Neurological Examination Protocol
Level of Consciousness Assessment
- The American College of Emergency Physicians recommends assessing alertness using the Glasgow Coma Scale components: eye opening, verbal response, and motor response, to evaluate the level of consciousness in patients 1, 2
- Evaluating orientation by asking patients their age and the current month can help assess their level of consciousness 1
- Testing the ability to follow commands by asking patients to open/close eyes and grip/release hand can provide valuable information about their neurological status 1
Cranial Nerve Assessment
- Assessing eye movements for palsy or forced deviation can help identify potential neurological deficits 1, 3
- Testing visual fields using confrontation or visual threat can detect hemianopia, a condition that may indicate a structural brain lesion 1, 4
- Checking for facial asymmetry, flat nasolabial fold, or weakness can provide insight into the patient's cranial nerve function 1, 5
- Testing bulbar function, including gag reflex, cough response, and swallowing, can help assess the patient's neurological status 3, 6
Motor Function Assessment
- Having patients extend their arms at 90° (seated) or 45° (supine) for 10 seconds can help detect drift or weakness in the upper extremities 1, 5
- Asking patients to raise their legs 30° and hold for 5 seconds can assess motor function in the lower extremities 1, 5
- Performing passive range of motion to detect abnormal resistance can provide information about the patient's tone assessment 3, 6
- Assessing strength in major muscle groups using the 0-5 scale can help evaluate the patient's motor function 2, 3
Sensory and Coordination Assessment
- Using a safety pin to check sensation in extremities can help identify any asymmetry or deficits in sensory function 1, 7
- Testing finger-to-nose and heel-to-shin movements can detect ataxia, a condition that may indicate a neurological deficit 1, 7
Pathological Reflexes and Higher Function
- Checking for the Babinski sign by stroking the lateral sole of the foot can provide information about the patient's reflexes 2, 3
- Assessing language function by asking patients to name objects or read simple sentences can help evaluate their higher cognitive function 1, 8
- Testing for neglect or inattention by simultaneous bilateral stimulation of hands or visual fields can provide insight into the patient's neurological status 1, 7