Neurological examination
TweetFive-part short neurological examination
- General demeanour
- Speech
- Gait
- Arm swinging
Part II neurological examination - Fundi
- Pupils
- Eye movements
- Facial movements
Tongue
Part III neurological examination - Posture of outstretched arms
- Wasting, fasciculation
- Power, tone
- Coordination
- Reflexes
Part IV neurological examination - Power (hip flexion, ankle dorsiflexion)
- Tone
- Reflexes
- Plantar responses
Part V neurological examination - Ask the patient
Part I neurological examination
- Look at the patient
- Examine the head
- Examine the upper limbs
- Examine the lower limbs
- Assess sensation
The relevant findings are drawn together in a brief written diagnostic summary. This will form the basis for investigations, transfer of information, and management.
Ten-part neurological examination
- Orientation in time and place, recall of recent and distant events (memory, level of intellect, language and speech/cerebral dominance, other disorders of skilled function, e.g. apraxia)
Upper limbs: - Wasting and fasciculation
- Posture of arms: drift, rebound, tremor
- Tone: spasticity or extrapyramidal rigidity
- Power: 0-5 scale
- Tendon reflexes: + or ++ normal; +++ increased:
- 0 absent with reinforcement
Thorax and abdomen: - Respiration
- Thoracic and abdominal muscles
- Abdominal reflexes
- Cremasteric reflexes
Lower limbs: - Wasting and fasciculation
- Tone, power and tendon reflexes
- Plantar responses
First, ask whether feeling in the limbs, face and trunk is entirely normal
-
Posterior columns:
- Vibration (using a 128 Hz tuning fork)
- Joint position
- Light touch
- 2-point discrimination (normal: 0.5 cm fingertips, 2 cm soles)
Spinothalamic tracts: - Pain: use a split orange-stick or a sterile pin
- Temperature: hot or cold tubes
If sensation is abnormal, chart areas involved
- State of consciousness, arousal, appearance (e.g. coma)
- Mental state, attitude, insight
- Cognitive function
- Gait and Romberg's test
- Skull shape- circumference, bruits
- Neck- stiffness, palpation and auscultation of carotid arteries
- Cranial nerves
- Motor system
- Coordination and fine movements
- Sensory system
Sometimes crying or laughing
are the only options left,
and laughing feels better right now.
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