The document describes the process for conducting a neurological examination. It involves collecting health history details from the patient and assessing subjective symptoms. The physical exam includes testing each of the 12 cranial nerves as well as examining the motor and sensory systems. Reflex testing is also performed to evaluate the integrity of sensory and motor pathways. The neurological exam provides important information to diagnose conditions affecting the brain and nervous system.

2. HEALTH HISTORY
• DETAILS ABOUT THE ONSET CHARACTER,SEVERITY
,LOCATION ,DURATION AND FREQUENCY OF
SYMPTOMS AND ASSOCIATED COMPLAINTS
• PRECIPITATING ,AGGREVATING AND RELIEVING
FACTORS ,PROGRESSION,REMISSION AND
EXACEREBATION THE PRESCENCE OR ABSENCE OF
SIMILAR SYMPTOMS AMONG FAMILY MEMBERS

3. ASSESSMENT INCLUDE
• HEALTH HISTORY
• PHYSICAL EXAMINATION

4. SUBJECTIVE DATA
HEADACHE
HEADINJURY
DIZZINESS/VERTIGO
SEIZURE
TREMORS
WEAKNESS
INCORDINATION
NUMBNESS OR TINGLING
DIFFICULTY SPEAKING
SIGNIFIANT PAST HISTORY
ENVIRONMENTAL/OCCUPATIONAL HAZARDS

5. OBJECTIVE DATA
THE NEUROLOGICAL EXAMINATION INCLUDE
MENTAL STATUS
CRANIAL NERVES
MOTOR SYSTEM
SENSORY SYSTEM
REFLEXES

7. CRANIAL NERVE EXAMINATION

8. OBSERVING THE PATIENT THE PATIENT’S
APPEARANCE AND BEHAVIOUR
NOTING THE DRESS, GROOMING AND PERSONAL
HYGINE
POSTURE, GESTURE,MOVEMENTS FACIAL
EXPRESSION AND MOTOR ACTIVITY
ASSESSING ORIENTATION TO TIME,PLACE AND
PERSON

9. CRANIAL NERVES
1) CRANIAL NERVE 1-OLFACTORY NERVE
2) CRANIAL NERVE 2-OPTIC NERVE
3) CRANIAL NERVE 3,4&6 OCULOMOTOR
,TROCHLEAR AND ABDUCENS NERVE
4) CRANIAL NERVE 5-TRIGEMINAL NERVE
5) CRANIAL NERVE 7-FACIAL NERVE
6) CRANIAL NERVE 8-ACOUSTIC NERVE
7) CRANIAL NERVE 9&10 –GLOSSOPHARYNGEAL
AND VAGUS NERVE
8) CRANIAL NERVE 11-SPINAL ACCESSORY NERVE
9) CRANIAL NERVE 12-HYPOGLOSSAL NERVE

10. EQUIPMENTS

11. OLFACTORY NERVE
1.The Olfactory nerve (CN I) is simply tested by offering something familiar
for the patient to smell and identify, for orange/lemon peel, coffee, or
vinegar.

12. OPTIC NERVE

13. • Visual inattention can be tested by moving both fingers at the
same time and checking the patient identifies this.

15. fundoscopy

16. OCULOMOTOR ,TROCHLEAR,ABDUCENS
• Asking the patient to keep their head perfectly still directly in front of you,
you should draw two large joining H’s in front of them using your finger
and ask them to follow your finger with their eyes. It is important the
patient does not move their head.

17. Trigeminal nerve (CN V)
• IT involved in sensory supply to the face and motor
supply to the muscles of mastication.
Initially test the sensory branches by lightly touching
the face with a piece of cotton wool followed by a
blunt pin in three places on each side of the face

19. FACIAL NERVE (CN VII)
• supplies motor branches to the muscles of facial expression.
• This nerve is therefore tested by asking the patient to crease up their
forehead (raise their eyebrows), close their eyes and keep them closed
against resistance, puff out their cheeks and reveal their teeth.

20. ACOUSTIC NERVE
• The Vestibulocochlear nerve (CN VIII) provides innervation to
the hearing apparatus of the ear and can be used to
differentiate conductive and sensori-neural hearing loss using
the Rinne and Weber tests.
• To carry out the Rinner test, place a sounding tuning fork on
the patient’s mastoid process and then next to their ear and
ask which is louder. A normal patient will find the second
position louder.

21. • To carry out the Weber’s test, place the tuning
fork base down in the centre of the patient’s
forehead and ask if it is louder in either ear.
Normally it should be heard equally in both
ears.

22. Glossopharyngeal nerve (CN IX
• The Glossopharyngeal nerve (CN IX) provides sensory supply to the
palate. It can be tested with the gag reflex or by touching the arches of the
pharynx.

23. Vagus nerve (CN X)
• Vagus nerve (CN X) provides motor supply to the pharynx.
• Asking the patient to speak gives a good indication to the efficacy of the
muscles. The uvula should be observed before and during the patient
saying “aah”. Check that it lies centrally and does not deviate on
movement

24. SPINAL NERVE
• The Accessory nerve (CN XI) gives motor supply to the
sternocleidomastoid and trapezius muscles. To test it, ask the
patient to shrug their shoulders and turn their head against
resistance.

25. Trapezius muscle against
resistancetest

26. Hypoglossal nerve (CN XII)
• Hypoglossal nerve (CN XII) provides motor
supply to the muscles of the tongue.
• Observe the tongue for any signs of wasting or
fasciculations. Ask the patient to stick their
tongue out. If the tongue deviates to either
side, it suggests a weakening of the muscles
on that side

27. Hypoglossal
examination

28. MOTOR SYSTEM
• INSPECT THE MUSCLE GROUP FOR SIZE
• COMPARE THE RIGHT SIDE WITH LEFT SIDE
• LOOK FOR ANY ASYMMETRY
CEREBELLAR FUNCTION
 BALANCE TEST-OBSERVE THE PERSON WALK WITH 10-20FEET
TURN OVER AND RETURN TO THE STARTING(ABNORMALLY WIDE
BASE SUPPORT NEEDED)
 FINGER TO FINGER TEST
 FINGER TO NOSE TEST

29. THE SENSORY SYSTEM
• BY SENSORY TESTING MAKING SURE THAT PERSON IS
ALERT,CO-OPERATIVEAND HAS ADEQUATE ATTENSIONSPAN
• IT IS DONE BY SUPERFICALPAIN, TEMERATURE,LIGHT TOUCH,

30. TEST THE REFLEXES
• Reflex testing incorporates an assessment of the function and
interplay of both sensory and motor pathways. It is simple yet
informative and can give important insights into the integrity
of the nervous system at many different levels.

31. DEEP TENDON REFLEXES
 STIMULATE THE REFLEXE BY DIRECTING A SHORT,SNAPPY
BLOW TO THE REFLEXE HARMER ONTO THE MUSCLE’S
INSERTION TENDON.
 THE REFLEXE RESPONSE IS GRADED ON 4-POINT SCALE
 4+ VERRY BRISK,HYPPERACTIVE WITH CLONUS,INDICATIVE OF
DISEASE
• 3+ BRISKER THAN AVERAGE,MAY INDICATE DISEASE
• 2+ AVERAGE ,NORMAL
• 1+ DIMINISHED ,LOW NORMAL
• 0 NO RESPONSE

32. BICEPS REFLEX
• easily done this is most with the seated. patient
• Identify the location of the biceps tendon. To do this,
have the patient flex at the elbow while you observe and
palpate the antecubital fossa. The tendon will look and
feel like a thick cord.

33. Biceps Reflex Testing

34. TRICEPS REFLEX
Triceps Tendon

36. BRACHO RADIALIS REFLEXES