Neurological Assessment

Mr. Nikhil D Ketkar ( MSc Nursing )

A neurological examination, also called a neuro exam, is an evaluation of a person's
nervous system that can be performed in the physician's office. It may be performed with
instruments, such as lights and reflex hammers, and usually does not cause any pain to the
patient. The nervous system consists of the brain, the spinal cord, and the nerves from these
areas. There are many aspects of this examination, including an assessment of motor and
sensory skills, balance and coordination, mental status (the patient's level of awareness and
interaction with the environment), reflexes, and functioning of the nerves. The extent of the
examination depends on many factors, including the initial problem that the patient is
experiencing, the age of the patient, and the condition of the patient.
A complete and thorough evaluation of a person's nervous system is important if there
is any reason to think there may be an underlying problem, or during a complete physical.
Damage to the nervous system can cause problems in daily functioning. Early identification
may help to identify the cause and decrease long-term complications. A complete neurological
examination may be performed:
 during a routine physical.
 following any type of trauma.
 to follow the progression of a disease.
 if the person has any of the following complaints:
o headaches
o blurry vision
o change in behavior
o fatigue
o change in balance or coordination
o numbness or tingling in the arms or legs
o decrease in movement of the arms or legs
o injury to the head, neck, or back
o fever
o seizures
o slurred speech
o weakness
o tremor

1
during a neurological examination
During a neurological examination, the physician will "test" the functioning of the
nervous system. The nervous system is very complex and controls many parts of the body.
The nervous system consists of the brain, spinal cord, 12 nerves that come from the brain, and
the nerves that come from the spinal cord. In infants and younger children, a neurological
examination includes the measurement of the head circumference. The following is an
overview of some of the areas that may be tested and evaluated during a neurological
examination:
 Mental Status
Mental status (the patient's level of awareness and interaction with the environment)
may be assessed by conversing with the patient and establishing their awareness of
person, place, and time. The person will also be observed for clear speech and making
sense while talking. This is usually done by the patient's physician just by being in the
room with the patient during normal interactions.
 Motor Function And Balance
This may be tested by having the patient push and pull against the physician's hands
with his/her arms and legs. Balance may be checked by having the patient stand with
his/her eyes closed while being gently pushed to one side or the other. The patient's
joints may also be checked simply by passive (performed by the physician) and active
(performed by the patient) movement.
 Sensory Examination
The patient's physician may also perform a sensory test which tests his/her ability to
feel. This may be done by using different instruments: dull needles, tuning forks,
alcohol swabs, or other objects. The physician may touch the patient's legs, arms, or
other parts of the body and have him/her identify the sensation (i.e., hot/cold,
sharp/dull).
 Newborn And Infant Reflexes
There are different types of reflexes that may be tested. In newborns and infants,
reflexes called infant reflexes (or automatisms) are evaluated. Each of these reflexes
disappears at a certain age as the infant grows. These reflexes include, but are not
limited to, the following:
o blinking - an infant will close his/her eyes in response to bright lights.
o Babinski reflex - as the infant's foot is stroked, the toes will extend upward.

2
 o crawling - if the infant is placed on his/her abdomen, crawling motions will be
made.
o Moro's reflex - a quick change in the infant's position will cause the infant to
throw the arms outward, open the hands, and throw back the head.
o palmar and plantar grasp - the infant's fingers or toes will curl around a finger
placed in the area.
o startle - a loud noise will cause the infant to extend and flex the arms while the
hands remain in a fist.
 Reflexes In The Older Child And Adult
These are usually examined with the use of a reflex hammer. The reflex hammer
is used at different points on the body to test numerous reflexes, which are noted by
the movement that the hammer causes.
 Evaluation Of The Nerves Of The Brain
There are 12 main nerves of the brain, called the cranial nerves. During a
complete neurological examination, most of these nerves are evaluated to help
determine the functioning of the brain:
o cranial nerve I (olfactory nerve)
This is the nerve of smell. The patient may be asked to identify different smells
with his/her eyes closed.
o cranial nerve II (optic nerve)
This is one of the nerves of the eye that helps control vision. A visual test may be
given and the patient's eye may be examined with a special light.
o cranial nerve III (oculomotor)
This is another nerve that controls part of the eye. This nerve is responsible for
the pupil size and the movement of the eye. The patient's physician may
examine the pupil (the black part of the eye) with a light and have the patient
follow the light in various directions.
o cranial nerve IV (trochlear nerve)
This nerve also helps with the movement of the eyes.
o cranial nerve V (trigeminal nerve)
This nerve allows for many functions, including the ability to feel the face, inside
the mouth, and move the muscles involved with chewing. The patient's
physician may touch the face at different areas and watch the patient as he/she
bites down.

3
 o cranial nerve VI (abducens nerve)
This nerve helps with the movement of the eyes. The patient may be asked to
follow a light or finger to move the eyes.
o cranial nerve VII (facial nerve)
This nerve is responsible for various functions, including the movement of the
face muscle and taste. The patient may be asked to identify different tastes
(sweet, sour, bitter), asked to smile, move the cheeks, or show the teeth.
o cranial nerve VIII (acoustic nerve)
This nerve is involved with hearing. A hearing test may be performed on the
patient.
o cranial nerve IX (glossopharyngeal nerve)
This nerve is involved with taste. Once again, the patient may be asked to
identify different tastes on the back of the tongue.
o cranial nerve X (vagus nerve)
This nerve is mainly responsible for the ability to swallow, the gag reflex, some
taste, and part of speech. The patient may be asked to swallow and a tongue
blade may be used to elicit the gag response.
o cranial nerve XI (accessory nerve)
This nerve is involved in the movement of the shoulders and neck. The patient
may be asked to turn his/her head from side to side against mild resistance, or
to shrug the shoulders.
o cranial nerve XII (hypoglossal nerve)
The final cranial nerve is mainly responsible for movement of the tongue. The
patient may be instructed to stick out his/her tongue and speak.

DIAGNOSTIC TESTS FOR NEUROLOGICAL DISORDERS

Evaluating and diagnosing damage to the nervous system is complicated and complex.
Many of the same symptoms occur in different combinations among the different disorders.
To further complicate the diagnostic process, many disorders do not have definitive causes,
markers, or tests.
In addition to a complete medical history and physical examination, diagnostic
procedures for nervous system disorders may include the following:
 Computed Tomography Scan (Also Called A CT OR CAT SCAN.) - a diagnostic
imaging procedure that uses a combination of x-rays and computer technology to

4
 produce cross-sectional images (often called slices), both horizontally and vertically, of
the body. A CT scan shows detailed images of any part of the body, including the bones,
muscles, fat, and organs. CT scans are more detailed than general x-rays.
 Electroencephalogram (EEG) - a procedure that records the brain's continuous,
electrical activity by means of electrodes attached to the scalp.
 Magnetic Resonance Imaging (MRI) - a diagnostic procedure that uses a combination
of large magnets, radiofrequencies, and a computer to produce detailed images of
organs and structures within the body.
 Electrodiagnostic tests (i.e., electromyography (EMG) And Nerve Conduction
Velocity, or NCV) - studies that evaluate and diagnose disorders of the muscles and
motor neurons. Electrodes are inserted into the muscle, or placed on the skin overlying
a muscle or muscle group, and electrical activity and muscle response are recorded.
 Positron Emission Tomography (PET) - in nuclear medicine, a procedure that
measures the metabolic activity of cells.
 Arteriogram (Also called an angiogram.) - an x-ray of the arteries and veins to
detect blockage or narrowing of the vessels.
 Spinal Tap (Also called a lumbar puncture.) - a special needle is placed into the
lower back, into the spinal canal. This is the area around the spinal cord. The pressure
in the spinal canal and brain can then be measured. A small amount of cerebral spinal
fluid (CSF) can be removed and sent for testing to determine if there is an infection or
other problems. CSF is the fluid that bathes the brain and spinal cord.
 Evoked Potentials - procedures that record the brain's electrical response to visual,
auditory and sensory stimuli.
 Myelogram - a procedure that uses dye injected into the spinal canal to make the
structure clearly visible on x-rays.
 Neurosonography - a procedure that uses ultra high-frequency sound waves that
enable the physician to analyze blood flow in cases of possible stroke.
 Ultrasound (Also Called Sonography.) - a diagnostic imaging technique which uses
high-frequency sound waves and a computer to create images of blood vessels, tissues,
and organs. Ultrasounds are used to view internal organs as they function, and to
assess blood flow through various vessels.