NEUROLOGICAL EXAM

Medical Skills Club 2013-2014

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Mental status
Cranial nerves
Cerebellar function
Peripheral sensory function
Cortical sensory function
Reflexes

Test for mental status, symmetry, abnormalities (either CNS or PNS)

1. Observe level of alertness, speech, language, orientation to date and place, conduct and judgement.
2. Evaluate the following Cranial Nerves
Acronym: On, On, On, They Traveled And Found Voldemort Guarding Very Ancient Horcruxes
I (olfactory)test sense of smell. Present familiar and non-irritating odours. Test both nostrils.
II (optic)test visual acuity, visual fields on confrontation, pupils & near response, optic fundis
III (oculomotor), IV (trochlear), VI (abducens) test extra-ocular movement (6 cardinal
directions); look for involuntary eye jerking, drooping of eyelids
V (trigeminal) sensory: test for pain/light touch/temperature on forehead, cheek, jaw
Motor: ask patient to clench teeth & palpate temporal & masseter muscles; move jaw side to side
VII (facial) ask patient to: raise eyebrows, frown, smile, puff out cheeks, shut eyes while you
try to open them
VIII (vestibulococchlear) test hearing with whispered voice
IX (glossopharyngeal), X (vagus)ask patient to say ah and look for rising of soft palate and
pharynx; is voice hoarse/nasaly? Any difficulty swallowing?
XI (spinal accessory) ask patient to shrug both shoulders & turn their head against your hands
XII (hypoglossal) listen for articulation, ask patient to stick tongue out straight, move side to side
3. Test Cerebellar Motor function
Body position, involuntary movements (tremors, tics, fasciculations)
Coordination:
Gait tandem walking (heel to toe in straight line)
Rapid alternating movements (tap thumb joint, hand slap thigh)
Point to point: finger-nose & finger-finger test; slide heel along shin eyes open, then closed
Pronator drift: ask patient to stand for 20-30 sec with arms forward, palms up, eyes closed; look
for side/upward drift
4. Test Peripheral Sensory function
Pain sharp or dull
Temperature hot or cold
Light touch when is sensation felt
Vibration test distal interpharyngeal joints; place your finger beneath their joint
Proprioception grasp sides of toe and move up or down
If sensory is impaired distally, move more proximal to determine extent of impairment

NEUROLOGICAL EXAM
Medical Skills Club 2013-2014
5. Test Cortical Sensory function
Discriminative senses:
- Stereognosis (object identification)
- Graphesthesia (number identification)
- Localization (ask patient to point to where you touched them)
- Two point discrimination
6. Test deep tendon/plantar reflexesbicep, brachioradialis, triceps, knee, ankle
Associated roots:
Biceps: C5/6, musculocutaneous nerve five, six, pick up sticks
Brachioradialis: C5/6, radial nerve five, six, pick up sticks
Triceps: C7/8, radial nerve seven, eight, lay them straight
Knee (Patellar): L3/4, femoral nerve three, four, shut the door
Ankle (Achilles): S1, tibial division of the sciatic nerve
Grade the reflexes: 0-4
0 = no response; always abnormal
1+ = a slight but definitely present response; may or may not be normal
2+ = a brisk response; normal
3+ = a very brisk response; may or may not be normal
4+ = a tap elicits a repeating reflex (clonus); always abnormal
EXTRAS

Corneal reflex for cranial nerve V (trigeminal) dont usually do this

If hearing loss: use Rinne (air & bone conduction), Weber (lateralization) tests
Gag reflex for cranial nerves IX & X dont usually do this
Plantar (Babinskis) reflex: not a deep tendon reflex
If toes splay above the age of 2 => upper motor neuron defect