Rural Emergency Medicine

A Neurological Clinical Exam is used in a variety of settings from the GP Clinic to in the Intensive Care Unit (ICU).

There are number of different neurological examinations (e.g. Glasgow Coma Scale, mini mental state examination), however  for the purpose of today we will be focusing on the assessment of the functioning of the peripheral nervous system (PNS).  This involves an assessment of both sensory and motor neuron responses. The ultimate aim is to identify and localise any lesions that may be effecting the health of the patient.

Important Symptoms
  • Headache
  • Changes in Vision
  • Changes in Hearing or Balance
  • Changes in Smell
  • Weakness of face, arms or legs
  • Abnormal Sensations
  • Fits & Faints

Throughout all stages of the Neurological Examination you should first be aware of basic neuroanatomy, so as to properly assess function.  I shall provide a brief overview of neuroanatomy at each stage, however I encourage you to also undertake your own study as well.

As always, before you begin, remember to explain to the patient  the purpose of the examination and wash your hands. It can also be useful to ask some general questions, like name, date, location, etc to assess mental status.

Examining Cranial Nerves
Examination of the cranial nerves can raise red flags that suggest a specific neurological dysfunction rather than a systemic disorder. An understanding of the function and location of each of the twelve cranial nerves is critically, and is summarised in the diagram below.

Adapted from original by Patrick J. Lynch

The examination is guided by each cranial nerve's function and is appropriately tested. The video below provides a demonstration of how to perform a cranial nerve examination.

Please note when assessing the Optic Nerve: Although the demonstrator asks the patient to focus on the pen, you actually want the patient looking at your eye and then telling you when the pen disappears. The purpose of this is to check the size of the blind spot.

Upper & Lower Limb Examination
Examination of the limbs forms the second component of the neurological exam. When examining the limbs you are assessing;
  • General function (e.g. lower limb - gait)
  • Tone
  • Power
  • Reflexes
  • Coordination
  • Sensation (Touch, painful stimuli, vibration & proprioception)   
Depending on the purpose of the exam you can assess entire regions or a specific nerve. As such it is important to know roughly both peripheral nerve distribution and dermatomes.

Adapted from Dermatomes & PNS via Wikipedia.

The videos below demonstrate how to examine the neurological function of both the upper and lower limbs.

Upper Limb

Lower Limb

Further investigations can include
  • Diagnostic imaging (X-ray, CT, MRI)
  • Fundoscopy
  • Electroencephalogram
  • Nerve conduction studies
Finally a useful resource is

Other Clinical Exams
Cardiovascular | Respiratory | Gastrointestinal | Neurological | Musculoskeletal

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