Nervous system
Mental status, cranial nerves, motor, reflexes, sensation, cerebellum, meningeal signs and neurological syndromes.
30 pages
Sign
- Abnormal gaits: hemiparetic, parkinsonian, ataxic, steppage, waddlingThe way a person walks reveals where the problem is: brain, basal ganglia, cerebellum, nerves or…
- Babinski signWhen the sole is stroked, the big toe goes up instead of down; in adults it means damage to the…
- Hoffmann sign and clonusTwo signs of brisk reflexes: the thumb flexes when the middle fingernail is flicked, and the…
- Meningeal signs: neck stiffness, Kernig and BrudzinskiManoeuvres that look for pain or resistance when inflamed meninges are stretched, as in…
- Pupils: light reflex and abnormal pupils (Marcus Gunn, Horner, Argyll Robertson)A check of pupil size and response to light, which localises lesions of the eye, the nerves and…
Syndrome
- Cerebellar syndromeClumsy coordination: staggering gait, tremor when aiming, broken-up speech and abnormal eye…
- Cortical syndromes: aphasia, apraxia, agnosia, neglect, frontal signsThe signs that show which lobe of the brain is damaged: problems with language, skilled…
- Intracranial hypertension syndromeRaised pressure inside the skull: headache, vomiting, blurred vision and drowsiness; it can be…
- Involuntary movements: tremor, chorea, dystonia, myoclonus and ticsHow to name the movements a patient cannot control, because the name points to the cause
- Meningeal syndromeSevere headache, stiff neck, discomfort with light and vomiting, with or without fever, from…
- Parkinsonian syndromeSlowness of movement with a resting tremor, stiffness and problems with gait and balance
- Sensory syndromes: where the lesion is from the pattern of numbnessThe shape of the area where a patient feels numbness or tingling tells you whether the problem…
- Spinal cord syndromes: complete, Brown-Séquard, central, anteriorPatterns of weakness and sensory loss that show which part of the spinal cord is damaged
- Upper vs lower motor neuron syndromeTwo patterns of weakness: one with stiffness and brisk reflexes (brain or cord) and one with…
Maneuver
- Cerebellar tests: finger–nose, heel–shin and rapid alternating movementsSimple aiming and rhythm tasks that show whether the cerebellum is coordinating movement well
- Pronator driftWith the arms outstretched and the eyes closed, an arm that turns in and sinks shows subtle…
- Romberg testThe patient stands with the feet together and closes the eyes; losing balance means position…
Exam technique
- Cranial nerve examinationSimple tests that check the twelve nerves that leave the brain and brainstem
- Deep tendon reflexes and their gradingA tap of the hammer on a tendon that triggers an automatic contraction; it checks nerves, roots…
- Examining the autonomic nervous system and the autonomic syndromesBedside tests of the nerves that control blood pressure, heart rate, pupils, sweating, bladder…
- Lumbar puncture and reading the cerebrospinal fluidA needle placed in the lower back below the end of the spinal cord to measure pressure and take…
- Mental status: orientation, attention and screening testsAn assessment of the patient's consciousness, attention, orientation, memory and language
- Motor examination: bulk, tone and strength gradingA check of muscle bulk, stiffness or floppiness of the muscles, and strength graded from 0 to 5
- Psychiatric mental status exam: mood, thought, perception, insightA structured description of how a person looks, feels, thinks and perceives during the…
- Sensory examination: modalities and dermatomesA check of touch, pain, temperature, vibration and position sense to find where sensation fails
- The neurological examination: order and screening examAn ordered check of the mind, cranial nerves, strength, reflexes, sensation, coordination and…
Topic
- Headache: primary or secondary, and the red flags (SNOOP)Most headaches are migraine or tension-type, but a few hide a bleed, an infection or raised…
- Neurological studies: EEG, EMG and nerve conduction, evoked potentialsTests that record the electrical activity of the brain, nerves and muscles to locate a problem…
- Recognising a stroke: BE-FAST and the NIH Stroke ScaleSudden signs of a brain attack: balance, eyes, face, arm and speech; every minute counts
- The patient with weakness: brain, cord, nerve, junction or muscleHow to tell where weakness comes from: the brain or spinal cord, a nerve, the nerve–muscle…
A to Z
Educational content on the clinical exam; it is learned and practised under supervision. It does not replace assessment by a health professional and is not for self-diagnosis.
Representative model, for educational purposes only.