OVERVIEW OF COMPHREHENSIVE NEUROLOGIC ASSESSMENT
(LOHMA CraRefMo CoSen)
I. Cerebral Function (Mental Status)
 LEVEL OF CONSCIOUSNESS (Glasgow Coma Scale)
 Point out a thing (verbal and motor)
 Ask patient to raise right hand
 Ask patient what is his last meal taken
 Assess if s/he is:
o Alert - The patient is alert, attentive, and
follows commands. If asleep, she responds
promptly to external stimulation and, once
awake, remains attentive.
o Lethargic - The patient is drowsy but awakens
although not fully to stimulation. She will
answer questions and follow commands, but
will do so slowly and inattentively.
o Obtunded - The patient is difficult to arouse
and needs constant stimulation in order to
follow a simple command. She may respond
verbally with one or two words, but will drift
back to sleep between stimulation.
o Stupor - The patient arouses to vigorous and
continuous stimulation; typically, a painful
stimulus is required. She may moan briefly but
does not follow commands. Her only response
may be an attempt to withdraw from or
remove the painful stimulus.
o Coma - The patient does not respond to
continuous or painful stimulation. She does not
move—except, possibly, reflexively—and does
not make any verbal sounds.
 Grade him by using GCS
MOTOR RESPONSE
Obeys commands fully  6
Localizes to noxious stimuli  5
Withdraws from noxious stimuli  4
Abnormal flexion, i.e. decorticate posturing  3
Extensor response, i.e. decerebrate posturing  2
No response 1
VERBAL RESPONSE
Alert and Oriented  5
Confused, yet coherent, speech  4
Inappropriate words and jumbled phrases consisting of words  3
Incomprehensible sounds  2
No sounds 1 a distance of 2-3 ft.; client and examiner lok
EYE OPENING
Spontaneous eye opening  4
Eyes open to speech  3
Eyes open to pain  2
No eye opening 1  Accomodation Test- Ask px to stare at an object
Brain Damage Classification:
Severe Brain Damage  GCS score of 8 or less
Moderate Brain Damage  GCS score of 9 to 12
Mild Brain Damage  GCS score of 13 to 15
E3V3M5= GCS 11 = Meaningless
 FINDINGS: Alert and awake with eyes open and
looking at the examiner; client responds
appropriately
 ORIENTATION
 Ask px’s full name.
 Ask where he is now.
 Ask what is the time and date today.
 Ask px to name 3 of his relatives.
 FINDINGS: Aware of self, others, place and time
 HISTORY
 Do you have any injury?
 Do you have sudden changes in mood/behavior?
 Do you have problems with swallowing or
speaking?
 Do you ever experience drooling of saliva?
 MEMORY
 Immediate- I’ll say phrase then repeat it after me
 Recent- Earlier, before our interview, I told you
my name, what is my name again?, What is the
meal taken?
 Remote- What is the age of your mother?
 ATTENTION
 Mathematical Problem
II. Cranial Nerves Function
 CN I: Olfactory
 Smell Test-Ask your px to identify, with his or her
eyes closed, each of the following common
nonirritating odors. Test each nostril separately.
Check for asymmetry.
 Anosmia- absence of smell
 FINDINGS: Identifies scent correctly with each
nostril.
 CN II: Optic
 Snellen’s Eye Chart- check distance vision with
snellen chart 20 ft from the px, FINDINGS: 20/20
OD and OS with no hesitation, frowning or
squinting
 Visual Field Test(Peripheral Vision) –Face client at
directly ahead and cover eye directly opposite
each other, FINDINGS: Px&nurse report seeing
object at the same time as it approaches from
the periphery.
JOYEE:D
3-4 feet away, and move object in toward client’s
nose, FINDINGS: Pupils converge and constrict as
obeject moves in toward the nose; pupil
responses are uniform.
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 CN III: Oculomotor
  Light Accomodation (PERRLA)  CN VIII: Vestibulocochlear/Auditory/Acoustic
o Direct- from right temporal then to the right  Hearing Test
eye then assess right pupil, FINDINGS: o Snap
constricted right pupil o Whisper Test
o Consensual- from right temporal then to the
 Weber (Lateralization Test)-sensory neural
right eye then assess left pupil, FINDINGS: hearing loss(Sound localizes to normal ear),
constricted left pupil conduction hearing loss(Sound localizes to
o CN II & CN III are assessed, ipsilateral for affected ear )
direct and contralateral for consensual.  Rinne(AC>BC)- with the affected side,
 6 Cardinal Visual Gaze Test – ask patient to follow BC>AC(conductive hearing loss), AC>BC (sensory
tip of the pen as it is moved in six cardinal fields, neural hearing loss)
FINDINGS: Both eyes move in smooth,
coordinated manner in all directions  CN IX: Glossopharyngeal
 Taste Test (posterior 1/3 of the tongue)
 Gag Reflex
 CN X: Vagus
 Elevation of Soft Palate (Say aaaah)
 Observe Uvula
 CN XI: Accessory
 Trapezius (Shrug Shoulders), right then left then
both, FINDINGS:
 Sternocleidomastoid(turn head to side with
{SO4, LR6, the rest are 3} resistance)look to the left, then to the right then
 Convergence with resistance, FINDINGS:
 Pupillary constriction- Isocoria(both pupils are
the same in size, reactive to light, dilating, and
 CN XII: Hypoglossal
 stick out tongue
constricting)/ Anisocoria (abnormal)
 CN IV: Trochelear (cardinal gaze)-finished
Oh-Some Feel-Brother
 CN V: Trigeminal Oh-Says Very-Said
 Corneal Reflex(sensory)- Touching cornea lightly Oh-Money Good-Big
with wisp of cotton, FINDINGS: Eyelids blinks To-Matters Velvet-Brains
bilaterally Touch-But Ah-Matters
 Temporal and Masseter muscle strength(motor)- And-My Heaven-Most
Paplpate masseter and temporal muscles as
client clench teeth, FINDINGS: Muscles contract
bilaterally. III. Reflexes
 Sensory function of ophthalmic, maxillary and (SUPERFICIAL/CUTANEOUS REFLEXES)
mandibular branch (pin test)- test the client’s  Corneal Reflex
ability to feel light touch, dull and sharp facial
sensation on both sides of face(forehead, cheek,
 Palatial Reflex and Pharyngeal Reflex- Gag reflex
chin), FINDINGS: Identifies light touch, dull, and  Abdominal Reflex
sharp sensations to forehead, cheek and chin.  Clemasetric Reflex-Inner thigh
 CN VI: Abducens (cardinal gaze)-finished  Anal Reflex
 CN VII: Facial  Plantar(Babinski’s) Reflex
 (motor)facial expression-smile, frown, show (DEEP TENDON REFLEX) -muscle stretch
teeth, blow out cheeks, raise eyebrows and
tightly close eyes, FINDINGS: Facial movements  Biceps Reflexes (C5-C6)
are symmetrical  Triceps Reflexes(C7-C8)
 Corneal reflex(CN V)- finished
Bracheoradialis Reflex(C3,C6)
JOYEE:D


 Taste Test (anterior 2/3 of tongue)-with eyes
closed and tongue protruded, FINDINGS:  Patellar Reflex(L2, L3, L4)
Identifies taste correctly  Achilles(S1-S2)
 stick out tongue, move to the left and right, say  encourage client to relax and position the px
aaaah(CN 12), soft palate and uvula must raise properly
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up(CN 11)
  Palpate tendon and use rapid wrist movement to  Tactile Discrimination
strike tendon briskly o One and Two-Point Discrimination
 For arm reflexes, ask client to clench his or her
o Stereogenesis- Place a familiar object in the
jaw
patient's hand (coin, paper clip, pencil, etc.).
 For leg reflexes, ask the client to lock his or her
Ask the patient to tell you what it is.
fingers of both hands and pull them against each
o Graphism- Agraphesthesia(AbN)
other
- With the blunt end of a pen or
pencil, draw a large number in the
IV. Motor Function
patient's palm. Ask the patient to
 Muscle Condition identify the number.
 Muscle Tone
o Ask the patient to relax.
o Flex and extend the patient's fingers, wrist,
and elbow.
o Flex and extend patient's ankle and knee.
o There is normally a small, continuous
resistance to passive movement.
o Observe for decreased (flaccid) or increased
(rigid/spastic) tone.
 Muscle Mass
 Muscle Strength- rate strength that is against
force of gravity and resistance
 Muscle Coordination- rapid alternating
movements & point to point maneuver
 Maintenance of truncal and head balance
 Ataxia-muscle incoordination
 Fine and Gross Motor
 Alternating Pronation and Supination of Hands
 Fine-Feet clockwise
 Gross- Gait
V. Cerebellar Function
 Fine motor test for the Upper Extremity
 Finger to Thumb- with eyes closed
 Finger to Finger- with eyes closed
 Finger to Nose Test-
 Fine Motor Test for the Lower Extremity
 Heels down the opposite shin
 Balance
 Walking Gait
 Heel-Toe Walking
 Romberg’s Test
VI. Sensory System
 Light Touch Sensation
 Pain Sensation(dull/sharp)-Superficial sensation
 Temperature Sensation
 Kinesthetic Sensation
 Mechanical Sensation
JOYEE:D

o Vibration- kneading, ask the patient if they

feel the vibration then when did it end.
o Proprioception- grasp the patient finger,
show the patient up and down. With the
patient’s eyes closed, ask the patient to
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identify the direction you move the finger