Focused Assessment- Neurological Examination

A focused neurological examination is an essential part of the clinical assessment of patients presenting with neurological symptoms. It is a systematic process that involves a detailed evaluation of the patient’s mental status, cranial nerves, motor and sensory functions, reflexes, and coordination. The purpose of the examination is to identify any neurological abnormalities that may be indicative of an underlying neurological condition. In this article, we will discuss the steps involved in a focused neurological examination and highlight the importance of this assessment in clinical practice.

History and Physical Examination

Before beginning the neurological examination, it is essential to take a thorough history of the patient’s presenting symptoms, medical history, and any relevant family history. The physical examination should include a general assessment of the patient’s appearance, level of consciousness, and vital signs. This initial assessment can provide important clues to help guide the neurological examination.

Mental Status Examination

The mental status examination assesses the patient’s cognitive function, including orientation, attention, memory, language, and executive function. Orientation to person, place, and time is assessed first. The patient is asked to state their name, the date, and their location. Attention is assessed by asking the patient to perform simple tasks, such as counting backward from 100 by sevens or repeating a list of numbers backward. Memory is assessed by asking the patient to recall recent and remote events, and language is assessed by evaluating the patient’s ability to name objects, follow commands, and repeat phrases. Executive function is assessed by evaluating the patient’s ability to plan, organize, and problem-solve.

Cranial Nerves Examination

The cranial nerves examination assesses the function of the twelve pairs of cranial nerves, which are responsible for sensory and motor functions in the head and neck. Each cranial nerve has a specific function, and abnormalities in their function can provide important clues to the underlying neurological condition.

The first cranial nerve, the olfactory nerve, is responsible for the sense of smell. It is tested by asking the patient to identify different smells.

The second cranial nerve, the optic nerve, is responsible for vision. It is tested by evaluating visual acuity, visual fields, and the fundus of the eye.

The third, fourth, and sixth cranial nerves control eye movement. Their function is assessed by evaluating extraocular movements, pupillary response, and eyelid position.

The fifth cranial nerve, the trigeminal nerve, is responsible for sensation in the face and motor function in the muscles of mastication. Its function is evaluated by assessing facial sensation and by asking the patient to clench their jaw and move it side to side.

The seventh cranial nerve, the facial nerve, is responsible for facial expression and taste sensation in the anterior two-thirds of the tongue. Its function is assessed by evaluating facial movements, testing taste sensation, and asking the patient to close their eyes tightly and show their teeth.

The eighth cranial nerve, the vestibulocochlear nerve, is responsible for hearing and balance. Its function is evaluated by testing hearing acuity and evaluating balance.

The ninth and tenth cranial nerves, the glossopharyngeal and vagus nerves, control swallowing and vocal cord function. Their function is assessed by evaluating the patient’s ability to swallow and speak.

The eleventh cranial nerve, the spinal accessory nerve, controls shoulder movement and head rotation. Its function is assessed by testing shoulder shrug and head rotation.

The twelfth cranial nerve, the hypoglossal nerve, controls tongue movement. Its function is evaluated by assessing tongue strength and mobility.

Motor Examination

The motor examination assesses the strength and coordination of the patient’s muscles. The patient is asked to perform various movements, including gripping, squeezing, and pushing against resistance. Muscle strength is assessed using the Medical Research Council scale, which ranges from 0 to 5. A score of 0 indicates no movement, 1 indicates a flicker of movement, 2 indicates movement against gravity but not resistance, 3 indicates movement against gravity and some resistance, 4 indicates movement against gravity and full resistance, and 5 indicates normal strength.

The examination also assesses muscle tone and reflexes. Muscle tone is evaluated by passively moving the patient’s limbs through a range of motion and assessing for resistance. Reflexes are evaluated by tapping on the patient’s tendons with a reflex hammer and assessing for the strength and symmetry of the reflexes.

Sensory Examination

The sensory examination assesses the patient’s ability to feel touch, pain, temperature, and vibration. The patient’s sensory function is evaluated by testing their ability to differentiate between different sensations, such as light touch and sharp touch, and by assessing their ability to detect vibration using a tuning fork.

Coordination Examination

The coordination examination assesses the patient’s ability to perform fine motor movements, such as finger tapping and rapid alternating movements, as well as gross motor movements, such as walking and balance. Abnormalities in coordination can indicate underlying neurological conditions, such as cerebellar disease.

Conclusion

In conclusion, a focused neurological examination is a crucial part of the clinical assessment of patients presenting with neurological symptoms. It involves a detailed evaluation of the patient’s mental status, cranial nerves, motor and sensory functions, reflexes, and coordination. The purpose of the examination is to identify any neurological abnormalities that may be indicative of an underlying neurological condition. A thorough history and physical examination can provide important clues to guide the neurological examination. The results of the neurological examination can help guide further diagnostic tests and treatment plans. It is essential that healthcare professionals who work with patients presenting with neurological symptoms have a thorough understanding of the steps involved in a focused neurological examination and how to interpret the findings.