The purpose of the neurologic examination is to establish whether the patient’s brain, special senses, spinal cord, peripheral nerves, and muscle and skin receptors are functioning normally. While doing the examination, clinicians should relate findings to anatomic structures in the nervous system. With this information, the differential diagnosis of the disorder causing the patient’s symptoms can be more focused. Repeated neurologic examinations can help evaluate the course of the patient’s illness and/or response to treatment.
The neurologic examination begins as soon as the clinician sees the patient and continues during history taking. Casual observation of the patient's posture and gait, the spontaneous use of the limbs and facial muscles, and the manner in which the patient responds to questions supplement the information obtained from the formal neurologic examination. The patient’s demeanor, posture, eye contact, dress, and responses provide important information about mood and social adaptation. Abnormal or unusual speech, difficulty understanding, incoordination when performing complex actions, abnormal postures or spontaneous movements, and neglect of space may be apparent before formal testing.
A complete neurologic examination should be done unless the examiner is skilled. Skilled examiners may exclude certain components of the examination based on their understanding of the relevant neuroanatomy and pathophysiology of the problem.
The complete neurologic examination includes the following:
Although a detailed neurologic examination can take considerable time, the fundamentals can be completed in about 4 minutes and can detect deficits in any of the major components. Abnormal findings trigger a more detailed examination of that component.