Neurologic Exam

Aka: Neurologic Exam

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II. Exam: Highest yield tests

  1. Cranial Nerve tests
    1. Visual Field testing with double stimulation upper fields and lower fields
    2. Extraocular Movements
  2. Motor Strength
    1. Upper extremity
      1. Grip strength
      2. Proximal Muscle Strength
    2. Lower extremity
      1. Heel Walk and Toe Walk
      2. Stand from chair without pushing off
        1. See Get Up and Go Test
  3. Balance and coordination
    1. Romberg Test
    2. Tandem Walking

III. Exam: General

  1. See Appearance, Behavior and Attitude Exam
  2. Personal Appearance
    1. Well groomed or unkempt
  3. Eye contact
    1. Good, fleeting, sporadic or avoidant
  4. Observable Behavior
    1. Cooperative, candid, withdrawn, guarded, hostile or irritable

IV. Exam: Eye

  1. See Eye Neurologic Exam
  2. See Extraocular Movement
  3. See Pupil and Pupil Constriction
  4. See Visual Acuity
  5. See Visual Field
  6. Abnormal Findings
    1. Acute Vision Loss or Visual Field Deficit
    2. Pupil Abnormalities (Anisocoria, Mydriasis, Miosis)
    3. Eye Deviation
    4. Nystagmus
    5. Internuclear Ophthalmoplegia
    6. Altered Conjugate Gaze

V. Exam: Face

  1. See Cranial Nerve Exam
  2. Palpebral fissures equal
  3. Facial symmetry (smile, puff cheeks)
  4. Eyelid opening and closing against resistance
  5. Jaw symmetric
  6. Abnormal Findings
    1. Eyelid Ptosis (CN 3) or incomplete closure (peripheral CN 7)
    2. Facial Nerve Palsy (forehead involved in peripheral CN 7)

VI. Exam: Oropharynx

  1. Uvula rises to phonation (CN 9, CN 10)
  2. Gag Reflex
  3. Swallow reflex
  4. Regurgitation (nasal or liquid)
  5. Tongue midline with no tongue Fasciculations (CN12)

VII. Exam: Larynx and Language

  1. Voice quality
    1. See Hoarseness
  2. Speech Exam
    1. Dysarthria (explosive or nasal)
    2. Aphasia (Inability to communicate via speech, writing, reading)

VIII. Exam: Sensory Exam

  1. See Sensory Exam (includes Dermatome)
  2. Two Point Discrimination
  3. Sharp and dull discrimination
  4. Proprioception (finger up or down?)
  5. Stereography

IX. Exam: Motor Exam

  1. See Motor Exam
  2. Motor Strength
  3. Tone (flaccid, rigid, or cogwheel)
  4. Atrophy
  5. Fasciculations
  6. Muscle tenderness
  7. Tremor

X. Exam: Reflexes

  1. See Deep Tendon Reflexes
  2. Primitive Reflexes
    1. Babinski Reflex
    2. Grasp Reflex
    3. Suck Reflex
    4. Glabellar Reflex
    5. Hoffman Reflex

XI. Exam: Cerebellar

  1. Finger-Nose-Finger
    1. Dysmetria
    2. Overshooting target
    3. Intention Tremor
  2. Rapid Alternating Movements
  3. Heel-Knee-Shin
  4. Romberg Test
  5. Vestibular Exam
  6. Gait
    1. See Gait and Stance Exam
    2. Walking on base of foot
    3. Tandem Walking
    4. Overall coordination

XII. Exam: Mental Status

  1. Appearance, Behavior and Attitude Exam
  2. Attention and Concentration
  3. Higher Integrative Function (Executive Function, Intellectual Function)
  4. Thought Process ( Thought Content, Thought Form, Delusion, Obsession, Abstract Thought)
  5. Speech Exam
  6. Affect Examination
  7. Insight and Judgement
  8. Memory Evaluation
  9. Orientation Exam
  10. Perception Exam ( Misperception, Illusion, Hallucination)

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