This presentation is on comprehensive yet complete bedside neurological examination including higher mental functions, cranial nerve examinations, motor examination, sensory examination, cerebellar examination, extra pyramidal system examination.

1. Dr. Suranjana Basak
DrNB Senior Registrar
Department of Neurology
Fortis Hospital, Mohali
1. Hutchinson’s textbook of clinical medicine 23rd edition
2. De Jong’s Clinical Handbook of Neurology
3. MSD Manual of Neurology
4. Handbook of Neurological Examination, Washington University
5. Handbook of Neurological Examination, Stanford University

2. 1. Mental Status : Level of Consciousness, Focal Cortical Functioning, Cognition, Mood and Affect, Thought
2. Skull, Spine and Meninges
3. Cranial Nerves
4. Motor Examination : Muscle Bulk, Tone, Strength
5. Reflexes : Superficial, Deep, Frontal Release/ Primitive
6. Sensory Examination : Lateral Spinothalamic tract , Dorsal Column
7. Cerebellar : Coordination, Truncal Stability, Gait, Station
8. Extra-Pyramidal

3. 1. Level of Consciousness: Awake / Stupurous / Comatose
Brain Reticular Activating system +/- Cerebral Hemisphere
2. Attentiveness
3. Orientation
Name/Location/Date

5. 5. Memory
Registration
Immediate Recall
Recent Memory
Remote Memory

6. 6. Higher Mental Functions
Thinking
Abstract
Judgement
Reasoning
Intellect
Construction
Agnosia: Defect in recognising a complex sensory stimulus.
Lesion involving “association cortex” in parietal and temporal lobes in
either dominant/non dominant hemisphere
Ex: Anosognosia : Denial of illness
Asomatagnosia : Denial of half of one’s body
Prosopagnosia : Inability to recognise faces
Extinction to double simultaneous stimulation
Geographic Disorientation
Apraxia: Defect in performance of a complex motor task
Lesion involving “association cortex” in frontal lobes of dominant or non
dominant hemispheres.
Ex: Ideomotor Apraxia : Inability to perform motor tasks on command
Ideational Apraxia : Inability to plan a series of complex tasks
Constructional Apraxia : Inability to copy complex figures.
Dressing Apraxia : Inability to dress oneself.

8. 7. Mood : Refers to how the patient feels
8. Affect : Refers to how the patient appears to others
9. Thought Content : Abnormal thought content such as hallucinations, paranoid behaviour,
psychosis, delirium to be noted

9. Skull : Defects secondary to trauma/ surgery
Burr holes - previous subdural/ epidural hematomas
Hematomas - Raccoon eyes , Battle sign (Basilar skull fracture)
CSF rhinorrhea/ otorrhea
Bruits over orbit/ mastoid process/ temporal (AV malformation)
Spine: Scoliosis (weakness of paraspinal muscles)
ROM (OA, Meningismus)
Straight Leg Raising test / Sciatic Stretch test / Lasague test/
Bragard Test (L4-S2)
Meninges: Neck Rigidity
Brudzinski sign
Kernig Sign

10. sensory sensory
motor
motor
motor
sensory
motor
motor
both
both
both
both

11. Visual Acuity - Snellen Chart, Jeager chart
Visual Field
Fundoscopy

12. Pupil size - miotic, mydriatic,
anisocoric
Pupillary light response
Ocular movements -
i. Vestibulo-Ocular Reflex
(VOR)/Doll’s Eye
ii. Visual Pursuit
iii. Visual Saccade
Ptosis

14. Motor : Symmetry, UMN/LMN
Taste : Sugar-Salt of anterior
tongue

16. Gag reflex
Healthy side deviation : CN 7, 10 palsy Ipsilateral side deviation : CN 5, 12

17. Muscle Bulk : Denervation Atrophy/ Disuse Atrophy
Muscle Tone

18. Intrinsic muscles of hand Thenar- OP, APB, FPB, Hypothenar- ODMADM, FDMB C8, T1
Finger Flexion Palmar Interossei, FDS C7, C8, T1
Wrist Flexion FCU, FCR, PL C7, C8, T1
Wrist Extension ECRL, ECRB, ECU C6, C7, C8
Elbow Flexion Biceps brachii, Coracobrachialis and Brachialis C5, C6
Elbow Extension Triceps brachii C7, C8
Shoulder Abduction Supraspinatus, Deltoid, Trapezius, Serratus anterior C5 - T1
Shoulder Adduction Teres major, Latissimus dorsi and Pectoralis major C5, C6
Hip Flexion Iliac, Psoas, Pectineus, Rectus femoris, Sartorius, L2,L3,L4
Hip Extension Gluteus maximus, Biceps femoris, Semitendinosus, Semimembranosus L5, S1
Hip Abduction Gluteus medius, gluteus minimus, tensor fascia latae L4, L5, S1
Hip Adduction Adductor longus, Brevis, Magnus, Gracilis L2, L3, L4
Knee Flexion Hamstrings, Biceps femoris L5, S1, S2
Knee Extension Rectus femoris, Vastus medialis, Lateralis, Intermedius L2, L3, L4
Ankle Dorsiflexion Tibialis anterior, EHL L4, L5
Ankle Plantarflexion Soleus, Gastrocnemius S1, S2
Foot Inversion Tibias Anterior, Posterior L5
Foot Eversion Fibularis longus, brevis S1

19. Abdominal Reflex
Upper - T6-T9
Lower - T10-T12
Anal wink reflex S3-S5
Cremasteric reflex L1-L2
Bulbo-cavernosus reflex S3-S4
Superficial Reflexes
Deep Tendon Reflexes

20. Frontal Release Reflexes / Primitive Reflexes
Palmomental Reflex
Grasp reflex - Palmar / Plantar
Glabellar tap reflex
Pout and snout reflex
Routing reflex
Head retraction
Corneomandibular reflex / Wartenberg reflex / Von Solder phenomenon

21. Spinothalamics
Pain
Crude Touch
Temperature
Dorsal Column
Fine Touch
Proprioception / Joint position
Vibration
Cortical Sensations
Stereognosis
Graphesthesia
2 point discrimination

22. Functional testing : Rhomberg’s Test
Truncal Stability (ataxia - midline cerebellar vermis)
Finger to nose test
Heel to shin test
Rapid alternating movements / Diadochokinesia
Past pointing
Rebound phenomenon
Pendular Knee Jerk
Titubation
Scanning Speech
Gait

23. Hypokinetic - Bradykinesia / Hypokinesia / Akinesia / Rigidity
Hyperkinetic - Tremor / chorea / balismus / dystonia / myoclonus / tics
Postural Instability / Pull Test
Akathisia

24. 1. Hutchinson’s textbook of clinical medicine 23rd edition
2. De Jong’s Clinical Handbook of Neurology
3. MSD Manual of Neurology
4. Handbook of Neurological Examination, Washington University
5. Handbook of Neurological Examination, Stanford University