great clinicians could pinpoint a lesion in the nervous system with often astounding accuracy. Today, with the availability of modern imaging techniques, the neurologic exam remains a critical way in the clinical decisionmaking process. All these questions can quickly be answered by a carefully performed neurologic exam
In addition, we will briefly discuss which neuroanatomic systems are tested by each part of the neurologic exam, so that its functional and practical relevance will be better appreciated. The neurologic exam is part of the general physical examination. Thus, the neurologic exam
should always be preceded by and interpreted in the context of a more general examination including vital signs, heart, lungs, abdomen, etc. The neurologic examination is always performed and recorded in a sequential and uniform manner in order to avoid omissions and to facilitate the subsequent analysis of case records.
Memory: Ask the patient to recall three items after a delay of 3 to 5 minutes Remote memory. Ask the patient about historical personal events. Calculation:subtract 7 from 100 and then subtract 7 from the product, and so on.
Level of consciousness is severely impaired in damage to the brainstem reticular formation, and in bilateral lesions of the thalami or cerebral hemispheres Different kinds of language abnormalities are caused by lesions in the dominant (usually left) frontal lobe, including
Broca's area; the left temporal and parietal lobes, including Wernicke's area The neurologic examination is always performed and recorded in a sequential and uniform manner in order to avoid omissions and to facilitate the subsequent analysis of case records.
. Test Extraocular Movements 1.Stand or sit 3 to 6 feet in front of the patient. 2.Ask the patient to follow your finger with their eyes without moving their
head. 3.Check gaze in the six cardinal directions using a cross or "H" pattern. 4.Pause during upward and lateral gaze to check for nystagmus.  5.Check convergence by moving your finger toward the bridge of the patient's nose. Test Pupillary Reactions to Light
1.Dim the room lights as necessary. Test Temporal and Masseter Muscle Strength 1.Ask patient to both open their mouth and clench their teeth. 2.Palpate the temporal and massetter muscles as they do this Test the Three Divisions for Pain Sensation
1.Explain what you intend to do. 2.Use a suitable sharp object to test the forehead, cheeks, and jaw on both sides.  3.Substitute a blunt object occasionally and ask the patient to report "sharp" or "dull
Screen Hearing  1.Face the patient and hold out your arms with your fingers near each ear. 2.Rub your fingers together on one side while moving the fingers noiselessly on the other. 3.Ask the patient to tell you when and on which side they hear the rubbing. 4.Increase intensity as needed and note any assymetry.
5.If abnormal, proceed with the Weber and Rinne tests Test for Lateralization (Weber) ++ 1.Use a 512 Hz or 1024 Hz tuning fork. Watch and palpate the sternomastoid muscle on the opposite side
The neurologic examination is always performed and recorded in a sequential and uniform manner in order to avoid omissions and to facilitate the subsequent analysis of case records. Rapid Alternating Movements 1. Ask the patient to strike one hand on the thigh, raise the hand, turn it
over, and then strike it back down as fast as possible. 2. Ask the patient to tap the distal thumb with the tip of the index finger as fast as possible. 3. Ask the patient to tap your hand with the ball of each foot as fast as possible. Point-to-Point Movements
1. Ask the patient to touch your index finger and their nose alternately several times. Move your finger about as the patient performs this task. 2. Hold your finger still so that the patient can touch it with one arm and The neurologic examination is always performed and recorded in a sequential and uniform manner in order to avoid omissions and to facilitate the
subsequent analysis of case records. Pain Use a suitable sharp object to test "sharp" or "dull" sensation.  Test the following areas: 1.Shoulders (C4)
2.Inner and outer aspects of the forearms (C6 and T1) 3.Thumbs and little fingers (C6 and C8) 4.Front of both thighs (L2) 5.Medial and lateral aspect of both calves (L4 and L5) 6.Little toes (S1) Temperature
The neurologic examination is always performed and recorded in a sequential and uniform manner in order to avoid omissions and to facilitate the subsequent analysis of case records. Biceps (C5, C6)
1.The patient's arm should be partially flexed at the elbow with the palm down. 2.Place your thumb or finger firmly on the biceps tendon. 3.Strike your finger with the reflex hammer. 4.You should feel the response even if you can't see it. Triceps (C6, C7)
1.Support the upper arm and let the patient's forearm hang free. 2.Strike the triceps tendon above the elbow with the broad side of the hammer. 3.If the patient is sitting or lying down, flex the patient's arm at the elbow and
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