1. Neurological History and Exam
Neurological History and Exam

2. Peculiarities Where is the lesion=localization
What is the lesion=differential diagnosis
What is the etiology of the lesion

3. Chief Complaint Time factor Location factor Associations Time of onset
Mode of onset
Change over time (progression)
If episodic: duration, recurrence
Location factor
Right/left, Upper/lower, Crossed
Associations

4. Past History Family History Social History

5. Neurological Symptoms
Headache
Changes in the level of consciousness
Weakness
Sensory changes
Abnormal movements
Memory and behavioral changes
Falls

6. Headache Description and history taking Possible etiologies
Checklist for pain
Possible etiologies
Primary
Secondary
Red flags in the history of headache

7. Level of Consciousness
Seizures
Classification
Temporal progression
Possible etiologies
Syncope
Breath holding spells
Mass effect and increased intracranial pressure

8. Weakness / Sensory Change
Onset
Distribution
Progression
Associated symptoms
Etiologies

9. Abnormal Movements Shaking movements of the hands
Slow writhing movements
Ballistic proximal movements
Sudden jerks

10. Memory and Confusion Baseline of the patient
History of trauma, incontinence, gait problem, anticoagulation, abnormal movements, language deficit, systemic disease.
Onset of the change
Specific manifestation
Living environment
Possible etiologies

11. Falls Loss of consciousness: seizure, syncope
Transient ischemic attacks
Third ventricular and posterior fossa tumors
Motor and sensory impairment of the lower limbs: neuromuscular disorders
myelopathy
cerebral and cerebellar disorders
basal ganglionic diseases
- Neuropathy.

12. Neurological Exam

13. Neurologic Exam General observations Neck and cervical spine
Cranial nerves
Motor system
Sensory system
Coordination
Cortical function

14. General Observations Level of consciousness Facial appearance Gait
Speech
Language
Involuntary movements
Hand writing
Neck and spine movements

16. Gait
Hemiparetic
Spastic
Foot drop
Parkinsonian
Cerebellar
Apraxic

17. Speech Disorder of articulation, motor weakness myasthenia gravis
motor neuron disease
multiple lacunes
parkinsonism
cerebellar lesions
Recurrent laryngeal nerve palsy

18. Language (Aphasia) Broca’s Wernicke’s Conduction aphasia
Global aphasia

19. Language Spontaneous speech Naming objects Comprehension
Repetition of spoken words
Reading aloud
Handwriting

20. Involuntary movements
- Tremor
Chorea:
Athetosis
Dystonia
Myoclonus
Hemiballismus
Orofacial-lingual dyskinesia
Tics

21. Chorea
repetitive, brief, irregular, somewhat rapid involuntary movements that start in one part of the body and move abruptly, unpredictably, and often continuously to another part

22. Athetosis
a continuous stream of slow, flowing, writhing involuntary movements.

23. Hemiballismus
a type of chorea, usually involving violent, involuntary flinging of one arm and/or one leg.

24. Dystonia
characterized by long-lasting (sustained) involuntary muscle contractions that may force into abnormal positions—for example, causing the entire body, the trunk, limbs, or neck to twist.

25. Neurologic Exam General observations Neck and cervical spine
Cranial nerves
Motor system
Sensory system
Coordination
Cortical function

26. Cranial Nerves Olfactory nerve Optic Nerve visual acuity
pupillary reflexes
visual fields
color vision
fundoscopy

27. Cranial Nerves Oculomotor, Trochlear, Abducent nerves Trigeminal nerve
sensory
motor
corneal reflex
jaw jerk

28. Cranial Nerves Facial nerve Vestibulocochlear nerve
Glossopharyngeal and Vagus nerves
Accessory nerve
Hypoglossal nerve

30. Neurologic Exam General observations Neck and cervical spine
Cranial nerves
Motor system
Sensory system
Coordination
Cortical function

31. Motor System Inspection and palpation of muscle groups
Assessment of tone
Testing of power
Deep tendon reflexes and plantar responses
Superficial and Pathological reflexes

34. Neurologic Exam General observations Neck and cervical spine
Cranial nerves
Motor system
Sensory system
Coordination
Cortical function

35. Sensory System Pattern and distribution peripheral neuropathy
mononeuropathy
radiculopathy
myelopathy
hemispheric

36. Sensory System Modalties pain temperature light touch vibration
positin

37. Neurologic Exam General observations Neck and cervical spine
Cranial nerves
Motor system
Sensory system
Coordination
Cortical function

38. Coordination Finger-Nose-Finger test Heel-Shin test
Rapid alternating movements
Stance and gait

39. Cortical Function Point localization Streiognosis Graphaesthesia
Sensory inattention
Calculating skills
Constructional apraxia