Neurologic Examination

The neurologic examination begins with information obtained from the neurologic history, which is similar to a general medical history. The chief complaint is determined by asking open-ended questions. Analysis of the chief complaint should include the following: Date of onset Character and severity Location and extension

Time relationship (acute, subacute, or chronic) Associated complaints Aggravating and alleviating factors Previous treatment and effects The sequence of the events and their progression is helpful in localizing the lesion and developing a differential diagnosis. A brief neurologic review of systems should include questions about headaches, visual changes, weakness, sensory changes, gait disturbances, and bowel and bladder function. The past medical history, social history, and family history are reviewed as well.

Much of the initial neurologic examination, including cranial nerve testing, carotid artery auscultation, and reflex and sensory assessment, can be conducted with the patient seated in a chair, on the bed, or on the examination table. Superficial reflexes, tests for meningeal irritability, and rectal examination are performed with the patient lying down. Gait, strength, and coordination can subsequently be evaluated with the patient standing. Traditionally, the neurologic examination is divided into five major areas: mental status, cranial nerves, motor system, sensory system, and reflexes.

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