This document provides guidance on performing a neurological examination. It outlines the components of the exam including mini-mental status testing, cranial nerve assessment, muscle strength testing, reflex testing, sensory function assessment, coordination tests, and gait observation. The cranial nerve assessment section describes how to test each of the 12 cranial nerves.

1. Prepared by,
Mr. Mahesh
Nurse Educator
MGMCRI

2. INTRODUCTION:
•A neurological examination is the
assessment of sensory
neuron and motor responses,
especially reflexes, to determine
whether the nervous system is
impaired.
• It can be used both as a
screening tool and as an
investigative tool.

3. Nervous System
Central Nervous System
•Brain
•Spinal cord
Peripheral Nervous System
•Cranial nerves
•Spinal nerves

5. Components Of The
Neurological Examination
 Mini Mental status testing
 Cranial Nerves
Assessment
 Muscle strength
 Reflexes
 Coordination
 Sensory Function
 Gait

6. Mini Mental Status Examination:
•The mental status exam really assesses the
patient’s cerebral function. Remember
that the cerebrum controls sophisticated
mental functions such as speech, problem
solving, and memory.
•As you perform this portion of the
neurological assessment, pay special
attention to the patient’s speech and
language abilities

7. 1.LEVEL OF CONSCIOUSNESS:

8. 2.Intellect: (Memory, Orientation,
Recognition, Calculations)

9. 3.Orientation :
Assess time, place, and
person.
Organic brain disorders
lose time first, then place,
rarely person.

10. 4.Attention span:
Should be able to
focus on
examiner’s
questions and
respond. Impaired
in anxiety, fatigue,
and intoxication.

11. Recent memory:
Ask for 24 hour diet
recall and other easily
verifiable information.
Impaired in organic
brain syndromes and
Alzheimer’s.

12. Ask for past health,
birthdays,
anniversary, relevant
history.
Lost in Alzheimer’s,
cortical injury, but
not in normal aging
or most organic
brain syndromes.
Remote memory:

13. NEW LEARNING:
 Assess 4-word recall (should be
able to recall all four at 10
minutes)
 Use the word groups “fun,
carrot, ankle, loyalty”. Four-
word recall is impaired in
Alzheimer’s, anxiety, and
depression.

14. Judgement:
• Ask questions such as
“What would you do if
your house caught
fire?” or “What are
your plans for the
future?”
• Judgement is impaired
in mental retardation,
emotional dysfunction,
schizophrenia, and
organic brain disease.

15. CRANIAL NERVE
ASSESSMENT

17. Common Symptoms of
the Nervous System
 Headache
 Dizziness or vertigo
 Weakness
 Numbness
 Loss of sensations
 Loss of consciousness
 Seizures
 Tremors or involuntary movements

18. ASSESSMENT:
I. Olfactory: smell
 Client both eyes and one naris
are closed
 Place a strong smelling item
under each nostril individually
and ask the person to identify
it.

19. II. Optic: vision
Visual acuity
-Reading newspapers
print grossly tests central vision.
Distance Visual Acquity:
-It is assessed through the
use of Snellen chart in the distance
of 6m. And the normal score is 6/6

20.  Visual Field:
The examiner positioned
directly opposite the patient,
asks the patient to close one
eye.
Look directly at the bridge of
the examiners nose and
indicate when an object
presented from the periphery
of the each of the four visual
field quadrants is seen.
Repeated on other eye.

21.  Eye movements are tested by
instructing the patient to cover
one eye and follow the nurse
fingers through all fields of
gaze.
 Observe for parallel movements
of the eyes in each direction or
any deviation from normal.
lll. Oculomotor, lV. Trochlear,
Vl. Abducens

22. Direct light reflex:
Darken the room and focus a
small beam of light directly
into each pupil. Normally
pupils constricts when
light is focused on the
retina.

23. Consensual light reflex:
When one pupil is directly
stimulated by light, the pupil
of the other eye also constricts
as a results of decussation of
nerve fibres both in optic
chiasm.

24. v. TRIGEMINAL:
Motor component:
-Tested by asking the patient
to clench the teeth and palpating the
mastoid muscles just above the
mandibular angles.
Sensor( Bilateral corneal reflex):
-A wisp of cotton brought
in from the side and lightly touched
the cornea( normally the patient clinks)

25. VII.FACIAL NERVE:
Motor:
Ask the patient to rise the
eyebrows, close the eyes tightly,
purse the lips, and draw back
the corners of the mouth in an
exaggerated smile
Sensory:
A cotton applicators
coated with a solution of
sugars, salt or vinegar applied
anterior two third of tongue
and ask the patient to identify

26. VIII. VESTIBULO COCHLEAR:
Rinnes’s Test:
Performed by placing the
vibrating tuning fork against the
patients’ mastoid process to assess
bone conducting until the vibrating
sound is no longer heard.
Then the tuning fork is placed 1
to 2cm from the auditory canal to
assess air conduction. Ask the patient
to inform the when the sound is no
longer heard

27. Weber’s test:
The vibrating tuning fork is
placed on the patients head or
teeth. Placement on the teeth is
generally more reliable.
Ask the patient whether
the tone is heard equally in both
ears and it’s stronger in the right or
left ear.

28. Vestibular function:
The vestibular function of the
nerve evaluated by assessing the
balance through Romberg’s test.
( Standing still with the feet
close together, first with eyes
open then with eyes closed)

29. IX. GLOSSOPHARYNGEAL,
X. VAGUS:
Gag reflex:
Bilateral contraction of the palate
muscles initiated by stroking or touching
either side of the posterior pharynx or soft
palate with a tongue blade.
AH test:
Have the patient phonate by saying
“ah” and to note the bilateral symmetry of
elevation of the soft palate.

30. XI: SPINAL ACCESSORY
• Test the Trapezius muscle:
have the client shrug the
shoulders while you resist
with your hands
• Ask the client to try to touch
the right ear to the right
shoulder without raising the
shoulder. Repeat with the left
shoulder

31. Xll. Hypoglossal
Ask patient to protrude
tongue and move it side to
side. Assess for symmetry,
atrophy.

32. MUSCLE STRENGHT
ASSESSMENT:
Test muscles strength
by asking the client to
move each extremity
through the full ROM
against resistance. Do
this by applying some
resistance against the
part being moved.

34. SENSORY ASSESSMENT
For each test ask clients to close
both eyes and tell you what they feel
and where they feel it.
To test light touch sensation, use a
wisp of cotton top touch the client
To test pain sensation, use the blunt
and sharp ends of safety pin or
paperclip.
.To test temperature sensation, use
test tubes filled with hot or cold
water.

35. Test vibratory sensation:
 Strike a low-pitched tuning
fork on the heel of your
hand and hold the base on a
bony surfaces of the fingers
or bid toe.
 Ask the client to indicate
what he feels. Repeat on the
other side.

36. Test sensitivity to
position:
Ask the client to close both eyes.
Then move the client’s toes or a
finger up or down. Ask the
client to tell you the direction it
is moved. Repeat on the other
side.

37. Assess tactile discrimination:
o Remember that the client
should have her eyes
closed.
o To test stereognosis, place
a familiar object such as a
paperclip, or key in the
client’s hand and ask the
client to identify it. Repeat
with another in the other
hand

38. o To test
graphesthesia, use a
blunt instrument to
write a number, such as
2, 3, or 5 on the palm of
the client’s hand. Ask
the client to identify the
number. Repeat with
another number on
the other hand.

39. REFLEX ASSESSMENT
Test deep tendon reflex:
1. Test biceps reflex:
Ask the client to
partially bend arm at elbow
with palm up. Place your
thumb over the biceps tendon
and strike your thumb with the
reflex hammer. Repeat on the
others side.

40. 2.Assess brachioradialis reflex:
Ask the client to flex
elbow with palm down
and hand resting on the
abdomen or lap. Tap the
tendon at the radius
about 2 inches above the
wrist. Repeat on other
side.

41. 3.Test triceps reflex:
Ask the client to
hang his or her arm
freely while you support
it with your non
dominant hand. With
the elbow flexed, tap the
tendon above the
olecranon process.

42. 4.Assess patellar reflex:
Ask the client to let both legs hang
freely off the side of the examination
table. Tap the patellar tendon. Which
is located just below the patella on
the others side.

43. 5.Achilles reflex:
With the client’s leg still hanging
freely, dorsiflex the foot. Tap the
Achilles tendon with the reflex
hammer. Repeat on the other side.

44. 6.Test plantar reflex:
With the end of the hammer, stroke the
lateral aspect of the sole from the heel to
the ball of the foot, curving medially across
the ball. Repeat on the other side.

46. COORDINATION
&
gait
Coordination is evaluated by testing
the patient's ability to perform
rapidly alternating and point-to-
point movements correctly.

47. Rapidly Alternating Movement
Evaluation:
 Ask the patient to place their
hands on their thighs and then
rapidly turn their hands over and
lift them off their thighs.
 Once the patient understands this
movement, tell them to repeat it
rapidly for 10 seconds. Normally
this is possible without difficulty.
 This is considered a rapidly
alternating movement.

48.  Dysdiadochokinesis is the clinical
term for an inability to perform
rapidly alternating movements.
 Dysdiadochokinesia is usually
caused by multiple sclerosis in
adults and cerebellar tumours in
children)

49. Point-to-Point Movements
 Ask the patient to touch your index
finger and their nose alternately
several times. Move your finger about
as the patient performs this task.
 Hold your finger still so that the
patient can touch it with one arm and
finger outstretched. Ask the patient to
move their arm and return to your
finger with their eyes closed.

51. (Dysmetria is the clinical term
for the inability to perform
point-to-point movements due
to over or under projecting ones
fingers.)

52. GAIT:
Ask the patient to:
Walk across the room, turn and
come back
Walk heel-to-toe in a straight
line
Walk on their toes in a straight
line
Walk on their heels in a straight
line