Agostini 2010

THE NEUROLOGICAL EXAMINATION

Adapted from the American Academy of Neurology Core Curriculum 2002

I. COMPREHENSIVE NEUROLOGIC EXAMINATION

“All medical students should be able to perform the following parts of the
neurologic examination.”

A. Mental Status
1. Level of alertness
2. Language function
a. Fluency
b. Comprehension
c. Repetition
d. Naming
3. Memory (short-term and long-term)
4. Calculation
5. Visuospatial Processing
6. Abstract Reasoning

B. Cranial Nerves
1. Vision
a. Visual fields
b. Visual acuity
c. Funduscopic exam
2. Pupillary light reflex
3. Eye movements
4. Facial sensation
5. Facial strength
6. Hearing
7. Palatal movement
8. Speech
9. Neck movements
a. Head rotation (SCM)
b. Shoulder elevation (Trapezius)
10. Tongue movements

Gelb DJ et al. The Neurology Clerkship Core Curriculum. Neurology 2002;58:849- 1

852. Appendix: Table E4 at www.neurology.org
Agostini 2010

C. Motor Function
1. Gait (casual, on toes, on heels, tandem gait)
2. Coordination
a. Fine finger movements
b. Rapid alternating movements
c. Finger-to-nose
d. Heel-to-shin
3. Involuntary movements
4. Pronator drift
5. Tone (resistance to passive manipulation)
6. Bulk
7. Strength
a. Shoulder abduction
b. Elbow flexion and extension
c. Wrist flexion and extension
d. Finger flexion, extension and abduction
e. Hip flexion and extension
f. Knee flexion and extension
g. Ankle dorsiflexion and plantar flexion

D. Reflexes
1. Deep tendon reflexes (DTRs)
a. Biceps
b. Triceps
c. Brachioradialis
d. Patellar
e. Achilles
2. Plantar responses

E. Sensation
1. Light touch
2. Pain or temperature
3. Proprioception
4. Vibration

Gelb DJ et al. The Neurology Clerkship Core Curriculum. Neurology 2002;58:849- 2

852. Appendix: Table E4 at www.neurology.org
Agostini 2010

II. SCREENING OR “BRIEF”

“All medical students should be able to perform a brief, screening neurologic

examination that is sufficient to detect significant neurologic disease even in patients with
no neurologic complaints. Although the exact format of such a screening examination
may vary, it should contain at least some assessment of mental status, cranial nerves, gait,
coordination, strength, reflexes, and sensation. One example of a screening examination
is given here.”

A. Mental Status
1. Level of alertness
2. Appropriateness of responses
3. Orientation to date and place

B. Cranial Nerves
1. Visual acuity
2. Pupillary light reflex
3. Eye movements
4. Hearing
5. Facial strength

C. Motor Function
1. Gait (casual, tandem)
2. Coordination
a. Fine finger movements
b. Finger-to-nose
3. Strength
a. Shoulder abduction
b. Elbow extension
c. Wrist extension
d. Finger abduction
e. Hip flexion
f. Knee flexion
g. Ankle dorsiflexion

D. Reflexes
1. Deep tendon reflexes (DTRs)
a. Biceps
b. Patellar
c. Achilles
2. Plantar responses

E. Sensation
1. One modality at the toes
a. light touch, pain/temp or proprioception

Gelb DJ et al. The Neurology Clerkship Core Curriculum. Neurology 2002;58:849- 3

852. Appendix: Table E4 at www.neurology.org
Agostini 2010

III. ALTERED LEVEL OF CONSICOUSNESS (“Coma”) EXAM

A. Mental Status
1. Level of arousal
2. Response to auditory stimuli (including voice)
3. Response to visual stimuli
4. Response to noxious stimuli (applied centrally and to each limb
individually)

B. Cranial Nerves
1. Response to visual threat
2. Pupillary light reflex
3. Oculocephalic reflex (doll’s eyes)
4. Vestibulo-ocular reflex (cold caloric)
5. Corneal reflex
6. Gag reflex

C. Motor Function
1. Voluntary movements
2. Reflex withdrawal
3. Spontaneous, involuntary movements
4. Tone (resistance to passive manipulation)

D. Reflexes
1. Deep tendon reflexes
2. Plantar responses

E. Sensation (to noxious stimuli).

Gelb DJ et al. The Neurology Clerkship Core Curriculum. Neurology 2002;58:849- 4

852. Appendix: Table E4 at www.neurology.org