1. THE NEUROLOGICAL EXAMINATION

2. NEUROLOGICAL EXAM MENTAL STATUS CRANIAL NERVES MOTOR EXAM REFLEXES
STRENGTH
GAIT
CEREBELLAR
REFLEXES
SENSATION

3. MENTAL STATUS

4. Level of Consciousness
Awake and alert
Agitated
Lethargic
Arousable with
Voice
Gentle stimulation
Painful/vigorous stimulation
Comatose

5. LANGUAGE FLUENCY NAMING REPETITION READING WRITING COMPREHENSION
Aphasia vs. dysarthria

6. MEMORY IMMEDIATE REMOTE 3 OBJECTS AT 0/3/5 MINUTES HISTORICAL EVENTS
REALLY A MEASURE OF ATTENTION RATHER THAN MEMORY
REMOTE
3 OBJECTS AT 0/3/5 MINUTES
HISTORICAL EVENTS
PERSONAL EVENTS

7. ORIENTATION
PERSON
NOT WHO THEY ARE BUT WHO YOU ARE
PLACE
TIME

8. OTHER COGNITIVE FUNCTIONS
CALCULATION
ABSTRACTION
SIMILARITIES/DIFFERENCES
JUDGEMENT
PERSONALITY/BEHAVIOR

9. CRANIAL NERVES

10. CRANIAL NERVE EXAM I - OLFACTORY II - OPTIC
DON’T USE A NOXIOUS STIMULUS
COFFEE, LEMON EXTRACT
II - OPTIC
VISUAL ACUITY
VISUAL FIELDS
FUNDOSCOPIC EXAM

11. CRANIAL NERVE EXAM III/IV/VI OCULMOTOR, TROCHLEAR, ABDUCENS
PUPILLARY RESPONSE
EYE MOVEMENTS
9 CARDINAL POSITIONS
OBSERVE LIDS FOR PTOSIS
V - TRIGEMINAL
MOTOR - JAW STRENGTH
SENS - ALL 3 DIVISIONS

12. CRANIAL NERVES VII - FACIAL VIII - VESTIBULAR
OBSERVE FOR FACIAL ASYMMETRY
FOREHEAD WRINKLING, EYELID CLOSURE, WHISTLE/PUCKER
VIII - VESTIBULAR
ACUITY
RINNE, WEBER

13. CRANIAL NERVES IX/X - GLOSSOPHARYNGEAL, VAGUS XI - SPINAL ACCESSORY
GAG
XI - SPINAL ACCESSORY
STERNOCLEIDOMASTOID M.
TRAPEZIUS MUSCLE
XII - HYPOGLOSSAL
TONGUE STRENGTH
RIGHT XII THRUSTS TONGUE TO LEFT

14. MOTOR EXAMINATION

15. STRENGTH STRENGTH GRADED 0 - 5 0 - NO MOVEMENT 1 - FLICKER
2 - MOVEMENT WITH GRAVITY REMOVED
3 - MOVEMENT AGAINST GRAVITY
4 - MOVEMENT AGAINST RESISTANCE
5 - NORMAL STRENGTH

16. STRENGTH EXAM UPPER AND LOWER EXTREMITIES DISTAL AND PROXIMAL MUSCLES
GRIP STRENGTH IS A POOR SCREENING TOOL FOR STRENGTH
SUBTLE WEAKNESS
TOE WALK, HEEL WALK
OUT OF CHAIR
DEEP KNEE BEND

17. Subtle signs of weakness on a cortical/subcortical basis
Motor exam, cont
Subtle signs of weakness on a cortical/subcortical basis
Pronator drift
Orbiting

18. Gait evaluation Include walking and turning Examples of abnormal gait
High steppage
Waddling
Hemiparetic
Shuffling
Turns en bloc

19. MUSCLE OBSERVATION
ATROPHY
FASCIULATIONS

20. ABNORMAL MOVEMENTS TREMOR CHOREA ATHETOSIS ABNORMAL POSTURES REST
WITH ARMS OUTSTRETCHED
INTENTION
CHOREA
ATHETOSIS
ABNORMAL POSTURES

21. CEREBELLAR FUNCTION RAPID ALTERNATING MOVEMENTS
FINGER TO FINGER TO NOSE TESTING
HEEL TO SHIN
GAIT
TANDEM

22. Romberg Sign
Stand with feet together - assure patient stable - have them close eyes
Romberg is positive if they do worse with eyes closed
Measures
Cerebellar function
Frequently poor balance with eyes open and closed
Proprioception
Frequently do worse with eyes closed
Vestibular system

23. REFLEXES

24. MUSCLE STRETCH REFLEXES (DEEP TENDON REFLEXES)
GRADED 0 - 5
0 - ABSENT
1 - PRESENT WITH REINFORCEMENT
2 - NORMAL
3 - ENHANCED
4 - UNSUSTAINED CLONUS
5 - SUSTAINED CLONUS

25. MSR / DTR
BICEPS
BRACHIORADIALIS
TRICEPS
KNEE
ANKLE

26. OTHER REFLEXES Upper motor neuron dysfunction Frontal release signs
BABINSKI
present or absent
toes downgoing/ flexor plantar response
HOFMAN’S
JAW JERK
Frontal release signs
GRASP
SNOUT
SUCK
PALMOMENTAL

27. TONE
INCREASED, DECREASED, NORMAL
COGWHEELING
CLASP KNIFE

28. SENSORY EXAM

29. SENSORY EXAM VIBRATION JOINT POSITION SENSE PIN PRICK TEMPERATURE
128 hz tuning fork
JOINT POSITION SENSE
PIN PRICK
TEMPERATURE
Start distally and move proximally

30. HIGHER CORTICAL SENSATIONS
GRAPHESTHESIA
STEREOGNOSIS
DOUBLE SIMULTANEOUS STIMULATION
BAROSTHESIA
TEXTURES