Neurological Examination

Question 1

The broad components of the neurological exam include

Answer 1

• Cranial nerve assessment
• Cerebellar assessement
• Limb/PNS examination

Question 2

Describe the process of cranial nerve examination

Answer 2

• I - Usually omitted (sometimes coffee beans or oil of cloves)
• II - Visual acuity and fields, fundoscopy
• III, IV, V
  
  • Eye movements (look also for nystagmus and diplopia)
  • Pupil reactions
• V, VII
  
  • Facial sensorimotor, jaw jerk (close mouth, open against pressure)
  • Corneal reflex (keep eye open for this, eyelids fluttering doesn’t count!)
• VIII
  
  • Hearing, vestibular function (nystagmus)
  • Whispering ear test, Rinne and Weber’s tests
• IX, X - Uvular deviation and gag reflex
• XI - SCM, trapezius (head turning, shrugging)
• XII - Tongue protrusion

Question 3

Describe the process of assessing someone’s cerebellar function

Answer 3

• Speech - “West Register Street”
• Nystagmus
• Dysmetria - finger-nose (and with closed eyes)
• Dysdiadochokinesis - hand supination/pronation
• Coordination - heel-shin
• Gait - normal and heel-toe walk
• Romberg test - if patient is unsteady with closed eyes (positive) - proprioceptive lesion

Question 4

Describe the process of the limb neurological examination

Answer 4

• Muscle bulk
  
  • Fasciculations
  • Normal
• Tone
• Coordination
  
  • Dysdiadochokinesis (rapid alternating movements poor)
  • Dysmetria
  • Intention tremor (worsening tremor closer to completion of action)
• Stretch reflexes
• Sensation
  
  • Proprioception
  • Vibration
  • Light touch
  • Pain/temperature