1. Assessing your patient
The neurological exam
Assessing your patient

2. What are the components of the neurological exam
Key points of the neuro exam
Mental Status
Language and Speech
Cranial nerves (2-12)
Motor
Reflexes
Sensory
Cerebellar
Gait

3. Assessing your patient’s mental status
MENTAL STATUS EXAM:
Orientation: Alert and oriented to person, place and time.
Memory: Cooperative, follows commands well. Recent and remote memory normal.
Attention, concentration: Attention span and concentration are normal.
Language: Speech is clear and language is normal.
Fund of knowledge: Aware of current events, vocabulary appropriate for patient age.

4. Cranial Nerves 2-12

5. Cranial nerve 2 Cranial Nerve 2 (Optic)
Visual fields are intact to confrontation
Funduscopic examination
1. Optic disc pallor
2. Optic disc edema
3. Retinal vessels are normal

6. Cranial Nerve 3, 4 and 6 Oculomtor (3)
Pupils should be equal and reactive to light
Extraocular eye movements ( superior, medial and inferior recti; inferior oblique
Trochlear (4)
Extraocular eye movements (superior oblique)
Abducens (6)
Extraocular movements (lateral rectus)

7. Cranial nerve 5 Trigeminal (5) Facial sensation
No weakness of the masticatory muscles

8. Cranial nerve 7
Facial (7)
Observe for facial weakness

9. Cranial nerve 8 Vestibulocochlear AKA Auditory (8) Hearing
Vestibular function

10. Cranial nerves 9 and 10 Glossopharyngeal (9) Taste
Check the that the Uvula is midline
Vagus (10)
Phonation
Check to make sure the palate elevates symmetrically

11. Cranial nerve 11 Spinal accessory
Normal sternocleidomastoid and trapezius strength

12. Cranial nerve 12 Hypoglossal (12) Tongue is midline
No atrophy or fasciculation

13. Motor exam Muscle strength Check for symmetry bilaterally
Look for pronation and drift
Grading muscle strength
5/5 Full Strength
4/5 can resist opposition to some extent, but do not exhibit full strength
3/5 can move against gravity
2/5 can move with gravity elimination
1/5 can see muscle contraction but no movement
0/5 no movement

14. Motor exam Cont. Muscle Tone
Look for increased or decreased tone in both upper and lower extremities
Check for symmetry ( more on the left vs more on the right)

15. Reflexes Reflexes symmetric bilaterally
Plantar response flexor bilaterally
Grading Reflexes
0 Absent
1+ Hyporeflexic
2+ Normal
3+ Brisk, without clonus
4+ Brisk, with clonus

16. Coordination Intact finger to nose Heal to shin
Check rapid alternating movements
Assess for tremor
Resting
Action

17. Sensation Check that sensation is intact to… Light touch Pinprick
Vibration
Check for symmetry bilaterally
Romberg test

18. Gait
Check for gait abnormalities
- Casual
- Heel
- Tandem

19. Other considerations for your neuro exam
Medications (Could they be effecting your exam)
Epilepsy medications
Blood pressure medications
Mood stabilizing medications