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Information about Neurological Examination

The neurological examination is the physical examination of the nervous system. It attempts to identify or exclude signs of nervous system disease, and - if these signs are present - to produce a likely anatomical or physiological explanation that can be tested through medical imaging, neurophysiology, blood tests, lumbar puncture or a combination.

The Neurological Examination is directed primarily towards the localization of lesions within the nervous system and is traditionally split into an examination of the cognitive state, cranial nerves, motor system, sensory system, cerebellar system, walking and gait and the extrapyramidal system.

Central nervous system

Peripheral nervous system

  • Cranial nerves (I-XII): sense of smell (I), visual fields and acuity (II), eye movements (III, IV, VI) and pupils (III, sympathetic and parasympathetic), sensory function of face (V), strength of facial (VII) and shoulder girdle muscles (XI), hearing (VII, VIII), taste (VII, IX, X), pharyngeal movement and reflex (IX), tongue movements (XII)
  • Reflexes: masseter, biceps and triceps tendon, knee tendon, ankle jerk and plantar (i.e. Babinski sign). Globally, brisk reflexes suggest an abnormality of the UMN or pyramidal tract, while decreased reflexes suggest abnormality in the anterior horn, LMN, peripheral nerve or motor end plate. A reflex hammer is used for this testing.
  • Muscle strength (typically graded on the MRC scale I-V)
  • Sensory system (to fine touch, pain, temperature)
  • Muscle tone and signs of rigidity

Specific tests

  • Finger-to-nose and ankle-over-tibia tests for ataxia
  • Various tests for dysdiadochokinesis
  • Tests for cogwheeling (abnormal tone suggestive of Parkinson's disease) or gegenhalten (more common in dementia). Gegenhalten is resistance to passive change, where the strength of antagonist muscles increases with increasing examiner force.
  • Closer examination of any tremors
  • Assessment of gait

Interpretation

The results of the examination are taken together to anatomically identify the lesion. This may be diffuse (e.g. neuromuscular diseases, encephalopathy) or highly specific (e.g. abnormal sensation in one dermatome due to compression of a specific spinal nerve by a tumor deposit). A differential diagnosis may then be constructed that takes into account the patient's background (e.g. previous cancer, autoimmune diathesis) and present findings to include the most likely causes. Examinations are aimed at ruling out the most clinically significant causes (even if relatively rare, e.g. brain tumor in a patient with subtle word finding abnormalities but no increased intracranial pressure) and ruling in the most likely causes.

External links

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Physical examination
Physical examination or clinical examination is the process by which a health care provider investigates the body of a patient for signs of disease. It generally follows the taking of the medical history — an account of the symptoms as experienced by the patient.
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nervous system of an animal coordinates the activity of the muscles, monitors the organs, constructs and also stops input from the senses, and initiates actions. Prominent parts of a nervous system include neurons and nerves, which are used in coordination.
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A medical test is any kind of medical procedure performed to aid in the detection or diagnosis of disease, or to guide its treatment.
  • A screening test is a simple test used to detect the presence of disease in individuals in a defined population.

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See also: Radiology, Radiography
Medical imaging refers to the techniques and processes used to create images of the human body (or parts thereof) for clinical purposes (medical procedures seeking to reveal, diagnose or examine disease) or medical science
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Neurophysiology is a part of physiology. Neurophysiology is the study of nervous system function. Primarily, it is connected with neurophysiology and also to with neurobiology, psychology, neurology, clinical neurophysiology, electrophysiology, ethology, neuroanatomy, cognitive
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Blood tests are laboratory tests done on blood to gain an appreciation of disease states and the function of organs. Since blood flows throughout the body, acting as a medium for providing oxygen and other nutrients, and drawing waste products back to the excretory systems for
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lumbar puncture (colloquially known as a spinal tap) is a diagnostic and at times therapeutic procedure that is performed in order to collect a sample of cerebrospinal fluid (CSF) for biochemical, microbiological, and cytological analysis, or—rarely—to relieve
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The central nervous system (CNS) represents the largest part of the nervous system, including the brain and the spinal cord. Together with the peripheral nervous system, it has a fundamental role in the control of behavior.
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Consciousness is a characteristic of the mind generally regarded to comprise qualities such as subjectivity, self-awareness, sentience, sapience, and the ability to perceive the relationship between oneself and one's environment.
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The Glasgow Coma Scale is a neurological scale which aims to give a reliable, objective way of recording the conscious state of a person, for initial as well as continuing assessment.
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Mental status examination, or MSE, is a medical process where a clinician working in the field of mental health (usually a psychotherapist, social worker, psychiatrist, psychiatric nurse or psychologist) systematically examines a patient's mind.
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The abbreviated mental test score (AMTS) was introduced by Hodkinson in 1972 to rapidly assess elderly patients for the possibility of dementia. Its uses in medicine have become somewhat wider, e.g.
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The mini-mental state examination (MMSE) or Folstein test is a brief 30-point questionnaire test that is used to assess cognition. It is commonly used in medicine to screen for dementia.
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Intracranial pressure, (ICP), is the pressure exerted by the cranium on the brain tissue, cerebrospinal fluid (CSF), and the brain's circulating blood volume. ICP is a dynamic phenomenon constantly fluctuating in response to activities such as exercise, coughing, straining,
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The ophthalmoscope is an instrument used to examine the eye. Its use is crucial in determining the health of the retina and the vitreous humor.

In patients with headaches, the finding of swollen optic discs, or papilledema, on ophthalmoscopy is a key sign, as this indicates
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The Peripheral nervous system resides or extends outside the "CNS" central nervous system (the brain and spinal cord) to serve the limbs and organs. Unlike the central nervous system, however, the PNS is not protected by bone, leaving it exposed to toxins and mechanical injuries.
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Cranial nerves are nerves that emerge directly from the brain in contrast to spinal nerves which emerge from segments of the spinal cord. Although thirteen cranial nerves in humans fit this description, twelve are conventionally recognized.
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ReFLEX is a wireless protocol developed by Motorola which is used for two-way paging. It is based on the one-way FLEX protocol and comes in two variants, ReFLEX25 and ReFLEX50. Later version 2.7 of the ReFLEX protocol was released. Devices compliant with ReFLEX 2.7.
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In medicine and neurology, the Babinski reflex or Babinski sign is a reflex that can identify disease of the spinal cord and brain and also exists as a primitive reflex in infants.
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In medicine and neurology, the Babinski reflex or Babinski sign is a reflex that can identify disease of the spinal cord and brain and also exists as a primitive reflex in infants.
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Upper motor neurons are motor neurons that originate in motor region of the cerebral cortex or the brain stem and carry motor information down to the final common pathway, that is, any motor neurons that are not directly responsible for stimulating the target muscle.
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The corticospinal or pyramidal tract is a massive collection of axons that travel between the cerebral cortex of the brain and the spinal cord.

The corticospinal tract mostly contains motor axons.
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The term Anterior horn can refer to two separate anatomical structures within the central nervous system:
  • The anterior division of the lateral ventricle of the brain.
  • The Anterior horn of the spinal cord.

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Lower motor neurons (LMNs) are the motor neurons connecting the brainstem and spinal cord to muscle fibers, bringing the nerve impulses from the upper motor neurons out to the muscles.
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The Peripheral nervous system resides or extends outside the "CNS" central nervous system (the brain and spinal cord) to serve the limbs and organs. Unlike the central nervous system, however, the PNS is not protected by bone, leaving it exposed to toxins and mechanical injuries.
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neuromuscular junction (NMJ) is the synapse or junction of the axon terminal of a motoneuron with the motor end plate, the highly-excitable region of muscle fiber plasma membrane responsible for initiation of action potentials across the muscle's surface, ultimately
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A reflex hammer is a medical instrument used by physicians to test deep tendon reflexes. Testing for reflexes is an important part of the neurological physical examination in order to detect abnormalities in the central or peripheral nervous system.
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MUSCLE (multiple sequence comparison by log-expectation) is public domain, multiple sequence alignment software for protein and nucleotide sequences.
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The Medical Research Council (MRC) is a UK organisation dedicated to "promot[ing] the balanced development of medical and related biological research in the UK".

Organisation


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sensory system: in this case, vision, for the visual system. ]]

A sensory system is a part of the nervous system responsible for processing sensory information.
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