Neurologic Examination Kefah Al-Hayek, MD Assistant Prof. of Neurology J.U.S.T ABPN, ABCNP, ABEM, ABNM
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
Neurologic Examination Mental Status Cranial Nerves Motor Reflexes Sensory Coordination and Gait Special Tests
Aphasia Repetition Comprehension Fluency - + Motor Sensory Conductive Global
Cranial Nerves I – Olfactory Not Normally Tested Suspected mass c/o smell
II - Optic Optic Fundi Visual Acuity Visual Fields Pupillary test Light accomodation
III – Oculomotor, IV – Trochlear, VI - Abducens Observe for Ptosis Test Extraocular Movements
Sensation Mastication Corneal reflex Jaw gerk V - Trigeminal Sensation Mastication Corneal reflex Jaw gerk
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
VIII - Acoustic Screen Hearing Lateralization (Weber( Compare Air and Bone Conduction (Rinne) Vestibular Function Not Normally Tested
IX – Glossopharyngeal X – Vagus XI – Accessory 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
XII - Hypoglossal Observe the tongue as it lies in the mouth Ask patient to: Protrude tongue Move tongue from side to side
Motor Observation Muscle Tone Involuntary Movements Muscle Symmetry Atrophy Muscle Tone Decreased (flaccid) or increased (rigid/spastic) tone
Muscle Strength Description Grade No muscle movement 0/5 Visible muscle movement, but no movement at the joint 1/5 Movement at the joint, but not against gravity 2/5 Movement against gravity, but not against added resistance 3/5 Movement against resistance, but less than normal 4/5 Normal strength 5/5
Reflexes Deep Tendon Reflexes Tendon Reflex Grading Scale Description Grade Absent Hypoactive 1+ or + "Normal" 2+ or ++ Hyperactive without clonus (spread) 3+ or +++ Hyperactive with clonus 4+ or ++++
Deep Tendon Reflexes Biceps (C5, C6) Brachioradialis (C5, C6) Triceps (C6, C7) Knee (L2, L3, L4( Ankle (S1, S2)
Plantar Response (Babinski)
Sensory Pain & Temp Vibration & position Light Touch Cortical sensory Graphesthesia Stereognosis Two Point Discrimination
Coordination Rapid Alternating Movements Point-to-Point Movements F-N-F H-K-S
Romberg Gait Sensory ataxia 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