When approching a patient with a

neurologic disorder always ask youself

1. Where is the lesion? 2. What is the cause of the lesion?

Examination of Nervous System • cerebrum • vascular
• cerebellum • infectious
• brainstem • neuroplastic
• spinal cord • degenerative
• nerve root • inflammatory-immunologic
• peripheral nerve • congenital-developmental
Hong Zhang, MD,PhD • neuromuscular junction • traumatic
Department of Neurology • muscle • toxic
• not confined to one level • metabolic
Zhongnan Hospital of Wuhan University
3. Is the lesion focal, multifocal or diffuse?

Neuroanatomy through Clinical Cases • INTRODUCTION

• MENTAL STATUS
• Hal Blumenfeld • CRANIAL NERVES
Yale University School of Medicine
• MOTOR EXAM
• Publishing Information: September 2001 • REFLEXES
• COORDINATION AND GAIT
• ISBN 0-87893-060-4 • SENSORY EXAM

INTRODUCTION

• The neurologic exam as a diagnostic tool

gained mythical proportions in the pre-
CT/MRI era when great clinicians could
INTRODUCTION pinpoint a lesion in the nervous system
with often astounding accuracy
• Today, with the availability of modern
imaging techniques, the neurologic exam
remains a critical way station in the clinical
decision-making process

1
 INTRODUCTION INTRODUCTION

• Does the patient with nausea and vomiting

• Does the patient who just collapsed on the
need a gastroenterology consult, a head
street have cardiac disease or an
CT, or emergency interventions to lower
intracranial bleed?
dangerously elevated intracranial pressure?
• Is the patient with leg weakness and
• Many similar questions that frequently
numbness suffering from degenerative
arise for health care providers in all
joint disease or from impending spinal
subspecialties can quickly be answered by
cord compression?
a carefully performed neurologic exam

INTRODUCTION INTRODUCTION

• In this course, we outline the main
components of the neurologic exam
• The goal will be to demonstrate how each
step of the neurologic exam is performed
• In addition, we will briefly discuss which
neuroanatomic systems are tested by
each part of the neurologic exam, so that
its functional and practical relevance will
be better appreciated
• The neurologic exam is part of the general
physical examination
• The neurologic exam should always be
preceded by and interpreted in the context of a
more general examination including vital signs,
heart, lungs, abdomen, etc.
• Most clinicians include certain important tests in
the neurologic exam, although there are
variations in personal style, emphasis and order
of the tests

INTRODUCTION INTRODUCTION
• Here, we will adopt a fairly widely accepted
• It is important to emphasize that the neurologic
format for the neurologic exam, consisting of
exam tests function
the following six subdivisions:
• For each part of the exam, the patient's level of
1. Mental Status
functioning must be titrated using several tests
2. Cranial Nerves ranging from easy to difficult
3. Motor Exam • The tests the patient can and cannot perform on
4. Reflexes a given day should be recorded for comparison
5. Coordination and Gait with follow-up examinations so that changes in
6. Sensory Exam the patient's status can be determined
accurately

2
 INTRODUCTION
• Depending on the clinical situation, certain parts
of the exam should be performed in greater or
less detail
• For example, an emergency neurologic exam in
a comatose patient can be performed in under
two minutes
• In contrast, a patient with unusual findings seen
in the office may require detailed testing for up to
an hour for accurate diagnosis
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INTRODUCTION
• Sometimes certain parts of the exam can
be combined, or performed in a slightly
different order to minimize the number of
times the patient has to change positions
• Understanding how to best tailor the exam
to the clinical situation comes with
experience and practice