Stephen Russell and Marc Triola; NYU School of Medicine
Project Advisor: Patrick Kelly, M.D., Chairman, NYU Dept. of Neurosurgery
Special thanks to Howard Greller and Sergai DeLamora
This module will instruct medical students and post graduate trainees on how to perform a thorough neurological examination. It stresses examination technique, so that the student may perform the exam in a real clinical setting with authority and confidence. Each examining maneuver is photographed clearly, with a concise, relevant discussion.
An organizational overview of the examination is provided early in the module to facilitate memorization and overall comprehension. Furthermore, the neurological terminology pertaining to the examination is fully explained, allowing one to communicate the results of the exam to fellow medical personnel or to the medicolegal record. The module is located on the NYU Neurosurgery Web Page to allow remote access and provide instruction at a user-controlled pace. Questions and clinical references during the module are present to reaffirm key clinical concepts and provide "pearls" of knowledge.
Introduction-a few basics
The objective of a neurological exam is threefold.
- To identify an abnormality in the nervous system.
- To differentiated peripheral from central nervous system lesions.
- To establish internal consistency, i.e. does the patient cooperate fully? and are the findings in a specific patient only a variant of normality?
The neurological examThe neurological exam can be divided into seven areas. The outline below should be memorized. Having immediate recall of this outline allows the examiner to quickly proceed through the exam without omitting any sections. The exam should be performed in an organized, step-wise manner.
Please choose a lesson by clicking on it.
Throughout these lessons you will see blue text (like this for example). This blue color indicates a clinical tip or medical pearl.
- I General Appearance, including posture, motor activity, vital signs and perhaps meningeal signs if indicated.
- II Mini Mental Status Exam, including speech observation.
- III Cranial Nerves, I through XII.
- IV Motor System, including muscle atrophy, tone and power.
- V Sensory System, including vibration, position, pin prick, temperature, light touch and higher sensory functions.
- VI Reflexes, including deep tendon reflexes, clonus, Hoffman's response and plantar reflex.
- VII Coordination, gait and Rhomberg's Test
- Examining the comatose patient