A neurological exam assesses the nervous system’s ability to process sensory input and produce a response. The exam includes assessments of general appearance, mental status, cranial nerves, motor system, sensory system, reflexes, coordination, and gait. The doctor evaluates posture, motor skills, tremors, and vital signs. The exam also tests the patient’s ability to think, feel pain, temperature, and light touch, and involuntary responses to stimuli. Coordination, gait, and balance are also evaluated.
A doctor performs a neurological exam to check how well a patient’s nervous system is functioning. The nervous system is a network of nervous tissues that must accept and process sensory input, and then produce a response to stimuli. Sensory input includes factors both external to and internal to the body, including pain, temperature, taste, pressure, blood pH, light, hormone levels, and sound, among other stimuli. If a patient or doctor suspects that the nervous system may be compromised, a doctor may perform a neurological exam to look for possible problems. The exam consists of several parts; an assessment of general appearance, mental status, cranial nerves, motor system, sensory system, reflexes, and finally coordination and gait.
A doctor will likely begin a neurological exam by talking to the patient and noting the patient’s posture, alertness, and motor skills. Motor skills are the body’s ability to move efficiently. A doctor will be especially on the lookout for tremors called fasciculations, sudden, jerky movements called chorea, and sustained twitching of the mouth, eyes, tongue, back, or mouth called dystonia. Vital signs, such as blood pressure and heart rate, obesity, abnormal thinness, deformities, and abnormal proportions, such as dilated eyes or low-set ears, should also be noted.
The mental status portion of a neurological exam consists of several questions that test the patient’s ability to think correctly. This may include drawing, writing, reading, command obedience, and memory exercises. Any changes in intellectual ability or speech patterns, such as the ability to speak fluently, should be evaluated, as these could be signs of a neurological problem.
The doctor then subjects the patient to several tests that help evaluate the individual function of the cranial nerves, which supply movement and sensation to the face. Eye movement, pupil dilation, vision in each eye, smell through each nostril, facial muscle function, tongue function, swallowing, and sensation in different parts of the face are examined with particular attention to symmetry. The movement, look and feel should be the same on both sides of the face.
The motor system phase of the neurological exam evaluates strength and muscle tone throughout the body. The patient will likely undress for this exam, as the doctor needs to evaluate the appearance of the muscles, looking for muscle overgrowth or wasting. The doctor may ask the patient to flex and extend muscles, fan fingers, grasp objects, and use muscles against resistance.
Sensory testing tests the patient’s ability to feel pain, temperature, position, and light touch. Tests may include a pin prick, asking the patient to close their eyes and identify a number written on their back or palm, or close their eyes and identify where it is touched on her body. A problem with the sensory system may indicate disorders such as thiamine deficiency, neurotoxic damage, or diabetes mellitus.
The doctor will then test the patient’s reflexes, the body’s involuntary responses to stimuli. This is usually done with a small reflex hammer that is struck against the tendons or muscles in the body. The classic example of this test occurs when the tendon just below the knee is struck, resulting in a kick of the lower leg.
The final tests in a neurological exam include coordination, gait, and balance. To test coordination, a doctor may ask the patient to repeat rapid movements on command, touch the nose with one finger, and then touch the tip of the doctor’s finger with one finger and slide the heel of the foot along the opposite shin. The physician tests gait by assessing the patient’s ability to walk smoothly, commanding the patient to walk normally, walk with one foot directly in front of the other, walk on heels, and walk on toes. Finally, the doctor may perform the Romberg test, which asks the patient to balance by closing his eyes. If the patient cannot balance, it could be a sign of a neurological disorder.
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