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Nervous System Exam

Protocols

Nervous System:

Higher Psychic Functions (HPF):

  • 1. Appearance
  • 2. Behavior
  • 3. Consciousness
  • 4. Memory
  • 5. Intelligence
  • 6. Orientation of time, space and person
  • 7. Emotional state
  • 8. Hallucination
  • 9. Delusion
  • 10. Speech.

Motor functions:

  • 1. Bulk of the muscle
  • 2.Tone of the muscle
  • 3. Power of the muscle
  • 4. Fasciculation
  • 5. Involuntary movement (mention the type, e.g. tremor, chorea, athetosis, hemiballismus, etc.)
  • 6. Coordination test:
  • 7. Finger nose test
  • 8. Heel shin test
  • 9. Romberg’s sign
  • 10. Gait and posture.
Reflexes (superficial and deep)

Superficial reflexes:

  • 1. Plantar reflex
  • 2. Abdominal reflex
  • 3. Corneal reflex
  • 4. Palatal reflex
  • 5. Cremasteric reflex.

Deep reflex: 

  • 1. Biceps 
  • 2. Triceps 
  • 3.Knee jerk 
  • 4.Ankle jerk

Clonus:

  • 1. Ankle
  • 2. Patellar.

Others: Gordon’s sign and Oppenheim’s sign (both in leg) and Hoffman’s sign.

Sensory functions:
  • 1. Pain
  • 2. Touch
  • 3. Temperature
  • 4. Position sense
  • 5. Sense of vibration
  • 6. Tactile localization
  • 7. Tactile discrimination
  • 8. Recognition of size and shape, weight and form of object
  • 9. Romberg’s sign.

Signs of meningeal irritation:

  • 1. Neck rigidity
  • 2. Kernig’s sign
  • 3. Brudzinski’s sign.

Examination of cranial nerves:

  • 1. Olfactory nerve (sense of smell or hallucination of smell)
  • 2. Optic nerve: 9
    • a. Visual acuity
    • b. Field of vision
    • c. Color vision
    • d. Light reflex (direct and consensual)
    • e. Fundoscopy (see last)
  • 3.. Oculomotor, trochlear and abducent nerve:
    • a. Ptosis
    • b. Squint
    • c. Ocular movements
    • d. Diplopia
    • e. Nystagmus
    • f. Pupils (size, shape, light reflex)
    • g. Accommodation reflex.
  • 5. Trigeminal nerve:
    • a. Motor
    • b. Sensory
    • c. Corneal reflex.
  • 7. Facial nerve (both sensory and motor)
  • 8. Vestibulocochlear nerve: (ask about any hearing abnormality, vertigo or dizziness or giddiness).
    • a. Look at the external auditory meatus (for any wax, rash)b. Rinne’s test and Weber’s test.
  • 9. Glossopharyngeal and vagus nerve:
    • a. Look for nasal voice, nasal regurgitation, hoarseness of voice, bovine cough
    • b. Movement of palate
    • c. Gag reflex
    • d. Taste sensation (in posterior 1/3 of tongue).
  • 11. Accessory nerve (spinal part): see the action of sternomastoid and trapezius
  • 12. Hypoglossal nerve (look at the tongue and see):
    • a. Wasting
    • b. Fasciculation
    • c. Movement of tongue.