Neurological Examination

What is a neurological examination?

A neurological examination, also called a neuro exam, is an evaluation of a person's nervous system that can be performed in the doctor's office. It may be performed with instruments, such as lights and reflex hammers, and usually does not cause any pain to the patient. The nervous system consists of the brain, the spinal cord, and the nerves from these areas. There are many aspects of this examination, including an assessment of motor and sensory skills, balance and coordination, mental status (the patient's level of awareness and interaction with the environment), reflexes, and functioning of the nerves. The extent of the examination depends on many factors, including the initial problem that the patient is experiencing, the age of the patient, and the condition of the patient.

Why is a neurological examination performed?

A complete and thorough evaluation of a person's nervous system is important if there is any reason to think there may be an underlying problem, or during a complete physical. Damage to the nervous system can cause problems in daily functioning. Early identification may help to identify the cause and decrease long-term complications. A complete neurological examination may be performed:

• During a routine physical

• Following any type of trauma

• To follow the progression of a disease

• If the person has any of the following complaints:

  • Headaches

  • Blurry vision

  • Change in behavior

  • Fatigue

  • Change in balance or coordination

  • Numbness or tingling in the arms or legs

  • Decrease in movement of the arms or legs

  • Injury to the head, neck, or back

  • Fever

  • Seizures

  • Slurred speech

  • Weakness

  • Tremor

What is done during a neurological examination?

During a neurological examination, the doctor will "test" the functioning of the nervous system. The nervous system is very complex and controls many parts of the body. The nervous system consists of the brain, spinal cord, 12 nerves that come from the brain, and the nerves that come from the spinal cord. The circulation to the brain, arising from the arteries in the neck, is also frequently examined. In infants and younger children, a neurological examination includes the measurement of the head circumference. The following is an overview of some of the areas that may be tested and evaluated during a neurological examination:

• Mental status Mental status (the patient's level of awareness and interaction with the environment) may be assessed by conversing with the patient and establishing his or her awareness of person, place, and time. The person will also be observed for clear speech and making sense while talking. This is usually done by the patient's physician just by observing the patient during normal interactions.

• Motor function and balance This may be tested by having the patient push and pull against the doctor's hands with his/her arms and legs. Balance may be checked by assessing how the person stands and walks or having the patient stand with his/her eyes closed while being gently pushed to one side or the other. The patient's joints may also be checked simply by passive (performed by the doctor) and active (performed by the patient) movement.

• Sensory examination The patient's doctor may also perform a sensory test that checks his/her ability to feel. This may be done by using different instruments: dull needles, tuning forks, alcohol swabs, or other objects. The physician may touch the patient's legs, arms, or other parts of the body and have him/her identify the sensation (for example, hot/cold, sharp/dull).

• Newborn and infant reflexes There are different types of reflexes that may be tested. In newborns and infants, reflexes called infant reflexes (or primitive reflexes) are evaluated. Each of these reflexes disappears at a certain age as the infant grows. These reflexes include:

  • Blinking - an infant will close his/her eyes in response to bright lights.

  • Babinski reflex - as the infant's foot is stroked, the toes will extend upward.

  • Crawling - if the infant is placed on his/her abdomen, he or she will make crawling motions.

  • Moro's reflex (or startle reflex) - a quick change in the infant's position will cause the infant to throw the arms outward, open the hands, and throw back the head.

  • Palmar and plantar grasp - the infant's fingers or toes will curl around a finger placed in the area.

• Reflexes in the older child and adult These are usually examined with the use of a reflex hammer. The reflex hammer is used at different points on the body to test numerous reflexes, which are noted by the movement that the hammer causes.

• Evaluation of the nerves of the brain There are 12 main nerves of the brain, called the cranial nerves. During a complete neurological examination, most of these nerves are evaluated to help determine the functioning of the brain:

  • Cranial nerve I (olfactory nerve) This is the nerve of smell. The patient may be asked to identify different smells with his/her eyes closed.

  • Cranial nerve II (optic nerve) This nerve carries vision to the brain. A visual test may be given and the patient's eye may be examined with a special light.

  • Cranial nerve III (oculomotor) This nerve is responsible for pupil size and certain movements of the eye. The patient's doctor may examine the pupil (the black part of the eye) with a light and have the patient follow the light in various directions.

  • Cranial nerve IV (trochlear nerve) This nerve also helps with the movement of the eyes.

  • Cranial nerve V (trigeminal nerve) This nerve allows for many functions, including the ability to feel the face, inside the mouth, and move the muscles involved with chewing. The patient's doctor may touch the face at different areas and watch the patient as he/she bites down.

  • Cranial nerve VI (abducens nerve) This nerve helps with the movement of the eyes. The patient may be asked to follow a light or finger to move the eyes.

  • Cranial nerve VII (facial nerve) This nerve is responsible for various functions, including the movement of the face muscle and taste. The patient may be asked to identify different tastes (sweet, sour, bitter), asked to smile, move the cheeks, or show the teeth.

  • Cranial nerve VIII (acoustic nerve) This nerve is the nerve of hearing. A hearing test may be performed on the patient.

  • Cranial nerve IX (glossopharyngeal nerve) This nerve is involved with taste and swallowing. Once again, the patient may be asked to identify different tastes on the back of the tongue. The gag reflex may be tested.

  • Cranial nerve X (vagus nerve) This nerve is mainly responsible for the ability to swallow, the gag reflex, some taste, and part of speech. The patient may be asked to swallow and a tongue blade may be used to elicit the gag response.

  • Cranial nerve XI (accessory nerve) This nerve is involved in the movement of the shoulders and neck. The patient may be asked to turn his/her head from side to side against mild resistance, or to shrug the shoulders.

  • Cranial nerve XII (hypoglossal nerve) The final cranial nerve is mainly responsible for movement of the tongue. The patient may be instructed to stick out his/her tongue and speak.