[Durgical](https://durgical.com/en/) › [DurgiPedia](https://durgical.com/en/durgipedia/) › [Clinical exam](https://durgical.com/en/clinical-exam/) › [Nervous system](https://durgical.com/en/clinical-exam/#a-neuro) › The neurological examination: order and screening exam [Clinical exam](https://durgical.com/en/clinical-exam/) · [Nervous system](https://durgical.com/en/clinical-exam/#a-neuro) # 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](https://durgical.com/en/anatomy/spinal-cord/) · [Cerebellum](https://durgical.com/en/anatomy/anterior-quadrangular-lobule/) · [Motor cortex](https://durgical.com/en/anatomy/precentral-gyrus/) · [Sensory cortex](https://durgical.com/en/anatomy/postcentral-gyrus/) ## Key points - Classic order: mental status, cranial nerves, motor (bulk, tone, strength), reflexes, sensation, coordination and gait. - The goal is to localise: cortex, brainstem, spinal cord, root, nerve, neuromuscular junction or muscle. - Always compare one side with the other; asymmetry is the most useful finding. - A screening exam can be done in about 4 minutes and is expanded only where something is abnormal. - In nursing, serial neuro checks cover the Glasgow Coma Scale, pupils, movement of all four limbs and vital signs; any change is reported at once. ## 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. ## Memory aid 'Mind, nerves, muscle, reflex, skin and steps': six stops from head to feet. ## 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. [Add to my cards (3)](https://durgical.app/estudiar/?add=/en/clinical-exam/the-neurological-examination-order-and-screening-exam/) ## See it in 3D The structures of Durgical's 3D anatomy where it is found. - [Spinal cord](https://durgical.com/en/anatomy/spinal-cord/) - [Cerebellum](https://durgical.com/en/anatomy/anterior-quadrangular-lobule/) - [Motor cortex](https://durgical.com/en/anatomy/precentral-gyrus/) - [Sensory cortex](https://durgical.com/en/anatomy/postcentral-gyrus/) ## Related - [Mental status: orientation, attention and screening tests](https://durgical.com/en/clinical-exam/mental-status-orientation-attention-and-screening-tests/) - [Cranial nerve examination](https://durgical.com/en/clinical-exam/cranial-nerve-examination/) - [Motor examination: bulk, tone and strength grading](https://durgical.com/en/clinical-exam/motor-examination-bulk-tone-and-strength-grading/) - [Deep tendon reflexes and their grading](https://durgical.com/en/clinical-exam/deep-tendon-reflexes-and-their-grading/) - [Sensory examination: modalities and dermatomes](https://durgical.com/en/clinical-exam/sensory-examination-modalities-and-dermatomes/) - [Cerebellar tests: finger–nose, heel–shin and rapid alternating movements](https://durgical.com/en/clinical-exam/cerebellar-tests-finger-nose-heel-shin-and-rapid-alternating-movements/) - [Abnormal gaits: hemiparetic, parkinsonian, ataxic, steppage, waddling](https://durgical.com/en/clinical-exam/abnormal-gaits-hemiparetic-parkinsonian-ataxic-steppage-waddling/) - [Recognising a stroke: BE-FAST and the NIH Stroke Scale](https://durgical.com/en/clinical-exam/recognising-a-stroke-be-fast-and-the-nih-stroke-scale/) ## Related conditions - [Ischaemic stroke](https://durgical.com/en/conditions/ischaemic-stroke/) - [Delirium](https://durgical.com/en/conditions/delirium/) - [Traumatic brain injury](https://durgical.com/en/conditions/traumatic-brain-injury/) [← All of the clinical exam](https://durgical.com/en/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](https://www.msdmanuals.com/professional/neurologic-disorders/neurologic-examination/introduction-to-the-neurologic-examination) (MSD Manual Professional Edition, 2024); [16.1 Overview of the Neurological Exam](https://openstax.org/books/anatomy-and-physiology-2e/pages/16-1-overview-of-the-neurological-exam) (OpenStax, Anatomy and Physiology 2e, 2022); [Neurological Exam](https://medlineplus.gov/lab-tests/neurological-exam/) (MedlinePlus, U.S. National Library of Medicine, 2024); [26.2 Physical Assessment - Clinical Nursing Skills](https://openstax.org/books/clinical-nursing-skills/pages/26-2-physical-assessment) (OpenStax, 2024). ## **Spotted a mistake?** We are always improving for the community. Tell us what is wrong and our team will review it. Report a mistake Representative model, for educational purposes only. --- Source: https://durgical.com/en/clinical-exam/the-neurological-examination-order-and-screening-exam/ License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/clinical-exam/the-neurological-examination-order-and-screening-exam/