraocular eye movements (superior oblique) • CN 5: Trigeminal • Muscles of mastication • Facial sensation (V1, 2, 3 divisions) • CN 6: Abducens • Extraocular eye movements (lateral rectus)

  6. Cranial Nerves, continued • CN 7: Facial • Facial muscles • Taste (anterior 2/3) • CN 8: Vestibulocochlear • Hearing • Vestibular function • CN 9: Glossopharyngeal • Taste (posterior 1/3) • Uvula • CN 10: Vagus • Phonation • Palate elevation • CN 11: Spinal accessory • Head turn • Shoulder shrug • CN 12: Hypoglossal • Tongue protrusion

  7. Motor • Tone • Muscle bulk • Strength: check agonist/antagonist pairs • Grading system • 0: no movement • 1: can see muscle contraction but no movement • 2: can move with gravity eliminated • 3: can move against gravity • 4: can resist opposition to some extent, but not full (+, - also) • 5: full strength • Pronator drift: correct position! • Orbiting • Abnormal movements

  8. Reflexes • Grading system • 0: absent • 1+: hyporeflexic • 2+: normal • 3+: brisk, without clonus • 4+: brisk, with clonus • More pathologic descriptors: crossed, spreading • Where to check • Clonus • Sustained • Unsustained • Other reflexes: pectoral, grasp, suck, moro, jaw jerk • Plantar response

  9. Sensory • How and what part of the nervous system are we checking? • Light touch • Pinprick • Temperature • Vibration • Joint position sense • Checking a level • Romberg- correct positioning!

  10. Cerebellar • Ataxia • Axial • Appendicular • Finger-nose-finger • Heel-knee-shin • Rapid alternating movements

  11. Gait • Casual • Toe • Heel • Tandem • What are those last 3 testing?

  12. Other Neuro Rotation Tips • Neuro exam on all patients • Report all AEDs in per dose and mg/kg/day • Know the patients primary neurologist • When applicable know the last head imaging and EEG done and the results • Make sure after their inpatient stay they have follow up and a breakthrough seizures plan/medication • In clinic, be sure to ask birth history, developmental history (gross motor, fine motor, language, social), about school performance, therapies

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