This document outlines the key components and procedures for performing a neurologic examination. It discusses the objectives, basic concepts, and outline of the exam. The exam is divided into 7 parts: mental status, cranial nerves, motor, sensory, reflexes, cerebellar, and miscellaneous. Each part is described in detail including the specific tests, scales for grading abilities, and instruments needed. Students are then instructed to form groups, each focusing on one part of the exam, to create an instructional video demonstrating how to perform that part.

1. The Neurologic
Examination

2. Objectives
 Understand the Basic Concepts of Neurologic
Examination
 Learn the Different Parts of Neurologic Examination
 Familiarize the techniques of Eliciting
Abnormalities

3. Outline
 Basic Concepts of Neurologic Examination
 Mental Status Examination
 Cranial Nerve Examination
 Motor Examination
 Sensory Examination
 Examination of the Reflexes
 Cerebellar Examination
 Miscellaneous Examination

4. Neurologic Examination
 The cornerstone in the evaluation of Neurologic
patients

5. Goals
 To facilitate communication
 To provide a baseline examination
 To direct testing and guide the physician on what
laboratory tests to request for the patients.
 To localize the lesion

6. Instruments for a Neurologic
Examination
 Must have:
 Pocket Snellen chart
 Neurologic hammer
 Pen light
 Disposable pin/toothpicks/cotton
 Tongue Depressor
 Tuning Fork (128 or 256 cps)
 Stethoscope
 BP Apparatus
 Ophthalmoscope
 Otoscope

7. Guidelines
 Perform the Neurologic Examination in an orderly
fashion
 Finish the examinations for one system before
starting another
 Always examine the left and the right side of the
body and compare
 Compare the proximal against the distal findings

8. Three Basic Steps
 Data Gathering
 Anatomic Localization
 Etiologic Diagnosis

9. Parts of Neurologic Examination
 Mental Status
 Cranial Nerves
 Motor Exam
 Sensory Exam
 Reflexes
 Cerebellar Function
 Miscellaneous

10. I. Mental Status Examination
 During history taking
 Formal cerebral function tests
 Mini-Mental State Exam

11. I. Mental Status Examination
 Frontal: Sensorium, Speech, Ability to follow
commands, Attention Span, Insight and Judgement,
Fund of Knowledge
 Parietal: Left/Right Orientation, finger agnosia,
Calculation, writing, stereognosis, graphesthesia,
hemineglect, Praxis
 Temporal: Orientation to time/place/person, Memory,
Comprehension
 Occipital: Ability to Identify familiar faces, colors and
Objects

12. II. Cranial Nerve Exam
 I. Olfactory: test one nostril at a time with eyes closed.
Avoid alcohol as a test material, Use (Vanilla, Coffee,
Tobacco)
 II. Optic: Visual Acuity (with and without glasses),
visual field examination, Fundoscopy (fundus, disc,
vessels, venous pulse, retina)
 II, III Reaction to light, direct and consensual
 III, IV, VI Oculomotor, Trochlear, Abducens Primary
gaze, Extra Ocular Muscle Movement

16. Cranial Nerve Exam
 V. Trigeminal Sensory on V1-V2-V3 Motor - jaw
movement (masseter, pterygoids)
 V, VII Corneal Reflex
 VII. Facial – motor - raise eyebrows, close eyes, show
teeth; sensory - taste (ant. 2/3 of tongue)

17. II. Cranial Nerve Exam
 VIII. Auditory –Rubbed fingers, Tuning fork tests -
Weber’s, Rinne’s, Schwabach’s
 IX, X. Glossopharyngeal, Vagus - gag, swallowing,
uvula, hoarseness, taste (posterior 1/3 of tongue)

18. II. Cranial Nerve Exam
 XI. Spinal Accesory - raise shoulders, turn head
against resistance
 XII. Hypoglossal - tongue deviation, atrophy,
fasciculation,

19. III. Motor Exam
 Strength: uppers and lowers, left and right, distal and
proximal
upper: proximal - arms outstretched, distal - grasp
lower: ask patient to walk, proximal - rise from chair,
distal - tiptoe

20. Scale in grading muscle
strength
0 No movement
1
Flicker or trace of contraction but no
associated movement at a joint
2 Movement with gravity eliminated
3
Movement against gravity but not against
resistance
4- Movement against a mild degree of resistance
4 Movement against moderate resistance
4+ Movement against strong resistance
5 Full power

21. III. Motor Exam
 Tone - passive movement; Increased: spasticity,
rigidity; Normal, Decreased: hypotonia
 Inspection - atrophy, fasciculations, tenderness or
hypertrophy and any involuntary movements

22. IV. Sensory Exam
 Touch
 Pin
 Position sense
 Vibration sense
 Temperature
 Graphesthesia
 Stereognosis
 Two-point discrimination
 Lateralization: double
simultaneous stimulation
 Romberg’s

23. V. Reflexes:
 DTRs
 biceps (C5-C6)
 triceps (C7-C8)
 brachioradialis (C6-C7)
 knee (L2-L4),
 ankle (S1-S2),
 Primitive - snout, suck, grasp
 Babinski, Hoffman’s

24. Grading Reflexes
Grade Description
4+
3+
2+
1+
0
Hyperactive (with clonus)
Brisker than average, not necessarily
Abnormal
Average, normal
Diminished, low normal
No response

25. VI. Cerebellar Function
 Coordination: finger-to-nose, alternating pronation-
supination, hand patting, finger tapping
Nystagmus
Tremor
 Gait and Stance
* stand with feet together with eyes open
* normal walking
* tandem walk

26. VII. Miscellaneous:
 Examination of head and spine: Inspection of the
neck and spine, straight-leg raising sign
 Meningeal signs: Neck rigidity, kernigs, brudzinski
 Carotids: bruits, palpation

27. Preceptorial Group Activity
 Form into 7 groups
 Each group is assigned a specific part of neurologic
exam to perform.
 Group I: Mental Status Examination
 Group II: Cranial Nerves I, II, III, IV, V, VI
 Group III: Cranial Nerves VII, VIII, IX, X, XI, XII
 Group IV: Motor Examination
 Group V: Sensory Examination
 Group VI: Reflexes
 Group VII: Cerebellar Examination
 Assign a Group leader

28. Preceptorial Group Activity
 Make a Video Clip on how you perform the assigned
Neurologic Examination
 Criteria: Mastery and Content 50% Creativity 30%
Participation of members 10% Submission on time 10%
 Due on March 19, 2021
 To be submitted in a Google drive together with all the
groups