Neurological Exam

What is a neurological exam?

A neurological (neuro) exam consists of a physical examination to identify signs of disorders affecting your brain, spinal cord and nerves (nervous system). Neurological examination is the best way for healthcare providers to check the function of your brain and nervous system. It helps them determine which tests to run. Every neurological exam is different depending on your symptoms. Sometimes, it can take time to complete the physical examination and the interview, as your nervous system is very complex.

If you already live with a nervous system disorder, a neurological exam helps healthcare providers track treatment response.

What does a neuro exam entail?

It includes a series of physical examination steps that assess nervous system functioning. These may include evaluation of your:

• Mental status (cognition) and speech.
• Cranial nerve (nerves of your head and face) function.
• Strength, coordination and muscle tone.
• Reflexes (such as “knee jerk”) and others.
• Perception of feeling in different parts of your body to different stimulation, like touch and vibration.
• Gait and mobility.
• Spine.
• Level of consciousness, after a traumatic brain injury, for example.

Who may need a neurological exam?

You may benefit from a neurological exam if you have symptoms of neurological dysfunction such as:

• Altered state of consciousness, including coma.
• Cognitive decline, including confusion, memory loss or changes in behavior.
• Blurred or double vision, impaired hearing or loss of sense of smell.
• Difficulty with speech (dysarthria or aphasia).
• Difficulty with balance or coordination.
• Dizziness.
• Headaches.
• Muscle weakness.
• Numbness or tingling in your arms and legs.
• Seizures.

How can a neurological exam help me?

Neurological exams help determine whether symptoms are due to a nervous system disorder or another medical issue. A neurological examination provides the basis for further testing.

Nervous system disorders detected by a neuro exam may include:

• Infections, like meningitis or encephalitis.
• Movement disorders, including Parkinson’s disease.
• Neurodegenerative disorders, including Alzheimer’s disease or other dementias.
• Neuromuscular disorders, like amyotrophic lateral sclerosis (ALS).
• Stroke.
• Multiple sclerosis and similar conditions.
• Traumatic brain injury.
• Epilepsy and seizure disorders.
• Headache disorders, such as migraine and cluster headaches.

Who conducts a neurological exam?

A neurologist or a specially trained physician extender, like a certified nurse practitioner or physician assistant, conducts the exam. This specialist diagnoses and treats brain, nerve and spinal cord disorders. Some neurologists specialize in areas such as movement disorders, epilepsy or pediatric neurology.

How do I prepare for a neurological exam?

There isn’t much preparation necessary. You may want to wear loose clothing. It may be helpful to write down information about your symptoms and health history, too. This can prevent you from forgetting important details that may help guide the exam.

How is a neurological exam performed?

The evaluation starts with an interview about your symptoms, including how long you’ve had them and how they affect everyday life. Your neurologist will want to know about other medical issues you have. Following this, your neurologist will perform a physical examination.

As part of your neuro exam, your healthcare provider will conduct a physical examination to test one or more aspects of your nervous system functioning. These include:

Mental status (cognition)

Testing cognition provides helpful information about thinking, memory and your emotional state. You may be asked to:

• Answer questions about the date, time and location.
• Count out loud.
• Describe how you’re feeling.
• Repeat a short sequence of words.

Cranial nerve assessment

Your cranial nerves enable your brain to communicate with your upper body. This assessment helps pinpoint disorders affecting specific areas of your brain. It may involve:

• Testing movements of your face, eyes and tongue.
• Testing of your pupils and vision.
• Testing of your hearing and sense of smell.

Movement, coordination and balance

These tests assess your brain’s communication with muscles that help you move, stay on your feet and perform simple tasks. They may involve:

• Closing your eyes and touching your nose with your finger.
• Moving your arms and legs.
• Performing fine motor skills, like writing your name.
• Walking a straight line or taking a few steps on your heels or toes.

Reflexes

Your neurologist tests your automatic response to specific triggers. These tests show how well nerves between your brain and body communicate. This may involve:

• Stimulating the sole of your foot.
• Tapping your knee or other tendons with a rubber hammer to see if your limb moves.
• Lightly stroking the skin on your abdomen to see if your abdominal muscles tighten.

Sensory exam

This part of the test evaluates your ability to perceive pain, temperature and other sensations. It may involve:

• Closing your eyes and moving your toes.
• Putting warm or cold objects against your skin.
• Lightly stroking your skin with a cotton ball and asking whether you feel it.
• Touching different areas of your body with a pin or a vibrating tuning fork.

Level of consciousness

If you’re not fully conscious, this type of testing assesses brain activity. It rates your ability to complete basic commands (Glasgow Coma Scale), such as:

• Movement to command.
• Opening your eyes.
• Speaking.

Autonomic nervous system

Your autonomic nervous system controls vital functions like breathing and blood pressure. This part of the exam may involve:

• Asking you about bowel and bladder control.
• Checking your blood pressure in different positions.
• Other tests as needed.

How quickly will I receive the results of my neurological exam?

Your neurologist will explain the results as soon as the exam is complete.

Will I need any additional tests?

If results aren’t within normal range, your neurologist may order extra tests to learn more. These may include:

• Blood test to rule out other conditions, such as a vitamin deficiency.
• Imaging studies like an MRI or CT scan.
• Electroencephalogram (EEG) to check the electrical function of your brain.
• Electromyogram (EMG) and nerve conduction studies to check nerve and muscle.
• Lumbar puncture.

A note from Cleveland Clinic

Neurological exams evaluate one or more aspects of nervous system functioning. They help confirm or rule out disorders affecting your brain, nerves and spinal cord. You may need additional testing to confirm a diagnosis. These exams also help neurologists track progress with neurological disorder treatments.