Neurological Exam

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KEY POINTS

• A neurological exam is a series of questions and a physical exam to check how well your nervous system is working. It may be done as part of a complete physical exam.
• A neurological exam may check your ability to walk and balance; your muscle strength and reflexes; your ability to see, hear, smell, and taste; your ability to think, speak, and remember; and your body’s response to pain, temperature and touch.
• If your healthcare provider finds problems with your nervous system, you may be referred to a specialist for more testing or treatment.

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What is a neurological exam?

A neurological exam is a series of questions and a physical exam to check how well your nervous system is working. Many diseases, such as dementia or stroke, cause changes in your ability to think, speak, and move. A neurological exam is a way to find out what parts of your brain and body may be affected. It may be done as part of a complete physical exam. In some cases, your provider may refer you to a specialist called a neurologist.

How is the exam done?

Sense of touch (Sensations)

A sensory exam involves checking how well you sense certain kinds of sensations such as pain, temperature change, and touch. For example, pinpricks may be used to test your response to pain. The exam can compare your response at different places on one side of your body and can compare your response from one side of your body to the other. A cold or warm object may be used to see how well you feel hot and cold temperatures. You may be asked to close your eyes and say which direction your provider is moving a part of your body, such as your big toe. You may be asked to touch and identify objects with your eyes closed, or to identify numbers or letters traced on your body.

The sensory exam may be repeated at different times. Your responses may be affected by how awake and well rested you are when you have the exam.

Mental status

The mental status exam is a series of questions designed to test your:

• Mood
• Ability to pay attention
• Memory
• Judgment
• Ability to think things through
• Ability to speak and to understand what is said to you
• Ability to read and write

You may be asked to:

• Repeat a list of objects and then remember the same list a short time later
• Repeat sentences
• Say your name, where you are, the day, and the date
• Solve simple math problems
• Copy a drawing of shapes like squares or diamonds
• Draw a clock and place the numbers and hands correctly
• Answer questions, such as who the president is.

Your healthcare provider also will assess how you look and act during the exam.

Cranial nerves

The cranial nerves relay messages between your brain and your head and neck. They control functions such as vision, smell, and movement of your tongue and vocal cords. The cranial nerve exam tests:

• Eyelid strength and eye muscle movements
• Vision and how well your eyes respond to light
• Strength of facial muscles
• Gag reflex
• Tongue and lip movements
• Hearing
• Sensation in the face, head, and neck
• Ability to smell and taste

Motor system, reflexes, and coordination

The motor system includes your muscles and the nerves that control your muscles. Usually you will need to undress for this part of the exam so that your healthcare provider can see your muscles and look for shrinkage, twitching, or abnormal movements. Tests are done to check the strength of your muscles.

Your provider may also check your reflexes. Reflexes are what make your knee or elbow jerk when your provider taps on a muscle or tendon. Abnormal reflexes may mean problems with your nervous system. The areas most often tested for reflexes are the knee, ankle, elbow, and wrist.

The coordination part of the exam can show if there are problems in the part of your brain that controls movement and coordination. You may be asked to:

• Move your finger from your nose to your healthcare provider's finger, going back and forth from nose to finger, touching the tip of each.
• Tap your fingers together quickly or move your hands one on top of the other, back and forth, as quickly as you can.
• Rub one heel up and down smoothly over the other shin.

Walking and Balance

Walking and balance depend on many different parts of the nervous system. It can be affected by many disorders. By watching the way you walk, your provider can gather important clues about what might be wrong. You are usually asked to walk in different ways:

• Walk heel to toe in a straight line.
• Turn quickly.
• Walk on your toes.
• Walk on your heels.

For many medical conditions, finding the problem early and starting treatment can help prevent more serious problems.