The neurological examination: order and screening exam !

Exam technique

An ordered check of the mind, cranial nerves, strength, reflexes, sensation, coordination and gait.

Updated 2026-11-01

See it in 3D: Spinal cord · Cerebellum · Motor cortex · Sensory cortex

What it is

The neurological exam moves through the nervous system in a fixed order so that no part is missed. It answers two questions: is there a lesion, and where is it? A good screening exam takes a few minutes; any abnormal part is then examined in depth.

Landmark anatomy

Mental status: cerebral cortex, especially the frontal and temporal lobes and the language-dominant hemisphere.
Cranial nerves: brainstem and diencephalon.
Strength and reflexes: the corticospinal tract (upper motor neuron) and the anterior horn, root and nerve (lower motor neuron).
Sensation: dorsal columns (vibration, position) and the spinothalamic tract (pain, temperature).
Coordination and gait: the cerebellum, with vestibular and proprioceptive input.

Technique, step by step

During the interview, note alertness, speech, mood and behaviour: this is the start of the mental status exam.
Mental status: orientation, attention, recall of three words and language (naming, repetition).
Cranial nerves: visual fields, pupils, eye movements, facial sensation and movement, hearing, palate and tongue.
Motor: inspect for wasting and fasciculations, move each limb passively to judge tone, and grade strength from 0 to 5.
Test for pronator drift with the arms outstretched and the eyes closed.
Reflexes: biceps, triceps, brachioradialis, patellar and Achilles on both sides, plus the plantar response.
Sensation: pain or temperature and vibration or position in the hands and feet, from distal to proximal.
Coordination: finger–nose, heel–shin and rapid alternating movements.
Normal gait, tandem gait (heel to toe) and the Romberg test, with the examiner close by to prevent falls.

Abnormal findings

Weakness with hyperreflexia and a Babinski sign points to the upper motor neuron; weakness with wasting, fasciculations and hyporeflexia to the lower motor neuron.
A deficit of one side of the body (face, arm and leg on the same side) suggests a lesion of the opposite hemisphere.
A sensory level on the trunk with weakness of both legs suggests a spinal cord lesion.
Stocking-and-glove sensory loss suggests polyneuropathy.

Common errors

Examining a tired or painful patient, or one without their usual glasses or hearing aids, distorts the result.
Calling a reflex absent without trying Jendrassik reinforcement.
Not recording the side or not comparing with the other side.
Skipping gait: it is one of the most informative tests.

Test yourself

Think of the answer, then tap the question to see it.

What is the usual order of the neurological exam?

Mental status, cranial nerves, motor, reflexes, sensation, coordination and gait.

Which combination of findings points to an upper motor neuron lesion?

Weakness with spasticity, hyperreflexia, clonus, pronator drift and a Babinski sign.

What do serial nursing neuro checks include?

Level of consciousness (Glasgow Coma Scale), pupil size and reaction, movement and strength of all four limbs and vital signs; any deterioration is reported at once.

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See it in 3D

The structures of Durgical's 3D anatomy where it is found.

← All of the clinical exam

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.

Sources: Introduction to the Neurologic Examination (MSD Manual Professional Edition, 2024); 16.1 Overview of the Neurological Exam (OpenStax, Anatomy and Physiology 2e, 2022); Neurological Exam (MedlinePlus, U.S. National Library of Medicine, 2024); 26.2 Physical Assessment - Clinical Nursing Skills (OpenStax, 2024).

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Representative model, for educational purposes only.