Neurological Examination

A neurological exam is a systematic assessment of cognitive, sensory, and motor responses to identify pathologies of the nervous system Nervous system The nervous system is a small and complex system that consists of an intricate network of neural cells (or neurons) and even more glial cells (for support and insulation). It is divided according to its anatomical components as well as its functional characteristics. The brain and spinal cord are referred to as the central nervous system, and the branches of nerves from these structures are referred to as the peripheral nervous system. General Structure of the Nervous System. A neurological exam allows for the localization of neurologic lesions to narrow the differential diagnosis and focus on subsequent laboratory and imaging examinations. The exam should include assessments of the subject’s mental status, speech, cranial nerves Cranial nerves There are 12 pairs of cranial nerves (CNs), which run from the brain to various parts of the head, neck, and trunk. The CNs can be sensory or motor or both. The CNs are named and numbered in Roman numerals according to their location, from the front to the back of the brain. Overview of the Cranial Nerves, motor system, deep tendon reflexes, sensation, balance, and coordination.

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Editorial responsibility: Stanley Oiseth, Lindsay Jones, Evelin Maza

Table of Contents

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Mental Status and Speech

Mental status examination is an assessment of a subject’s current mental capacity based on the following factors:

  • Appearance:
    • Age
    • Gender (be aware of the increasing disparity in gender identification)
    • Race:
      • Be sensitive about the assumption of race based on skin Skin The skin, also referred to as the integumentary system, is the largest organ of the body. The skin is primarily composed of the epidermis (outer layer) and dermis (deep layer). The epidermis is primarily composed of keratinocytes that undergo rapid turnover, while the dermis contains dense layers of connective tissue. Structure and Function of the Skin color.
      • Be aware of cultural differences.
    • Body build
    • Posture
    • Eye contact
    • Dress/grooming
    • Alertness/attentiveness to the examiner
    • Distinguishing features
    • Physical features/abnormalities
    • Emotional facial expression
  • Orientation (awareness) to:
    • Person
    • Place
    • Time
  • Attention and concentration:
    • Ability to spell a word backward and forward
    • Ability to count by serial 7’s
  • Spatial orientation: ability to draw a house or a clock face within a specific time
  • General motor status:
    • Retardation
    • Agitation
    • Abnormal movements
    • Gait
    • Catatonia
  • Speech:
    • Rate
    • Rhythm
    • Volume
    • Articulation
    • Spontaneity
  • Affect:
    • Stability
    • Range
    • Appropriateness
    • Intensity
    • Mood
  • Thought process:
    • Associations
    • Coherence
    • Logic stream
    • Perseveration
    • Neologism
    • Blocking
  • Thought content:
    • Suicidal ideation
    • Homicidal ideation
    • Depressive cognitions
    • Obsessions
    • Ruminations
    • Phobias
    • Ideas of reference
    • Paranoid ideation
    • Magical ideation
    • Delusions
    • Overvalued ideas
  • Memory:
    • Ability to recall 3 simple objects after 2 and 5 minutes
    • Able to provide a reliable history
  • Abstract reasoning: ability to identify a unifying theme connecting 3–4 objects
  • Perception:
    • Hallucinations
    • Illusions
    • Depersonalization
    • Derealization
    • Déjà vu
    • Jamais vu
  • Intellect:
    • Average versus above average/below average
    • Educational and professional achievements
  • Insight: awareness of the illness and its implications
  • Judgment: ability to satisfactorily resolve a proposed hypothetical scenario utilizing good judgment

Related videos

Cranial Nerves

A basic understanding of the underlying neuroanatomy of the head and neck is required before discussing the components of examining the cranial nerves Cranial nerves There are 12 pairs of cranial nerves (CNs), which run from the brain to various parts of the head, neck, and trunk. The CNs can be sensory or motor or both. The CNs are named and numbered in Roman numerals according to their location, from the front to the back of the brain. Overview of the Cranial Nerves.

Table: Examination of cranial nerves Cranial nerves There are 12 pairs of cranial nerves (CNs), which run from the brain to various parts of the head, neck, and trunk. The CNs can be sensory or motor or both. The CNs are named and numbered in Roman numerals according to their location, from the front to the back of the brain. Overview of the Cranial Nerves
Cranial nerve (CN) Examination
CN I: olfactory nerve Test olfaction Olfaction The sense of smell, or olfaction, begins in a small area on the roof of the nasal cavity, which is covered in specialized mucosa. From there, the olfactory nerve transmits the sensory perception of smell via the olfactory pathway. This pathway is composed of the olfactory cells and bulb, the tractus and striae olfactoriae, and the primary olfactory cortex and amygdala. Olfaction of the subject using nonirritant substances.
CN II: optic nerve
  • Visual acuity: Evaluate using a Snellen chart.
  • Visual field: Evaluate using confrontation test.
  • Pupillary light reflex is tested by shining a light into the subject’s eyes:
    • Normal finding: prompt, consensual constriction in both pupils
    • Abnormal finding: anisocoric dilation (not equal in both pupils)
  • Fundoscopic examination:
    • Normal finding: pink optic disc
    • Abnormal findings: optic disk cupping ( glaucoma Glaucoma Glaucoma is an optic neuropathy characterized by typical visual field defects and optic nerve atrophy seen as optic disc cupping on examination. The acute form of glaucoma is a medical emergency. Glaucoma is often, but not always, caused by increased intraocular pressure (IOP). Glaucoma), papilledema (elevated intracranial pressure), optic neuritis (infection, multiple sclerosis Multiple Sclerosis Multiple sclerosis (MS) is a chronic inflammatory autoimmune disease that leads to demyelination of the nerves in the CNS. Young women are more predominantly affected by this most common demyelinating condition. Multiple Sclerosis)
CN III: oculomotor nerve; CN IV: trochlear nerve; CN VI: abducens nerve
  • Responsible for eye movement and accommodation
  • Eye movement: tested by asking the subject to follow the examiner’s finger
  • Accommodation:
    • Tested by moving a finger toward the subject’s eyes
    • The normal response is constriction of the pupil Pupil The pupil is the space within the eye that permits light to project onto the retina. Anatomically located in front of the lens, the pupil's size is controlled by the surrounding iris. The pupil provides insight into the function of the central and autonomic nervous systems. Physiology and Abnormalities of the Pupil.
CN V: trigeminal nerve
  • Responsible for facial sensation; tested by lightly touching different facial areas (forehead, cheek, jaw Jaw The jaw is made up of the mandible, which comprises the lower jaw, and the maxilla, which comprises the upper jaw. The mandible articulates with the temporal bone via the temporomandibular joint (TMJ). The 4 muscles of mastication produce the movements of the TMJ to ensure the efficient chewing of food. Jaw and Temporomandibular Joint) and comparing both sides
  • Innervates the anterior ⅔ of the tongue Tongue The tongue, on the other hand, is a complex muscular structure that permits tasting and facilitates the process of mastication and communication. The blood supply of the tongue originates from the external carotid artery, and the innervation is through cranial nerves. Oral Cavity: Lips and Tongue with general sensations ( pain Pain Pain has accompanied humans since they first existed, first lamented as the curse of existence and later understood as an adaptive mechanism that ensures survival. Pain is the most common symptomatic complaint and the main reason why people seek medical care. Physiology of Pain, temperature)
  • Innervates the muscles of mastication
  • Reflexes:
    • Masseter reflex:
      • Tapping the subject’s chin with a reflex hammer while their mouth is slightly open
      • The normal finding is jaw Jaw The jaw is made up of the mandible, which comprises the lower jaw, and the maxilla, which comprises the upper jaw. The mandible articulates with the temporal bone via the temporomandibular joint (TMJ). The 4 muscles of mastication produce the movements of the TMJ to ensure the efficient chewing of food. Jaw and Temporomandibular Joint closure.
    • Corneal reflex:
      • Lightly touch the cornea with a cotton swab.
      • The normal finding is closing of the eyelid.
  • In trigeminal nerve injuries, the jaw Jaw The jaw is made up of the mandible, which comprises the lower jaw, and the maxilla, which comprises the upper jaw. The mandible articulates with the temporal bone via the temporomandibular joint (TMJ). The 4 muscles of mastication produce the movements of the TMJ to ensure the efficient chewing of food. Jaw and Temporomandibular Joint deviates toward the affected side.
CN VII: facial nerve
  • Innervates the muscles responsible for facial expressions
  • Tested by asking the subject to perform certain movements (forehead wrinkling, closing the eyes tightly, inflating the cheeks, smiling, whistling)
  • Innervates the anterior ⅔ of the tongue Tongue The tongue, on the other hand, is a complex muscular structure that permits tasting and facilitates the process of mastication and communication. The blood supply of the tongue originates from the external carotid artery, and the innervation is through cranial nerves. Oral Cavity: Lips and Tongue with special sensation (sweet, salty, and sour)
CN VIII: vestibulocochlear nerve
  • A simple test to check hearing includes rubbing fingers together near the subject’s ears.
  • Tested using Weber and Rinne tests
CN IX: glossopharyngeal nerve; CN X: vagus nerve
  • Tested by evaluating the uvula:
    • Normal finding: centrally located
    • Abnormal finding: deviation toward the normal side
  • Responsible for the gag reflex: tested by lightly touching the uvula with a spatula
  • CN IX innervates the posterior ⅓ of the tongue Tongue The tongue, on the other hand, is a complex muscular structure that permits tasting and facilitates the process of mastication and communication. The blood supply of the tongue originates from the external carotid artery, and the innervation is through cranial nerves. Oral Cavity: Lips and Tongue with general and special sensations.
  • Hoarseness or an impaired cough reflex indicates damage to CN X.
CN XI: accessory nerve
  • Innervates the trapezius muscle: Ask the subject to elevate their shoulders against resistance.
  • Innervates the sternocleidomastoid muscle: Ask the subject to rotate their head against resistance.
CN XII: hypoglossal nerve
  • Innervates the tongue Tongue The tongue, on the other hand, is a complex muscular structure that permits tasting and facilitates the process of mastication and communication. The blood supply of the tongue originates from the external carotid artery, and the innervation is through cranial nerves. Oral Cavity: Lips and Tongue muscles: Ask the subject to press against their cheek from the inside, while the examiner tests the strength from the outside.
  • In CN XII injury, the tongue Tongue The tongue, on the other hand, is a complex muscular structure that permits tasting and facilitates the process of mastication and communication. The blood supply of the tongue originates from the external carotid artery, and the innervation is through cranial nerves. Oral Cavity: Lips and Tongue deviates toward the site of injury.

Motor System

Motor system examination includes the following:

  • Inspection
  • Passive motion (muscle tone)
  • Active motion (muscle power)

Inspection

  • Gait
  • Gross movements and coordination
  • Abnormal movements (e.g., tics Tics Tics and related diseases represent a set of neurobehavioral disorders of childhood that are characterized by sudden, repeated, nonrhythmic, stereotyped muscle movements sometimes accompanied by sounds or vocalizations. Tics and Tourette Syndrome, tremors, chorea, myoclonus, hemiballismus)
  • Abnormal posture
  • Atrophy versus hypertrophy
  • Contractures
  • Tremors
  • Fasciculations:
    • Lower motor neuron sign
    • Spontaneous contraction affecting a small number of muscle fibers
    • Mostly seen in tongue Tongue The tongue, on the other hand, is a complex muscular structure that permits tasting and facilitates the process of mastication and communication. The blood supply of the tongue originates from the external carotid artery, and the innervation is through cranial nerves. Oral Cavity: Lips and Tongue muscles

Passive motion

  • Examined by moving the subject’s limbs and individual muscles through a range of motion
  • Note abnormalities:
    • Atonia (flaccidity, no resistance to passive motion)
    • Hypotonia (focal or generalized weakness)
    • Hypertonia (rigidity, resistance to passive motion)
    • Contracture (fixed resistance to passive motion)

Active motion

  • Examined by asking the subject to flex and extend their extremities against resistance
  • Strength is graded on a scale of 0–5 based on the quality of response:
    • 0: no muscle activation
    • 1: trace/minor muscle activation, such as a twitch, without achieving full range of motion
    • 2: muscle activation with gravity eliminated while achieving full range of motion
    • 3: muscle activation against gravity, full range of motion
    • 4: muscle activation against some resistance, full range of motion
    • 5: muscle activation against examiner’s full resistance, full range of motion

Deep Tendon Reflexes

Reflex testing and grading Grading Cancer is the 2nd leading cause of death in the US after cardiovascular disease. Many malignancies are treatable or curable, but some may recur. Thus, all malignancies must be assigned a grade and stage in order to guide management and determine prognosis. Grading, Staging, and Metastasis

  • In healthy subjects, briskly striking a muscle tendon with a reflex hammer results in immediate muscle contraction.
  • Muscle contraction is due to a 2-neuron reflex arc involving the spinal cord Spinal cord The spinal cord is the major conduction pathway connecting the brain to the body; it is part of the CNS. In cross section, the spinal cord is divided into an H-shaped area of gray matter (consisting of synapsing neuronal cell bodies) and a surrounding area of white matter (consisting of ascending and descending tracts of myelinated axons). Spinal Cord and/or brainstem segment innervating the muscle(s).
  • A test of reflexes is, therefore, a test of the function of these 2 neurons and the innervated muscle(s).
  • The deep tendon reflex test can help distinguish upper motor neuron lesions Upper motor neuron lesions Upper motor neurons (UMNs) and lower motor neurons (LMNs) combine to form a neuronal circuit for movement. UMN lesions cause damage to neurons above the motor nuclei of the cranial nerves in the brain stem or the anterior horn cells in the spinal cord. LMN lesions affect the nerve fibers traveling from the anterior horn of the spinal cord to the peripheral muscle. Upper and Lower Motor Neuron Lesions from lower motor neuron lesions Lower motor neuron lesions Upper motor neurons (UMNs) and lower motor neurons (LMNs) combine to form a neuronal circuit for movement. LMN lesions affect the nerve fibers traveling from the anterior horn of the spinal cord to the peripheral muscle. Upper and Lower Motor Neuron Lesions.
  • Reflexes are graded on a scale of 0–4 based on the magnitude of response:
    • 0: no reflex
    • 1: hyporeflexia
    • 2: low normal reflex
    • 3: high normal reflex
    • 4: hyperreflexia
  • Decreased reflexes (0–1) may indicate:
    • Peripheral nerve (lower motor neuron) lesions
    • Hypometabolic state (e.g., hypothyroidism Hypothyroidism Hypothyroidism is a condition characterized by a deficiency of thyroid hormones. Iodine deficiency is the most common cause worldwide, but Hashimoto's disease (autoimmune thyroiditis) is the leading cause in non-iodine-deficient regions. Hypothyroidism)
    • Normal finding with advanced aging
  • Exaggerated reflexes (4) may indicate:
    • CNS (upper motor neuron) lesions
    • Hypermetabolic state (e.g., hyperthyroidism Hyperthyroidism Thyrotoxicosis refers to the classic physiologic manifestations of excess thyroid hormones and is not synonymous with hyperthyroidism, which is caused by sustained overproduction and release of T3 and/or T4. Graves' disease is the most common cause of primary hyperthyroidism, followed by toxic multinodular goiter and toxic adenoma. Thyrotoxicosis and Hyperthyroidism)
  • General notes on eliciting deep tendon reflexes:
    • Apprehension or anticipation in the subject may lead to misleading reflex findings.
    • Distract the subject’s attention using the Jendrassik maneuver or ask them to relax the group of tested muscles to obtain a more reliable response.
Distracting the patient with the jendrassik maneuver

Distracting the subject using the Jendrassik maneuver may lead to more reliable reflex testing.

Image by Lecturio.

Clinically relevant upper limb reflexes

  • Biceps reflex:
    • Nerve root: C5–C6
    • Place the thumb on the biceps tendon and strike it.
    • Notice flexion at the elbow.
  • Brachioradialis reflex:
    • Nerve root: C5–C6
    • Strike the brachioradialis tendon at the distal end of the radius with the wrist in a flexed, dependent position.
    • Notice extension at the wrist.
  • Triceps reflex:
    • Nerve root: C7–C8
    • Strike the triceps tendon below the triceps muscle complex in the olecranon fossa while the elbow is in a flexed, dependent position.
    • Notice extension at the elbow joint Elbow joint The elbow is the synovial hinge joint between the humerus in the upper arm and the radius and ulna in the forearm. The elbow consists of 3 joints, which form a functional unit enclosed within a single articular capsule. The elbow is the link between the powerful motions of the shoulder and the intricate fine-motor function of the hand. Elbow Joint.

Clinically relevant lower limb reflexes

  • Knee reflex:
    • Nerve root: L2–L4
    • Strike the patellar tendon below the patella while the knee is in a flexed, dependent position.
    • Notice extension at the knee joint Knee joint The knee joint is made up of the articulations between the femur, tibia, and patella bones, and is one of the largest and most complex joints of the human body. The knee is classified as a synovial hinge joint, which primarily allows for flexion and extension with a more limited degree of translation and rotation. Knee Joint.
  • Ankle reflex:
    • Nerve root: S1–S2
    • Strike the Achilles tendon below the gastrocnemius/soleus complex while the ankle is supported by the examiner in a position of slight dorsiflexion.
    • Notice plantar flexion at the ankle joint.

Upper Versus Lower Motor Neuron Lesions

Evidence of upper versus lower motor neuron lesions Lower motor neuron lesions Upper motor neurons (UMNs) and lower motor neurons (LMNs) combine to form a neuronal circuit for movement. LMN lesions affect the nerve fibers traveling from the anterior horn of the spinal cord to the peripheral muscle. Upper and Lower Motor Neuron Lesions may become evident during motor examination of the subject due to abnormalities in:

  • Muscle tone
  • Muscle strength
  • Deep tendon reflexes
  • Spontaneous muscle activity
Table: Upper versus lower motor neuron lesions Lower motor neuron lesions Upper motor neurons (UMNs) and lower motor neurons (LMNs) combine to form a neuronal circuit for movement. LMN lesions affect the nerve fibers traveling from the anterior horn of the spinal cord to the peripheral muscle. Upper and Lower Motor Neuron Lesions
Upper motor neuron Lower motor neuron
Site of lesion Brain, spinal cord Spinal cord The spinal cord is the major conduction pathway connecting the brain to the body; it is part of the CNS. In cross section, the spinal cord is divided into an H-shaped area of gray matter (consisting of synapsing neuronal cell bodies) and a surrounding area of white matter (consisting of ascending and descending tracts of myelinated axons). Spinal Cord Anterior horn, nerve root, peripheral nerve
Muscle strength Weakness Weakness
Muscle tone Hypertonic Flaccid
Fasciculations Absent Present
Deep tendon reflexes Hyperreflexia Hyporeflexia

Sensation

Table: Upper versus lower motor neuron lesions Lower motor neuron lesions Upper motor neurons (UMNs) and lower motor neurons (LMNs) combine to form a neuronal circuit for movement. LMN lesions affect the nerve fibers traveling from the anterior horn of the spinal cord to the peripheral muscle. Upper and Lower Motor Neuron Lesions
Sensation Pathway Examination Abnormal findings
Light touch Dorsal columns Touch the subject’s body at different locations bilaterally.
  • Paresthesia: abnormal sensation (tingling, pricking, numbing) without an apparent cause
  • Dysesthesia: unpleasant sensation due to peripheral nerve damage
  • Allodynia: a painful sensation following normally nonpainful stimulation
  • Hypesthesia: reduced sensitivity to touch
Vibration Dorsal columns Bony projections tested with a tuning fork Decreased sensation of vibration indicates peripheral nerve damage.
Proprioception Dorsal columns Identify the positional change of the big toe while moving it up and down. Abnormal proprioception indicates peripheral nerve damage.
Pain and temperature Spinothalamic tract
  • Use a sharp object to test for pain Pain Pain has accompanied humans since they first existed, first lamented as the curse of existence and later understood as an adaptive mechanism that ensures survival. Pain is the most common symptomatic complaint and the main reason why people seek medical care. Physiology of Pain.
  • Use objects with different temperature to test for perception of temperature.
Abnormal perception of pain Pain Pain has accompanied humans since they first existed, first lamented as the curse of existence and later understood as an adaptive mechanism that ensures survival. Pain is the most common symptomatic complaint and the main reason why people seek medical care. Physiology of Pain and temperature indicates peripheral nerve damage.
Stereognosis Cerebral cortex Cerebral cortex The cerebral cortex is the largest and most developed part of the human brain and CNS. Occupying the upper part of the cranial cavity, the cerebral cortex has 4 lobes and is divided into 2 hemispheres that are joined centrally by the corpus callosum. Cerebral Cortex Ask the subject to identify a familiar object with their eyes closed. Inability to identify a familiar object
Graphesthesia Cerebral cortex Cerebral cortex The cerebral cortex is the largest and most developed part of the human brain and CNS. Occupying the upper part of the cranial cavity, the cerebral cortex has 4 lobes and is divided into 2 hemispheres that are joined centrally by the corpus callosum. Cerebral Cortex Trace a familiar symbol on the subject’s palm while their eyes are closed. Inability to identify the symbol
Tactile extinction Cerebral cortex Cerebral cortex The cerebral cortex is the largest and most developed part of the human brain and CNS. Occupying the upper part of the cranial cavity, the cerebral cortex has 4 lobes and is divided into 2 hemispheres that are joined centrally by the corpus callosum. Cerebral Cortex Apply a tactile stimulus on each side of body and then bilaterally, and compare perception. Asymmetry of perception or inability to perceive stimulus on 1 side of the body

Cerebellar Function

A cerebellar examination should be performed in any subject exhibiting signs or symptoms of cerebellar pathology including:

  • Dizziness
  • Loss of balance
  • Poor coordination
  • Gait or limb ataxia
  • Tremors
  • Pyramidal signs
  • Myoclonus

There are many causes of cerebellar dysfunction, including:

  •  Stroke
  • Space-occupying lesions
  • Multiple sclerosis
  • Friedreich ataxia

Components of the exam

Cerebellar examination includes the following:

Coordination:

  • Finger-to- nose Nose The nose is the human body's primary organ of smell and functions as part of the upper respiratory system. The nose may be best known for inhaling oxygen and exhaling carbon dioxide, but it also contributes to other important functions, such as tasting. The anatomy of the nose can be divided into the external nose and the nasal cavity. Anatomy of the Nose test
  • Heel-knee-shin test
  • Rapid alternating movement test (dysdiadochokinesia)

Gait assessment:

  • Ask the subject to walk a few steps backward and forward.
  • Perform the Romberg test to distinguish between sensory and cerebellar ataxia:
    • Ask the subject to stand with their feet together, raise their arms, and close their eyes.
    • Positive Romberg test: The subject starts swaying after closing their eyes, indicating sensory ataxia.
    • Negative Romberg test: Closing the subject’s eyes does not result in increased swaying.
    • Uncontrollable swaying even when the eyes are open is indicative of dysfunction in peripheral sensation and/or poor transmission of peripheral inputs up the dorsal columns.
    • Cerebellar lesions may not manifest in the Romberg test unless a perturbation of equilibrium is introduced externally (e.g., the subject is unable to maintain equilibrium if gently “pushed” off balance).
Testing for gait ataxia

Testing for gait ataxia is often performed by simply having the subject ambulate across the room.

Image by Lecturio.

Abnormalities

Many cerebellar syndromes can manifest with gait abnormalities.

Table: Clinically significant abnormalities of gait/when stationary
Gait Description Associated signs Causes
Cerebellar
  • Ataxic
  • Staggering
  • Wide based
  • Dysdiadochokinesia
  • Dysmetria
  • Nystagmus
  • Positive Romberg sign only if external inputs are introduced
  • Cerebellar degeneration
  • Stroke
  • Alcohol intoxication
  • Vitamin B12 Vitamin B12 Folate and vitamin B12 are 2 of the most clinically important water-soluble vitamins. Deficiencies can present with megaloblastic anemia, GI symptoms, neuropsychiatric symptoms, and adverse pregnancy complications, including neural tube defects. Folate and Vitamin B12 deficiency
Sensory
  • Wide based
  • High stepping
  • Positive Romberg sign
  • Absence of deep tendon reflexes
  • Impaired proprioception
Damage to peripheral nerves, dorsal roots, or posterior columns
Vestibular Unsteady, falling to 1 side
  • Nausea, vertigo Vertigo Vertigo is defined as the perceived sensation of rotational motion while remaining still. A very common complaint in primary care and the ER, vertigo is more frequently experienced by women and its prevalence increases with age. Vertigo is classified into peripheral or central based on its etiology. Vertigo
  • Normal sensation
  • Normal reflexes
  • Acute labyrinthitis
  • Meniere disease
Parkinsonian
  • Short steps
  • Shuffling
  • Narrow based
  • Bradykinesia
  • Resting tremor
  • Postural instability
  • Decreased arm Arm The arm, or "upper arm" in common usage, is the region of the upper limb that extends from the shoulder to the elbow joint and connects inferiorly to the forearm through the cubital fossa. It is divided into 2 fascial compartments (anterior and posterior). Arm swing
Parkinson disease
Steppage gait Foot drop while walking Distal sensory loss and weakness Motor neuropathy
Trendelenburg gait/sign Pelvis Pelvis The pelvis consists of the bony pelvic girdle, the muscular and ligamentous pelvic floor, and the pelvic cavity, which contains viscera, vessels, and multiple nerves and muscles. The pelvic girdle, composed of 2 "hip" bones and the sacrum, is a ring-like bony structure of the axial skeleton that links the vertebral column with the lower extremities. Pelvis drops to the unaffected side. Weakness in the gluteus medius and gluteus minimus muscles Damage to the superior gluteal nerve
Spastic Slow, stiff, and labored movements Scissoring of the legs
  • Lesions of the upper motor neuron
  • Cerebral palsy Cerebral palsy Cerebral palsy (CP) refers to a group of conditions resulting in motor impairment affecting tone and posture and limiting physical activity. Cerebral palsy is the most common cause of childhood disability. It is caused by a nonprogressive CNS injury to the fetal or infant brain. Cerebral Palsy

Clinical Relevance

The following conditions might be found during neurological examination:

  • Glaucoma: a group of eye diseases marked by elevated intraocular pressure (IOP) and resulting in optic neuropathy. Glaucoma is a progressive disease that leads to a loss of retinal ganglion cell axons. Glaucoma manifests initially as visual field loss and may ultimately lead to irreversible blindness if left untreated.
  • Multiple sclerosis ( encephalitis Encephalitis Encephalitis is inflammation of the brain parenchyma caused by an infection, usually viral. Encephalitis may present with mild symptoms such as headache, fever, fatigue, and muscle and joint pain or with severe symptoms such as seizures, altered consciousness, and paralysis. Encephalitis disseminate): a chronic inflammatory autoimmune disease of the CNS that primarily affects younger women. Owing to its diverse symptoms, multiple sclerosis Multiple Sclerosis Multiple sclerosis (MS) is a chronic inflammatory autoimmune disease that leads to demyelination of the nerves in the CNS. Young women are more predominantly affected by this most common demyelinating condition. Multiple Sclerosis is known as a disease with many manifestations. Several neurologic abnormalities may be present on exam, which may wax and wane in severity and location over time.
  • Parkinson disease: a progressive neurodegenerative disease with diverse clinical features that include neuropsychiatric and other nonmotor manifestations in addition to its motor symptomatology. Common neurologic abnormalities may include abnormal gait, cogwheel rigidity, and speech difficulties.

References

  1. Gelb, D. (2021). The detailed neurologic examination in adults. Retrieved November 18, 2021, from https://www.uptodate.com/contents/the-detailed-neurologic-examination-in-adults
  2. Mendez, M. (2021). The mental status examination in adults. Retrieved November 18, 2021, from https://www.uptodate.com/contents/the-mental-status-examination-in-adults
  3. Shahrokhi M, Asuncion, RM.D. Neurologic Exam. [Updated 2021 Apr 29]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 January. Retrieved November 18, 2021, from https://www.ncbi.nlm.nih.gov/books/NBK557589/
  4. Ooman, K. (2021). Neurological History and Physical Examination. Retrieved November 18, 2021, from https://emedicine.medscape.com/article/1147993-overview

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