Neurological Exam

What is a neurological exam?

A neurological exam is also called a neuro exam. It is an evaluation of a person's nervous system that can be done in the healthcare provider's office. It may be done with instruments, such as lights and reflex hammers. It usually does not cause any pain. The nervous system consists of the brain, the spinal cord, and the nerves from these areas. There are many aspects of this exam. They include an assessment of:

• Motor and sensory skills. The provider will check your muscle strength and your ability to feel things.

• Balance and coordination. You may be asked to walk on a straight line, tap your fingers quickly, or reach and touch things.

• Mental status (the person's level of awareness and interaction with the environment). Your memory and ability to calculate, read, and follow directions will be tested.

• Reflexes

• Functioning of the nerves

The extent of the exam depends on many factors, including the initial problem that the person is having, the age of the person, and the condition of the person.

Why is a neurological exam done?

A complete and thorough evaluation of a person's nervous system is important if there is any reason to think there may be an underlying problem. Damage to the nervous system can cause problems in daily functioning. Early identification may help to find the cause and decrease long-term complications. A complete neurological exam may be done:

• During a routine physical

• Following any type of trauma

• To follow the progression of a disease

• If the person has any of these complaints: 

  • Loss of memory

  • Headaches

  • Blurry vision

  • Change in behavior

  • Fatigue

  • Change in balance or coordination

  • Numbness or tingling in the arms or legs

  • Decrease in movement of the arms or legs

  • Injury to the head, neck, or back

  • Fever

  • Seizures

  • Slurred speech

  • Weakness

  • Tremor

What is done during a neurological exam?

During a neurological exam, the healthcare provider will test the functioning of the nervous system. The nervous system is very complex and controls many parts of the body. The nervous system consists of the brain, spinal cord, 12 pairs of nerves that come from the brain and brain stem, and the nerves that come from the spinal cord. The circulation to the brain, arising from the arteries in the neck, is also frequently examined. In infants and younger children, a neurological exam includes the measurement of the head circumference. The following is an overview of some of the areas that may be tested and evaluated during a neurological exam:

• Mental status. Mental status (the person's level of awareness and interaction with the environment) may be assessed by talking with the person and establishing their awareness of person, place, and time. The person will also be observed for clear speech and making sense while talking. The healthcare provider usually does this just by observing the person during normal interactions, such as asking to remember things or to count backward.

• Motor function and balance. This may be tested by having the person push and pull against the healthcare provider's hands with their arms and legs. Balance may be checked by assessing how the person stands and walks or having the person stand with their eyes closed while being gently pushed to one side or the other. The person's joints may also be checked simply by passive (performed by the healthcare provider) and active (performed by the person) movement.

• Sensory exam. The healthcare provider may also do a sensory test that checks the person's ability to feel. This may be done by using different instruments, such as a toothpick, tuning forks, alcohol swabs, or other objects. The healthcare provider may touch the person's legs, arms, or other parts of the body and have them identify the sensation (for example, hot or cold, sharp or dull).

• Newborn and infant reflexes. There are different types of reflexes that may be tested. In newborns and infants, reflexes called infant reflexes (or primitive reflexes) are evaluated. Each of these reflexes disappears at a certain age as the infant grows. These reflexes include:

  • Blinking. An infant will close their eyes in response to bright lights.

  • Babinski reflex. As the infant's foot is stroked, the toes will extend upward.

  • Crawling. If the infant is placed on their stomach, they will make crawling motions.

  • Moro's reflex (or startle reflex). A quick change in the infant's position will cause the infant to throw the arms outward, open the hands, and throw back the head.

  • Palmar and plantar grasp. The infant's fingers or toes will curl around a finger placed in the area.

• Reflexes in the older child and adult. These are usually examined with the use of a reflex hammer. The reflex hammer is used at different points on the body to test numerous reflexes, which are noted by the movement that the hammer causes.

• Evaluation of the nerves of the brain. There are 12 main nerves of the brain, called the cranial nerves. During a complete neurological exam, most of these nerves are evaluated to help determine the functioning of the brain:

  • Cranial nerve I (olfactory nerve). This is the nerve of smell. The person may be asked to identify different smells with their eyes closed.

  • Cranial nerve II (optic nerve). This nerve carries vision to the brain. A visual test may be given, and the person's eye may be examined with a special light.

  • Cranial nerve III (oculomotor). This nerve is responsible for pupil size and certain movements of the eye. The healthcare provider may examine the person's pupil (the black part of the eye) with a light and have the person follow the light in various directions.

  • Cranial nerve IV (trochlear nerve). This nerve also helps with the movement of the eyes.

  • Cranial nerve V (trigeminal nerve). This nerve allows for many functions, including the ability to feel the face, inside the mouth, and move the muscles involved with chewing. The healthcare provider may touch the person's face at different areas and watch the person as they bite down.

  • Cranial nerve VI (abducens nerve). This nerve helps with the movement of the eyes. The person may be asked to follow a light or finger to move the eyes.

  • Cranial nerve VII (facial nerve). This nerve is responsible for various functions, including the movement of the face muscle and taste. The person may be asked to identify different tastes (sweet, sour, bitter), asked to smile, move the cheeks, or show the teeth.

  • Cranial nerve VIII (acoustic nerve). This nerve is the nerve of hearing. A hearing test may be performed on the person. This nerve also helps with balance. You may be asked to move your head or eyes.

  • Cranial nerve IX (glossopharyngeal nerve). This nerve is involved with taste and swallowing. Once again, the person may be asked to identify different tastes on the back of the tongue. The gag reflex may be tested.

  • Cranial nerve X (vagus nerve). This nerve is mainly responsible for the ability to swallow, the gag reflex, some taste, and part of speech. The person may be asked to swallow, and a tongue blade may be used to elicit the gag response.

  • Cranial nerve XI (accessory nerve). This nerve is involved in the movement of the shoulders and neck. The person may be asked to turn their head from side to side against mild resistance, or to shrug the shoulders.

  • Cranial nerve XII (hypoglossal nerve). The final cranial nerve is mainly responsible for movement of the tongue. The person may be directed to stick out their tongue and speak.

• Coordination exam:

  • The person may be asked to walk normally or on a line on the floor.

  • The person may be directed to tap their fingers or foot quickly or touch something, such as their nose with eyes closed.