How To: Perform a general neurological exam on a patient

Perform a general neurological exam on a patient

As a doctor, sometimes it will be necessary to perform a neurological examination of your patient to rule out any neurological disorders. Your objective is to identify abnormalities in the nervous system, to differentiate peripheral from central nervous system lesions, and to establish internal consistency. This is a great video less that outlines the complete neurological exam procedure. It's great for medical students or doctors, and even nursing students can learn a thing or two.

Cranial Nerve Examination:
* CN II (optic): visual fields; pupillary reaction and accommodation
* CN III, IV, VI (Oculomotor, Trochlear, Abducens): extraocular movements; convergence
* CN V (trigeminal): sensory (sharp) and motor (clenches teeth while examiner palpates masseter and temporalis)
* CN VII (facial): smile, frown, puff cheeks, raise eyebrows, shut eyes while examiner attempts to pry them open
* CN VIII (auditory): finger rubs
* CN IX and X (glossopharyngeal, vagus): articulation; "ah" and note palate movement
* CN XI (accessory): shoulder shrug and neck strength against resistance
* CN XII (hypoglossal): stick out the tongue and move side to side

Special Considerations — CNVIII:
* Use tuning fork is decreased hearing (Weber test)

Motor Exam — compare side to side:
* Observe for bulk and abnormal movements
* Testing tone: passively flex and extend elbows
* Strength Testing against resistance
* Abduct shoulder
* Flex and extend elbow
* Spread fingers
* Thumb opposition to pinkie
* Flex hips
* Flex and extend knee
* Dorsiflex and plantarflex ankle

Coordination and Gait — Cerebellar Function:
* Finger to nose testing
* Heel to shin testing
* Rapid alternating movements
* Romberg Testing
* Gait: walking and turning
* Tandem gait
* Walking on heels and toes

Go to OPETA for complete written instructions, including sensory examination & reflex examination for tendon reflexes.

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