creation date: 2025-08-03 03:56
tags: Assessments
Neurological Assessment
Background
A quick neurologic exam is crucial for ruling out ominous diagnoses (primarily stroke). In the emergency department, this should not take longer than 5 minutes.
A neurological exam should be performed for:
- Suspected stroke
- Head injury
- Headache
- Syncope
- Seizure
History
Pertinent positives/negatives:
- Headaches
- Nausea/vomiting
- Dizziness (clarify)
- Vision changes (eg. double vision)
- Hearing loss
- Difficulty speaking or swallowing
- Weakness
- Paresthesia
- Paresis
- Difficulty walking
Assessed during history taking.
- Cognition and speech
- GCS score
Exam
Cranial nerves
Assessment of CN II-XII:
- Pupil response (PERRLA = pupils equal, round, reactive to light, and accommodation) (CN II-III)
- Visual field (CN II) - “which side is moving”
- Extra-ocular movements (CN III, IV, VI)
- Facial sensation and masseter function (CN V)
- Puff out cheeks, show teeth (CN VII)
- Hearing (assessed during history) (CN VIII)
- Symmetric palate elevation and tongue extension with “ah” (CN IX, X, XII)
- Shoulder against resistance (CN XI)
Motor
Upper extremities:
- Shoulder abduction (C5)
- Elbow flexion, wrist extension (C6)
- Elbow extension, wrist flexion (C7)
- Grip strength (C8)
- Finger abduction (T1)
Lower extremities:
- Hip flexion (L2)
- Knee extension (L3)
- Foot dorsiflexion (L4)
- Great toe dorsiflexion (L5)
- Foot plantarflexion (S1/S2)
Gait, truncal stability, and proprioception
Normal, heel, toe, and tandem gait should be assessed. Truncal stability can be assessed during gait assessment or when seated.
Pronator drift should be accessed.
Coordination
Following pronator drift, keep eyes closed:
- “Bring your pointer finger to your nose” - repeat for both hands
Then have patient open eyes for:
- Rapid alternating movement
- Fine motor coordinator (fingers)
Additional Components
- Sensory
- Reflexes