Neurological Examination - List of Tests

List of Tests

Specific tests in a neurological examination include:

Category Tests Example of writeup
Mental status examination
  • The assessment of consciousness, often using the Glasgow Coma Scale (EMV)
  • Mental status examination, often including the abbreviated mental test score (AMTS) or mini mental state examination (MMSE)
  • Global assessment of higher functions
  • Intracranial pressure is roughly estimated by fundoscopy; this also enables assessment for microvascular disease.
 "A&O x 3, short and long-term memory intact"
Cranial nerve examination 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). These are tested by their individual purposes (e.g. the visual acuity can be tested by a Snellen chart). "CNII-XII grossly intact"
Motor system
  • Muscle strength, often graded on the MRC scale 0 to 5 (i.e. 0 = Complete Paralysis to 5 = Normal Power).
    • grades 4 -, 4 and 4+ maybe used to indicate movement against slight, moderate and strong resistance respectively.
  • Muscle tone and signs of rigidity.
  • Examination of posture
    • Decerebrate
    • Decorticate
    • Hemiparetic
  • Resting tremors
  • Abnormal movements
    • Seizure
    • Fasciculations
    • Tone
      • Spasticity
        • Pronator drift
      • Rigidity
        • Cogwheeling (abnormal tone suggestive of Parkinson's disease)
        • Gegenhalten - is resistance to passive change, where the strength of antagonist muscles increases with increasing examiner force. More common in dementia.
 "strength 5/5 throughout, tone WNL"
Deep tendon reflexes 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, nerve or motor end plate. A reflex hammer is used for this testing. "2+ symmetric, downgoing plantar reflex"
Sensation

Sensory system testing involves provoking sensations of fine touch, pain and temperature. Fine touch can be evaluated with a monofilament test, touching various dermatomes with a nylon monofilament to detect any subjective absence of touch perception.

  • Sensory
    • Light touch
    • Pain
    • Temperature
    • Vibration
    • Position sense
    • Graphesthesia
    • Stereognosis, and
    • Two-point discrimination (for discriminative sense)
    • Extinction
    • Romberg test - 2 out of the following 3 must be intact to maintain balance: i. vision ii. vestibulocochlear system iii. epicritic sensation
 "intact to sharp and dull throughout"
Cerebellum
  • Cerebellar testing
    • Dysmetria
      • Finger-to-nose test
      • Ankle-over-tibia test
    • Dysdiadochokinesis
      • Rapid pronation-supination
    • Ataxia
      • Assessment of gait
    • Nystagmus
    • Intention tremor
    • Staccato speech
 "intact finger-to-nose, gait WNL"

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