Neurological Examination: Comprehensive Components & Clinical Utility

The neurological exam systematically evaluates the central and peripheral nervous systems. It localizes lesions, guides differential diagnosis, and monitors progression.

Standardized Components

I. Mental Status

• Consciousness (GCS), orientation, attention.
• Language: fluency, comprehension, repetition, naming.
• Memory: registration, recall (immediate/delayed), recognition.
• Executive: abstraction, set-shifting, judgment.
• Mood/affect, thought content/process, insight.

II. Cranial Nerves (I–XII)

• I Olfaction; II Visual acuity, fields, fundi, pupils.
• III, IV, VI: Ocular motility, ptosis, pupil reactivity.
• V: Facial sensation (V1/V2/V3), corneal reflex, jaw jerk.
• VII: Facial symmetry (upper vs. lower face = UMN vs. LMN).
• VIII: Hearing (Weber/Rinne), vestibular (nystagmus, Dix-Hallpike).
• IX, X: Palate elevation, gag, voice, uvula deviation.
• XI: SCM/trapezius strength (spinal accessory).
• XII: Tongue protrusion, fasciculations, atrophy.

III. Motor

• Bulk, tone (spasticity, rigidity, flaccidity), fasciculations.
• Strength (MRC 0–5): Key myotomes (deltoid, biceps, wrist ext, grip, hip flex, knee ext, ankle dorsi/plantar).
• Functional: Gait, heel/toe walk, squat, chair rise.

IV. Sensory

• Light touch, pinprick (spinothalamic), vibration/proprioception (dorsal columns).
• Dermatomal vs. peripheral nerve vs. stocking-glove patterns.
• Cortical: Graphesthesia, stereognosis, 2-point discrimination, extinction.

V. Reflexes

• Deep tendon (biceps, brachioradialis, triceps, patellar, Achilles) — 0–4+; clonus.
• Superficial: Plantar (Babinski), abdominal, cremasteric.
• Primitive (if frontal release): Grasp, snout, palmomental.

VI. Coordination & Cerebellar

• Finger-nose-finger, heel-knee-shin, rapid alternating, rebound.
• Gait: Tandem, Romberg (proprioceptive vs. cerebellar).

VII. Meningeal Signs

• Nuchal rigidity, Brudzinski, Kernig, jolt accentuation.

Systematic, reproducible, hypothesis-driven. Documentation enables longitudinal comparison.