A neurological exam is a series of simple questions and tests that provide information about your nervous system. Many diseases, such as dementia or stroke, cause changes in your ability to think, respond, and move. The neurological exam is a way to find out what might be wrong. It may be done as part of a complete physical exam.
Primary care physicians are trained to know how to check almost everything listed below. For most people’s healthcare problems, most of the time, a neurological exam by a primary care provider gives all of the information needed. In some cases, your provider may refer you to a specialist in neurology.
The neurological exam checks several parts of the nervous system:
Senses
A sensory exam involves checking your response to pain, temperature, and pressure. For example, pinpricks may be used to test your response to pain. The exam can compare your response at different spots or opposite sides of your body. A cold or warm object may be used to see how well you feel hot and cold temperatures. You may be asked to close your eyes and say which direction the provider is moving a part of your body, such as the big toe. You may be asked to identify objects with your eyes closed or identify numbers or letters traced on your body.
For accurate results, the sensory exam should be repeated. Your responses may be affected by how alert, aware, and well rested you are when you have the exam. The sensory exam is usually one of the first tests done during a neurological exam.
Mental status
The mental status exam is a series of questions designed to test your:
You may be asked to:
In addition to asking questions, your healthcare provider observes your general behavior during the exam.
Cranial nerves
The cranial nerves relay messages between the brain and the head and neck. They control vision, smell, and movement of the tongue and vocal cords. The cranial nerve exam commonly tests:
Motor system, reflexes, and coordination
The motor system includes your muscles and the nerves that control your muscles. You are usually asked to undress, so your provider can see the muscles and look for shrinkage, twitching, or abnormal movements. Tests are done to check the strength of your muscles. Your provider may also check for the Babinski response. To do this test, he or she will stroke or scratch, heel to toe, the outer side of the sole of the foot. In people over the age of 2, the toes normally curl downward in response to this touch. If the toes fan upward, you may have a brain or spinal cord disorder or injury.
Reflexes are what make your knee or elbow jerk when your provider taps on a muscle or tendon. Abnormal reflexes may mean problems with the nervous system. The areas most often tested for reflexes are the knee, ankle, elbow, and wrist.
The coordination part of the exam can show if there are problems in the part of the brain that controls movement and coordination. You may be asked to:
Walking
Walking depends on many different parts of the nervous system. It can be affected by many disorders. By watching the way you walk, your provider can gather important clues about what might be wrong. You are usually asked to walk in different ways:
A neurological exam is less expensive than many other kinds of tests. It can help your provider check for problems in the brain and nervous system. For many medical conditions, early treatment can help prevent more serious problems.
