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Neurological examination

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840: 40: 136:. It can be used both as a screening tool and as an investigative tool, the former of which when examining the patient when there is no expected neurological deficit and the latter of which when examining a patient where you do expect to find abnormalities. If a problem is found either in an investigative or screening process, then further tests can be carried out to focus on a particular aspect of the nervous system (such as 343:(I-XII): sense of smell (I), visual fields and acuity (II), eye movements (III, IV, VI) and pupils (III, sympathetic and parasympathetic), sensory function of face (V), strength of facial (VII) and shoulder girdle muscles (XI), hearing (VII, VIII), taste (VII, IX, X), pharyngeal movement and reflex (IX, X), tongue movements (XII). These are tested by their individual purposes (e.g. the visual acuity can be tested by a 231:
that is responsible for language). As patients answer questions, it is important to gain an idea of the complaint thoroughly and understand its time course. Understanding the patient's neurological state at the time of questioning is important, and an idea of how competent the patient is with various
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Establishing the lesion's location. If the process involves the CNS, clarifying if it is cortical, subcortical, or multifocal. If subcortical, clarifying whether it is white matter, basal ganglia, brainstem, or spinal cord. If the process involves the PNS then determining whether it localizes to the
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A patient's history is the most important part of a neurological examination and must be performed before any other procedures unless impossible (i.e., if the patient is unconscious certain aspects of a patient's history will become more important depending upon the complaint issued). Important
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Determining whether the process involves the peripheral nervous system (PNS), central nervous system (CNS), or both. Considering if the finding (or findings) can be explained by a single lesion or whether it requires a multifocal
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may then be constructed that takes into account the patient's background (e.g., previous cancer, autoimmune diathesis) and present findings to include the most likely causes. Examinations are aimed at ruling
175:. Finally, it is the role of the physician to find the cause for why such a problem has occurred, for example finding whether the problem is due to inflammation or is congenital. 232:
tasks and his/her level of impairment in carrying out these tasks should be obtained. The interval of a complaint is important as it can help aid the diagnosis. For example,
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Betts, J Gordon; Desaix, Peter; Johnson, Eddie; Johnson, Jody E; Korol, Oksana; Kruse, Dean; Poe, Brandon; Wise, James; Womble, Mark D; Young, Kelly A (June 5, 2023).
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Carrying out a 'general' examination is just as important as the neurological exam, as it may lead to clues to the cause of the complaint. This is shown by cases of
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disorders (such as strokes) occur very frequently over minutes or hours, whereas chronic disorders (such as Alzheimer's disease) occur over a matter of years.
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the most clinically significant causes (even if relatively rare, e.g., brain tumor in a patient with subtle word-finding abnormalities but no increased
633: 1524: 1000: 71: 450:– is resistance to passive change, where the strength of antagonist muscles increases with increasing examiner force. More common in dementia. 900:
Medical Research Council (1976). "Medical Research Council scale. Aids to examination of the peripheral nervous system. Memorandum no. 45".
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or there is another diffuse process that is troubling the patient. Once the patient has been thoroughly tested, it is then the role of the
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Looking for side to side symmetry: one side of the body serves as a control for the other. Determining if there is focal asymmetry.
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Handedness is important in establishing the area of the brain important for language (as almost all right-handed people have a
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grades 4−, 4 and 4+ maybe used to indicate movement against slight, moderate and strong resistance respectively.
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testing involves provoking sensations of fine touch, pain and temperature. Fine touch can be evaluated with a
1873: 1868: 1645: 588:– 2 out of the following 3 must be intact to maintain balance: i. vision ii. vestibulocochlear system iii. 366: 301: 297: 187:. Any new symptom of any neurological order may be an indication for performing a neurological examination. 491: 844: 183:
A neurological examination is indicated whenever a healthcare provider suspects that a patient may have a
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nerve root, plexus, peripheral nerve, neuromuscular junction, muscle or whether it is multifocal.
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to determine whether these findings combine to form a recognizable medical syndrome or
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In general, a neurological examination is focused on finding out whether there are
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with a nylon monofilament to detect any subjective absence of touch perception.
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The results of the examination are taken together to anatomically identify the
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Time of onset, duration and associated symptoms (e.g., is the complaint
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Specific tests in a neurological examination include the following:
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due to compression of a specific spinal nerve by a tumor deposit).
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scale 0 to 5 (i.e., 0 = Complete Paralysis to 5 = Normal Power).
743:"Clinical neurology: why this still matters in the 21st century" 1668: 1101: 408: 362: 247: 148: 117: 1354: 499: 444:
Cogwheeling (abnormal tone suggestive of Parkinson's disease)
1131: 666: 1015: 482:). Globally, brisk reflexes suggest an abnormality of the 931:
Murray ED, Price BH. "The Neurological Examination." In:
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Assessment to determine if the nervous system is impaired
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factors to be taken in the medical history include:
972:- "Neurological History and Physical Examination" 246:where the initial complaint was of a mass in the 1860: 881:"Neurological History and Physical Examination" 740: 1525: 1001: 858:. Houston: OpenStax CNX. 16.0 Introduction. 1532: 1518: 1008: 994: 211:Age, gender, and occupation of the patient 38: 766: 872: 741:Nicholl DJ, appleton JP (May 29, 2014). 808: 806: 132:, but not deeper investigation such as 124:is impaired. This typically includes a 14: 1861: 812: 804: 802: 800: 798: 796: 794: 792: 790: 788: 786: 734: 598:"intact to sharp and dull throughout" 1513: 989: 307:Global assessment of higher functions 817:. Churchill Livingstone. p. 1. 461:"strength 5/5 throughout, tone WNL" 190: 1578: 1395:Upper limb neurological examination 783: 317:; this also enables assessment for 24: 878: 815:Neurological Examination Made Easy 214:Handedness (right- or left-handed) 25: 1885: 957: 933:Comprehensive Clinical Psychiatry 675: 843: This article incorporates 838: 253: 1416:Ballard Maturational Assessment 1276:Peripheral vascular examination 1042:History of the present illness 925: 893: 365:strength, often graded on the 178: 128:and a review of the patient's 13: 1: 1383:Mini–mental state examination 1294:Ankle–brachial pressure index 747:J Neurol Neurosurg Psychiatry 727: 302:mini mental state examination 298:abbreviated mental test score 691:General principles include: 7: 120:, to determine whether the 10: 1890: 1646:Charcot's neurologic triad 634:Rapid pronation-supination 510:is used for this testing. 350:"CNII-XII grossly intact" 157:peripheral nervous systems 1832: 1816: 1785: 1750: 1743: 1723: 1692: 1676: 1667: 1660:Peripheral nervous system 1658: 1619: 1569: 1561:Cranial nerve examination 1551: 1484: 1452: 1424: 1403: 1390:Cranial nerve examination 1368: 1332: 1304: 1261: 1243: 1196: 1163: 1129: 1120: 1027: 513:"2+ symmetric, downgoing 377:Muscle tone and signs of 336:Cranial nerve examination 294:Mental status examination 276:Mental status examination 223:Family and social history 91: 77: 65: 49: 37: 32: 1556:Neurological examination 856:Anatomy & Physiology 813:Fuller, Geraint (2004). 759:10.1136/jnnp-2013-306881 724:the most likely causes. 573:Two-point discrimination 326:"A&O x 3, short and 106:neurological examination 44:The human nervous system 33:Neurological examination 1462:Athletic heart syndrome 1764:carpal tunnel syndrome 1571:Central nervous system 1499:Differential diagnosis 1434:Well-woman examination 981:Simplified Motor Score 913:Cite journal requires 709:differential diagnosis 296:, often including the 116:responses, especially 1628:Intracranial pressure 718:intracranial pressure 623:Ankle-over-tibia test 319:microvascular disease 311:Intracranial pressure 185:neurological disorder 173:motor neurone disease 165:neurological disorder 108:is the assessment of 1874:Physical examination 1869:Neurology procedures 1808:Trendelenburg's sign 1467:Sudden cardiac death 1350:Shoulder examination 1289:Abdominojugular test 1122:Physical examination 1069:Past medical history 879:Oommen, Kalarickal. 847:available under the 577:discriminative sense 467:Deep tendon reflexes 217:Past medical history 126:physical examination 1684:Jendrassik maneuver 1486:Assessment and plan 1271:Cardiac examination 1216:Swinging light test 1084:Psychiatric history 1017:Medical examination 619:Finger-to-nose test 610:Cerebellar testing 590:epicritic sensation 535:, touching various 413:Abnormal movements 169:Parkinson's disease 1803:Straight leg raise 1541:Signs and symptoms 1444:Breast examination 1319:Rectal examination 1253:Respiratory sounds 1052:Nursing assessment 976:Glasgow Coma Scale 643:Assessment of gait 629:Dysdiadochokinesis 288:Glasgow Coma Scale 286:, often using the 282:The assessment of 1856: 1855: 1852: 1851: 1848: 1847: 1739: 1738: 1731:Hoffmann's reflex 1654: 1653: 1507: 1506: 1494:Medical diagnosis 1480: 1479: 1355:Elbow examination 865:978-1-947172-04-3 673: 672: 533:monofilament test 313:is estimated by 191:Patient's history 102: 101: 18:Neurological exam 16:(Redirected from 1881: 1748: 1747: 1710:Oppenheim's sign 1674: 1673: 1665: 1664: 1641:Lhermitte's sign 1576: 1575: 1543:relating to the 1534: 1527: 1520: 1511: 1510: 1340:Knee examination 1188:Respiratory rate 1127: 1126: 1010: 1003: 996: 987: 986: 951: 929: 923: 922: 916: 911: 909: 901: 897: 891: 890: 888: 887: 876: 870: 869: 842: 835: 829: 828: 810: 781: 780: 770: 738: 651:Intention tremor 328:long-term memory 261: 260: 138:lumbar punctures 95:edit on Wikidata 87: 61: 60: 42: 30: 29: 21: 1889: 1888: 1884: 1883: 1882: 1880: 1879: 1878: 1859: 1858: 1857: 1844: 1828: 1812: 1781: 1775:Phalen maneuver 1735: 1719: 1715:Westphal's sign 1705:Chaddock reflex 1688: 1650: 1634:Cushing's triad 1615: 1565: 1547: 1538: 1508: 1503: 1476: 1448: 1420: 1399: 1364: 1345:Hip examination 1333:Musculoskeletal 1328: 1300: 1257: 1239: 1206:Eye examination 1192: 1159: 1116: 1037:Chief complaint 1029:Medical history 1023: 1014: 960: 955: 954: 930: 926: 914: 912: 903: 902: 898: 894: 885: 883: 877: 873: 866: 836: 832: 825: 811: 784: 739: 735: 730: 678: 654:Staccato speech 504:motor end plate 488:pyramidal tract 384:Examination of 256: 229:left hemisphere 193: 181: 130:medical history 98: 83: 56: 55: 45: 28: 23: 22: 15: 12: 11: 5: 1887: 1877: 1876: 1871: 1854: 1853: 1850: 1849: 1846: 1845: 1843: 1842: 1836: 1834: 1830: 1829: 1827: 1826: 1820: 1818: 1814: 1813: 1811: 1810: 1805: 1800: 1795: 1789: 1787: 1783: 1782: 1780: 1779: 1778: 1777: 1772: 1760: 1758:Froment's sign 1754: 1752: 1745: 1741: 1740: 1737: 1736: 1734: 1733: 1727: 1725: 1721: 1720: 1718: 1717: 1712: 1707: 1702: 1700:Plantar reflex 1696: 1694: 1690: 1689: 1687: 1686: 1680: 1678: 1671: 1662: 1656: 1655: 1652: 1651: 1649: 1648: 1643: 1638: 1637: 1636: 1623: 1621: 1617: 1616: 1614: 1613: 1608: 1603: 1601:Myerson's sign 1598: 1596:Macewen's sign 1593: 1588: 1582: 1580: 1573: 1567: 1566: 1564: 1563: 1558: 1552: 1549: 1548: 1545:nervous system 1537: 1536: 1529: 1522: 1514: 1505: 1504: 1502: 1501: 1496: 1490: 1488: 1482: 1481: 1478: 1477: 1475: 1474: 1469: 1464: 1458: 1456: 1450: 1449: 1447: 1446: 1441: 1436: 1430: 1428: 1422: 1421: 1419: 1418: 1413: 1407: 1405: 1401: 1400: 1398: 1397: 1392: 1387: 1386: 1385: 1374: 1372: 1366: 1365: 1363: 1362: 1357: 1352: 1347: 1342: 1336: 1334: 1330: 1329: 1327: 1326: 1321: 1316: 1310: 1308: 1302: 1301: 1299: 1298: 1297: 1296: 1291: 1283: 1278: 1273: 1267: 1265: 1263:Cardiovascular 1259: 1258: 1256: 1255: 1249: 1247: 1241: 1240: 1238: 1237: 1236: 1235: 1230: 1220: 1219: 1218: 1213: 1211:Ophthalmoscopy 1202: 1200: 1194: 1193: 1191: 1190: 1185: 1183:Blood pressure 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375: 374: 373: 358: 352: 351: 348: 341:Cranial nerves 338: 332: 331: 324: 323: 322: 308: 305: 291: 278: 272: 271: 268: 265: 255: 252: 225: 224: 221: 218: 215: 212: 209: 192: 189: 180: 177: 122:nervous system 110:sensory neuron 100: 99: 92: 89: 88: 81: 75: 74: 69: 63: 62: 53: 47: 46: 43: 35: 34: 26: 9: 6: 4: 3: 2: 1886: 1875: 1872: 1870: 1867: 1866: 1864: 1841: 1840:Pain stimulus 1838: 1837: 1835: 1831: 1825: 1824:Beevor's sign 1822: 1821: 1819: 1815: 1809: 1806: 1804: 1801: 1799: 1798:Hoover's sign 1796: 1794: 1793:Gowers's sign 1791: 1790: 1788: 1784: 1776: 1773: 1771: 1768: 1767: 1766: 1765: 1761: 1759: 1756: 1755: 1753: 1749: 1746: 1742: 1732: 1729: 1728: 1726: 1722: 1716: 1713: 1711: 1708: 1706: 1703: 1701: 1698: 1697: 1695: 1691: 1685: 1682: 1681: 1679: 1675: 1672: 1670: 1666: 1663: 1661: 1657: 1647: 1644: 1642: 1639: 1635: 1632: 1631: 1630: 1629: 1625: 1624: 1622: 1618: 1612: 1609: 1607: 1604: 1602: 1599: 1597: 1594: 1592: 1591:Kernig's sign 1589: 1587: 1586:Battle's sign 1584: 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493: 492:anterior horn 489: 485: 481: 480:Babinski sign 477: 473: 470: 468: 465: 464: 460: 449: 446: 443: 442: 440: 436: 433: 432: 431: 428: 427: 425: 423: 420: 418: 415: 414: 412: 410: 406: 402: 399: 397: 394: 392: 389: 388: 387: 383: 380: 376: 371: 370: 368: 364: 361: 360: 359: 357: 354: 353: 349: 346: 345:Snellen chart 342: 339: 337: 334: 333: 329: 325: 320: 316: 312: 309: 306: 303: 299: 295: 292: 289: 285: 284:consciousness 281: 280: 279: 277: 274: 273: 269: 266: 263: 262: 259: 254:List of tests 251: 249: 245: 242: 237: 235: 230: 222: 219: 216: 213: 210: 207: 203: 199: 198: 197: 188: 186: 176: 174: 170: 166: 162: 158: 154: 150: 145: 143: 139: 135: 131: 127: 123: 119: 115: 111: 107: 96: 90: 86: 82: 80: 76: 73: 70: 68: 64: 59: 54: 52: 48: 41: 36: 31: 19: 1770:Tinel's sign 1762: 1626: 1555: 1370:Neurological 1369: 1324:Bowel sounds 1281:Heart sounds 1145:Auscultation 963: 932: 927: 906:cite journal 895: 884:. Retrieved 874: 855: 837: 833: 814: 750: 746: 736: 721: 713: 706: 690: 681: 679: 586:Romberg test 567:Stereognosis 532: 527: 447: 356:Motor system 257: 238: 226: 220:Drug history 194: 182: 146: 134:neuroimaging 105: 103: 1677:Combination 1611:Hirano body 1606:Stroop test 1411:Apgar score 1360:GALS screen 1245:Respiratory 1173:Temperature 1165:Vital signs 1062:Medications 552:Temperature 546:Light touch 448:Gegenhalten 401:Hemiparetic 396:Decorticate 391:Decerebrate 179:Indications 142:blood tests 1863:Categories 1314:Liver span 1178:Heart rate 1155:Percussion 1140:Inspection 1093:Mnemonics 941:0323047432 886:2008-04-22 728:References 604:Cerebellum 582:Extinction 537:dermatomes 430:Spasticity 315:fundoscopy 300:(AMTS) or 244:metastases 1306:Abdominal 1150:Palpation 1057:Allergies 970:eMedicine 965:neuro/632 849:CC BY 4.0 686:dermatome 648:Nystagmus 614:Dysmetria 555:Vibration 523:Sensation 441:Rigidity 264:Category 161:physician 58:neurology 51:Specialty 1669:Reflexes 1439:Pap test 1404:Neonatal 1130:General/ 1111:COASTMAP 851:license. 777:24879832 699:process. 661:"intact 543:Sensory 472:Reflexes 407:Resting 379:rigidity 330:intact" 270:Example 241:cerebral 234:vascular 167:such as 118:reflexes 67:ICD-9-CM 1833:General 1223:Hearing 768:4316836 640:Ataxia 478:(i.e., 476:plantar 417:Seizure 409:tremors 386:posture 202:chronic 153:central 151:in the 149:lesions 85:D009460 1454:Sports 1285:Other 1102:OPQRST 1097:SAMPLE 947:  939:  862:  821:  775:  765:  682:lesion 363:Muscle 304:(MMSE) 267:Tests 248:breast 1817:Torso 1744:Other 1620:Other 1472:RED-S 1233:Rinne 1228:Weber 1198:HEENT 669:WNL" 575:(for 569:, and 500:nerve 426:Tone 290:(GCS) 206:acute 114:motor 93:[ 72:89.13 1786:Legs 1751:Arms 1724:Arms 1693:Legs 1579:Head 1132:IPPA 1107:SOAP 1019:and 945:ISBN 937:ISBN 919:help 860:ISBN 845:text 819:ISBN 773:PMID 667:gait 549:Pain 506:. A 155:and 140:and 112:and 79:MeSH 968:at 763:PMC 755:doi 714:out 502:or 496:LMN 486:or 484:UMN 367:MRC 347:). 204:or 171:or 144:). 1865:: 943:. 910:: 908:}} 904:{{ 785:^ 771:. 761:. 751:86 749:. 745:. 722:in 707:A 665:, 517:" 498:, 494:, 250:. 104:A 1533:e 1526:t 1519:v 1009:e 1002:t 995:v 921:) 917:( 889:. 868:. 827:. 779:. 757:: 579:) 381:. 321:. 208:) 97:] 20:)

Index

Neurological exam

Specialty
neurology
ICD-9-CM
89.13
MeSH
D009460
edit on Wikidata
sensory neuron
motor
reflexes
nervous system
physical examination
medical history
neuroimaging
lumbar punctures
blood tests
lesions
central
peripheral nervous systems
physician
neurological disorder
Parkinson's disease
motor neurone disease
neurological disorder
chronic
acute
left hemisphere
vascular

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