Neurological Exam

What is a neurological exam?

A neurological exam is a series of simple questions and tests that provide information about your nervous system. Many diseases, such as dementia, cause changes in your ability to think, respond, and move. The neurological exam offers a way to find out what might be wrong. It may be done as part of a complete physical exam.

The neurological exam checks several parts of the nervous system:

• mental status
• cranial nerves
• motor system
• senses
• reflexes
• coordination
• walking.

Mental status

The mental status exam is a series of questions designed to test your:

• awareness of and responsiveness to the environment
• appearance and general behavior
• mood
• ability to pay attention
• memory
• judgment
• ability to think things through
• ability to speak and to understand what is said to you
• ability to read and write.

You may be asked to:

• Remember a list of objects.
• Repeat sentences.
• Give your name and location and the day and date.
• Solve simple math problems.
• Copy a geometric drawing.
• Draw a clock and place the numbers and hands correctly.

In addition to asking questions, your healthcare provider observes your general behavior during the exam.

Cranial nerves

The cranial nerves relay messages between the brain and the head and neck. They control vision, smell, and movement of the tongue and vocal cords. The cranial nerve exam commonly tests:

• eyelid strength and function
• vision
• how the pupils of the eye respond to light
• eye muscle movements
• strength of facial muscles
• gag reflex
• tongue and lip movements
• ability to smell and taste
• hearing
• sensation in the face, head, and neck.

Motor system

The motor system includes your muscles and the nerves that control your muscles. You are usually asked to undress, so your provider can see the muscles and look for shrinkage, twitching, or abnormal movements. Tests are done to check the strength of your muscles. Your provider may also check for the Babinski response. To do this test, he or she will strokes or scratch, heel-to-toe, the outer side of the sole of the foot. In people over the age of 2, the toes normally curl downward in response to this touch. If the toes fan upward, you may have a brain or spinal cord disorder or injury.

Reflexes

Normally, when a specific area of a muscle tendon is tapped with a soft rubber hammer, the muscles contract. Abnormal responses may mean problems with the nervous system. Many tendon reflexes can be tested. The tendons most often tested are at the knee, ankle, elbow, and wrist.

Senses

A sensory exam involves checking your response to pain, temperature, and pressure. For example, pinpricks may be used to test your response to pain. The exam can compare your response in different parts or opposite sides of your body. A cold or warm object may be used to test your sensation of temperature. You may be asked to close your eyes and tell which direction the provider is moving a part of your body such as the big toe. You may be asked to identify objects with your eyes closed or identify numbers or letters traced on your body.

The sensory exam should be repeated to provide accurate results. Your responses may be affected by how alert, aware, and well rested you are. The sensory exam is usually one of the first tests done during a neurological exam.

Coordination

This part of the exam can show if there are problems in the part of the brain that controls voluntary movement and coordination. You may be asked to:

• Move your finger from your nose to the provider's finger, going back and forth from nose to finger, touching the tip of each.
• Tap your fingers together quickly or move your hands one on top of the other, back and forth, as smoothly as you can.
• Rub one heel up and down smoothly over the other shin.

Walking

Walking depends on many different parts of the nervous system. It can be affected by many disorders. By observing the way you walk, your provider can gather important clues about what might be wrong. You are usually asked to walk in different ways:

• Walk heel to toe in a straight line.
• Turn quickly.
• Walk on your toes.
• Walk on your heels.

A neurological exam is less expensive than many other kinds of tests. It can help your provider check for problems in the brain and nervous system. For many medical conditions, early treatment can help prevent more serious problems.

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Published by RelayHealth.
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