NEUROLOGICAL EXAMINATION

BY,MR. RAMPRASAD.S M.SC NURSING

ASST.PROFESSOR

DEPT.MEDICAL SURGICAL

NEUROSCIENCES NURSING

GOPALA GOWDA SHANTHAVERI MEMORIAL COLLEGE OF

NURSING, MYSORE.

A MECHANIC DOES NOT NEED TO USE

EVERY TOOL ON EVERY PROJECT

REQUIRED TOOLS ARE

STEPS

1. A COMPREHENSIVE HISTORY

2. A NEUROLOGICAL PHYSICAL

EXAMINATION

3. GENERAL AND SPECIFIC

NEUROLOGICAL STUDIES

A PROPER NEUROLOGIC

EXAMINATION BEGINS WITH A

CAREFUL CLINICAL HISTORY

http://www.cbu.edu/~mcondren/IRM/Stop-Look-Listen-sign-IRM-7-7-07.jpg

A COMPREHENSIVE HISTORY

1. DEMOGRAPHICAL DATA

2. CURRENT HEALTH

1. Chief complaints

2. Symptom analysis

3. PAST HISTORY

1.Childhood infectious diseases, immunization

2. Major illness

3. Growth and development

4. FAMILY HEALTH HISTORY

5. PSYCHO SOCIAL HISTROY

6. REVIEW OF SYSTEMS

PHYSICAL EXAMINATION

1. VITAL SIGNS

2. MENTAL STATUS

3. HEAD, NECK, BACK

4. CRANIAL NERVES

5. MOTOR SYSTEMS

6. SENSORY FUNCTION

7. REFLEXES

8. ANS

MENTAL STATUS

1. LOC

2. ORIENTATION

3. MEMORY

4. MOOD AND AFFECT

5. INTELLECTURAL PERFORMANCE

6. JUDGEMENT AND INSIGHT

1. LANGUAGE AND COMMUNICATION

2. INTEGRATED SENSORY FUNCTIONS

GLASGOW COMA SCALE

HEAD NECK AND BACK

1. INSPECTION

2. PALPATION

3. PERCUSSION

4. AUSCULTATION

CRANIAL NERVES FUNCTION TEST

1. OLFACTION

Test by asking if patients can

smell,coffee,vanilla, or cinnamon in

each nostril. Avoid noxious odors

2. OPTIC

Visual Acuity (test with hand card)

Visual Fields (can be tested at the bedside by

counting fingers in each quadrant)

OCULOMOTOR NERVE

The size and shape of the pupil should be

recorded at rest. Under normal

conditions, the pupil constricts in

response to light. by having the patient

follow an object moved across their full

range of horizontal and vertical

eyemovements.

TRIGEMINAL NERVE

1. Cotton fore head,cheeks,jaw Check for tactile sensation

2. Sharp and blunt edge of the tongue blade check for pain sensations

3. Hot and cold water test tubes check

for temperature.

4. Eyes looks up cotton against

temporal surface of the cornea

blinking

FACIAL NERVE

Observe symmetry while patient performs

facial movements, smiles, elevates eye

brow.

ACOUSTIC NERVE

GLASSO PHARYNGEAL NERVE

Ability to swallow and discriminate

between sugar and salt on posterior

third of the tongue.

VAGUS NERVE

Depress the tongue blade n

posterior tongue and stimulate the

posterior pharynx to elicit gag reflex

see hoarseness of the voice.

SPINAL ACCESSORY NERVE

Ask the patient to shrug their

shoulders, turn their head in both

directions, and raise their head from

the bed, flexing forward against the

force of your hands.

HYPOGLOSSAL NERVE

Protrude the tongue note for any

deviation and tremors.

EXAMINING THE MOTOR SYSTEM

1. MUSCLE STRENGTH

2. BALANCE AND CO-ORDINATION

A. POINT TO POINT TEST

B. ROMBERG TEST

3. GAIT

4. ARM BOUNCE

Upper extremity

1. Pat the thigh with each hand separately

2. Alternatively pronate and supinate the

hand

3. Touch each fingers with the thumb in a

consecutive manner

4. Finger to nose {eye open and eye

closed }

Lower extremity

Run the patient heel down the anterior

surface of the tibia of the other leg.

COORDINATION TEST

1. Romberg test

Stand with feel together and arm at the

Side, both with eye closed and eye open

stand for 20-30 sec.

EXAMING THE REFLEXES

1. BICEPS REFLEX

2. TRICEPS REFLEX

3. BRACHIO RADIALIS REFLEX

4. PATELLAR REFLEX

5. ANKLE REFLEX

6. CLONOUS

7. SUPERFICIAL REFLEX

1. Biceps reflex

Response is flexion at the elbow and

contraction of the biceps

2. Triceps reflex

Response is extension of the elbow and

contraction of the triceps muscle

3. Brachio radialis reflex

Response is flexion and supination of the

fore arm

4. Patellar reflex

Response is contraction of the quadriceps

and knee extension are normal

5. Ankle reflex

Response is plantar flexion

6. Clonus reflex

Unsustained clonus is normal

7. Corneal reflex

Blink and tearing are normal

8. Gag reflex

Equal elevation of the uvula and gag

with stimulation

9. Plantar reflex

Flexion of the toe is normal response

10. Babinski reflex

Toes are contract and draw together

is normal

1. Tactile sensation

2. Pain sensation

3. Proprioception