The Neuro Exam

The primary goal of the neuro exam is to "localize the lesion" - you need to figure out which part of the nervous system is broken. It's best to have a good, thorough routine when you perform the exam - we've included a basic outline covering the essentials. Following this, we've included some hints that will help you to figure out, at least generally, where the problem lies.

The Exam
Mental Status
Cranial Nerves
  1. Olfactory - usually not tested
  2. Optic - can they see? Use eye chart.
  3. Oculomotor - do their eyes move? "Follow this with your eyes, keep your head still."
  4. Trochlear - moves superior oblique. Do eyes move normally and without rotation? Do they have double vision? Do they tilt their neck?
  5. Trigeminal - can they chew? Do they have sensation in all three segments of the face bilaterally?
  6. Abducens - moves lateral rectus. Can they look laterally in both eyes (past midline)?
  7. Facial - can they smile symmetrically? Can their eyes tear? Can they salivate? Do they have feeling in the eardrum?
  8. Auditory (Vestibulocochlear) - can they hear? Do they have balance? Rub your fingers near the ears.
  9. Glossopharyngeal - Do they have a gag reflex? Can they feel their ears?
  10. Vagus - is the soft palate arch symmetric ("Say 'aahh'")?
  11. Accessory - can they shrug their shoulders against resistance?
  12. Hypoglossal - can they stick the tongue out straight?
It's common to simply write "CN II-XII intact" in a chart if everything is OK.
Mnemonic = "Oh, Oh, Oh, To Touch And Feel A Girl's V___ - AH."
 
Motor
Sensory
Cerebellar
DTR's
Localization
General terms:
Upper motor neuron
Lower motor neuron