What is a neurological examination?
During a neurological examination, physicians check the function of the central nervous system (CNS: brain and spinal cord) as well as the peripheral nervous system. In this way, many neurological disorders can be detected and localized.
When do you perform a neurological exam?
Common reasons for a neurological exam are:
- acute circulatory disorders in the CNS, e.g. stroke
- brain hemorrhage, brain tumors or abscesses
- Herniated disc
- epilepsy
- chronic inflammatory diseases of the CNS, e.g. multiple sclerosis
- acute inflammations of the brain or meninges
- metabolic disorders of the peripheral nerves, e.g. polyneuropathy in diabetes
- pressure-related functional disorders of the peripheral nerves
- Vertigo
What do you do during a neurological exam?
A neurological exam includes:
- a medical interview about the patient’s medical history and current complaints (anamnesis)
- a mental assessment of the patient’s level of consciousness
- palpation of the pulses and measurement of blood pressure
- examination of the twelve cranial nerves
- examination of strength, sensitivity, reflexes and coordination of the body
Testing alertness, sensitivity and motor function
At the beginning, the doctor assesses the patient’s alertness (vigilance), using various questions – such as date of birth, first name or location. If the patient can answer all the questions correctly, his or her condition is classified as “awake and oriented.”
In addition, the doctor checks the sensitivity of the entire body. The sensation of touch, pain, temperature, vibration and changes in position are tested.
In addition, the doctor examines the motor function and divides the patient’s muscle strength into different degrees of strength. In this way, any existing paralysis or cramps (spasticity) can be detected.
Examination of coordination, stance and balance
The neurological examination of coordination can be performed by means of the so-called finger-nose test. In this test, the patient, with eyes closed and arms initially outstretched, must first bring his right and then his left index finger to his nose.
The Unterberger step test is used to test stance, gait and balance: Here, the patient must take 50 to 60 steps on the spot with eyes closed and arms outstretched. The knees should always be raised to hip height.
Checking the cranial nerves
The cranial nerves, which originate directly from the brain, are checked separately in the neurological examination:
- I. Olfactory nerve: Verification by olfactory tests
- II. Optic nerve – vision: Objects or letters must be recognized from a certain distance. Pupillary response is checked by the physician shining a lamp into the eyes and assessing pupillary response.
- III. Oculomotor nerve – eye movement: Here the patient should be able to follow the physician’s finger with the eyes
- IV. Trochlear nerve – eye movement: For the test, the patient looks inward and downward. The doctor tests both eyes separately.
- VI. abducens nerve – eye movement: The patient looks outward for verification. This is also tested by side-to-side comparison.
- VII. Facial nerve – facial expressions and taste: Here the patient puffs out his cheeks, frowns and makes a kissing mouth. The patient’s sense of taste is also asked.
- VIII. Vestibulocochlear nerve – hearing and balance: the doctor rubs fingers near the ears to check hearing. A balance test is used to check nerve function.
- IX. Glossopharyngeal nerve – swallowing: The doctor inspects the throat and swallowing ability
- X. Nervus vagus – control of internal organs: the doctor asks about abnormalities in the heartbeat, breathing or digestion
- XI. Nervus accessorius – part of the head muscles: the doctor presses the shoulders down while the patient pulls them up. Also, the head should be able to be rotated against resistance.
- XII. Nervus hypoglossus – tongue: the patient sticks out the tongue and moves it to all sides
Examination of reflexes
The neurological examination also includes testing of reflexes. Using a reflex hammer, the doctor tests the so-called muscle reflexes, such as the biceps tendon reflex. The physician places a thumb on the biceps tendon and strikes it with the hammer. If the forearm bends, injuries to the nerves involved are almost impossible.
In the case of the so-called external reflexes, the reflex response does not occur in the organ perceiving the stimulus. If, for example, the doctor strokes the thigh, the testicle of a man will be lifted.
In addition, the primitive reflexes are tested, which should not be triggered in healthy individuals and are only present in newborns and infants. In the Babinski reflex, for example, the outer edge of the foot is brushed vigorously. If there is nerve damage, the toes spread and the big toe lifts upwards.
What are the risks of a neurological examination?
What do I need to consider after a neurological examination?
Once the neurological examination is complete, your doctor will discuss the results with you. Depending on the diagnosis, further technical neurological examinations such as a magnetic resonance imaging (MRI), a computer tomography (CT) or an electroneurography (ENG) will now be performed.
