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

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Fluency Comprehension Repetition
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Motor frontal - + -
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 Cranial Nerves
arises ban the brainstem
• I – Olfactory the only one
– Not Normally Tested
– Suspected mass
– c/o smell
 II - Optic
•
•
•
Optic Fundi
Visual Acuity
Visual Fields
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•
–
–
Pupillary test
Light
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 III – Oculomotor, IV – Trochlear, VI
- Abducens 48,6
Senator PapebraeSuperiors

• Observe for Ptosis HE

eyelid
• Test Extraocular Movements
 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
– 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
– Involuntary Movements
– Muscle Symmetry
– Atrophy
• Muscle Tone
– Decreased (flaccid) or increased
(rigid/spastic) tone
 Muscle Strength
Grade Description
0/5 No muscle movement
Visible muscle movement, but no movement at
1/5
the joint
2/5 Movement at the joint, but not against gravity
Movement against gravity, but not against
3/5
added resistance
Movement against resistance, but less than
4/5
normal
5/5 Normal strength
 Reflexes
• Deep Tendon Reflexes

Tendon Reflex Grading Scale

Grade Description
0 Absent
1+ or + Hypoactive
2+ or ++ "Normal"
3+ or +++ Hyperactive without clonus (spread)
4+ or ++++ Hyperactive with clonus
 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
– Sensory ataxia
• Gait
– 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