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Neurological examination

     

Five-part short neurological examination


    Part I 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
  1. Look at the patient
  2. Examine the head
  3. Examine the upper limbs
  4. Examine the lower limbs
  5. 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

  1. State of consciousness, arousal, appearance (e.g. coma)
  2. Mental state, attitude, insight
  3. Cognitive function
  4. Gait and Romberg's test
  5. Skull shape- circumference, bruits
  6. Neck- stiffness, palpation and auscultation of carotid arteries
  7. Cranial nerves
  8. Motor system
  9. Coordination and fine movements
  10. Sensory system


Sometimes crying or laughing
are the only options left,
and laughing feels better right now.




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