1. Neurologic Examination
Kefah Al-Hayek, MD
Assistant Prof. of Neurology
J.U.S.T
ABPN, ABCNP, ABEM, ABNM

2. 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

3. Neurologic Examination
Mental Status
Cranial Nerves
Motor
Reflexes
Sensory
Coordination and Gait
Special Tests

5. Aphasia Repetition Comprehension Fluency - + Motor Sensory Conductive
Global

6. Cranial Nerves I – Olfactory Not Normally Tested Suspected mass
c/o smell

7. II - Optic Optic Fundi Visual Acuity Visual Fields Pupillary test
Light
accomodation

8. III – Oculomotor, IV – Trochlear, VI - Abducens
Observe for Ptosis
Test Extraocular Movements

9. Sensation Mastication Corneal reflex Jaw gerk
V - Trigeminal
Sensation
Mastication
Corneal reflex
Jaw gerk

10. 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

11. VIII - Acoustic Screen Hearing Lateralization (Weber(
Compare Air and Bone Conduction (Rinne)
Vestibular Function
Not Normally Tested

12. 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

13. XII - Hypoglossal Observe the tongue as it lies in the mouth
Ask patient to:
Protrude tongue
Move tongue from side to side

14. Motor Observation Muscle Tone Involuntary Movements Muscle Symmetry
Atrophy
Muscle Tone
Decreased (flaccid) or increased (rigid/spastic) tone

15. 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

16. 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 ++++

17. Deep Tendon Reflexes Biceps (C5, C6) Brachioradialis (C5, C6)
Triceps (C6, C7)
Knee (L2, L3, L4(
Ankle (S1, S2)

18. Plantar Response (Babinski)

19. Sensory Pain & Temp Vibration & position Light Touch Cortical sensory
Graphesthesia
Stereognosis
Two Point Discrimination

20. Coordination Rapid Alternating Movements Point-to-Point Movements
F-N-F
H-K-S

21. 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