Examination of the Patient Without Neurologic Symptoms: the Screening Neurologic Examination
Authors: Lewis,
Steven L.
Steven L.
Title: Field
Guide to the Neurologic Examination, 1st Edition
Guide to the Neurologic Examination, 1st Edition
Copyright ©2004 Lippincott Williams &
Wilkins
Wilkins
> Table of Contents > Section 3 –
Neurologic Examination in Common Clinical Scenarios > Chapter 53 –
Examination of the Patient Without Neurologic Symptoms: the Screening Neurologic
Examination
Neurologic Examination in Common Clinical Scenarios > Chapter 53 –
Examination of the Patient Without Neurologic Symptoms: the Screening Neurologic
Examination
Chapter 53
Examination of the Patient Without Neurologic Symptoms: the
Screening Neurologic Examination
Screening Neurologic Examination
PURPOSE OF THE SCREENING NEUROLOGIC EXAMINATION
The purpose of the examination of the patient without neurologic
complaints is to look for evidence of unrecognized neurologic disease or the
presence of unrecognized neurologic complications in a patient with a chronic
systemic illness.
complaints is to look for evidence of unrecognized neurologic disease or the
presence of unrecognized neurologic complications in a patient with a chronic
systemic illness.
WHEN TO PERFORM THE SCREENING NEUROLOGIC EXAMINATION
A screening neurologic examination (in contrast to the thorough
neurologic examination, as described in Chapter 40,
Performing a Complete Neurologic Examination) should be performed as part of any
comprehensive general medical examination.
neurologic examination, as described in Chapter 40,
Performing a Complete Neurologic Examination) should be performed as part of any
comprehensive general medical examination.
NEUROANATOMY OF THE SCREENING NEUROLOGIC EXAMINATION
The basic relevant neuroanatomy underlying each examination element
is briefly described in the chapters of Section 2, Neurologic
Examination.
is briefly described in the chapters of Section 2, Neurologic
Examination.
EQUIPMENT NEEDED TO PERFORM THE SCREENING NEUROLOGIC
EXAMINATION
EXAMINATION
An ophthalmoscope
A reflex hammer
128-Hz tuning fork
HOW TO PERFORM THE SCREENING NEUROLOGIC EXAMINATION
Implementing the elements below, in the order shown, is one
practical method of performing a screening neurologic examination in a typical
patient without neurologic symptoms. If any abnormal findings are seen, then
more detail should be included and more examination elements should be added, as
indicated.
practical method of performing a screening neurologic examination in a typical
patient without neurologic symptoms. If any abnormal findings are seen, then
more detail should be included and more examination elements should be added, as
indicated.
Mental Status
(In the patient without any neurologic complaints or symptoms and
in whom there is no suspicion of a disorder of alertness, language, memory or
any other aspect of cognition suggested during your history-taking, no formal
evaluation of mental status is necessary.)
in whom there is no suspicion of a disorder of alertness, language, memory or
any other aspect of cognition suggested during your history-taking, no formal
evaluation of mental status is necessary.)
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Examine the Cranial Nerves
1. Look at the resting size and symmetry of the pupils and examine
the response of each pupil to light (see Chapter 10,
Examination of the Pupils).
the response of each pupil to light (see Chapter 10,
Examination of the Pupils).
2. Perform a funduscopic examination to look at the optic discs
(see Chapter 11, Funduscopic Examination); a funduscopic
examination should be a routine part of any comprehensive medical
examination.
(see Chapter 11, Funduscopic Examination); a funduscopic
examination should be a routine part of any comprehensive medical
examination.
3. Test visual fields to confrontation (see Chapter
13, Visual Field Examination). In the screening examination, this can be
done quickly with both eyes open simultaneously and by just checking the left
and the right visual fields (not the four quadrants).
13, Visual Field Examination). In the screening examination, this can be
done quickly with both eyes open simultaneously and by just checking the left
and the right visual fields (not the four quadrants).
4. Test horizontal eye movements and vertical eye movements (see
Chapter 14, Examination of Eye Movements).
Chapter 14, Examination of Eye Movements).
5. [Look for obvious facial asymmetry while you are talking to the
patient, but unless obvious asymmetry is seen, there is probably no need to
formally test facial strength (see Chapter 16, Examination
of Facial Strength) in a screening examination.]
patient, but unless obvious asymmetry is seen, there is probably no need to
formally test facial strength (see Chapter 16, Examination
of Facial Strength) in a screening examination.]
Examine Motor Function
6. Test for drift of the outstretched arms (see Chapter 25, Examination of Upper Extremity Muscle
Strength).
Strength).
7. Test the strength of a few upper extremity muscles (see Chapter 25, Examination of Upper Extremity Muscle Strength). In
a simple screening examination of the patient with no neurologic complaints, it
usually suffices to simply test one proximal and one distal muscle on each side,
such as the deltoids (or biceps) and the interossei bilaterally.
a simple screening examination of the patient with no neurologic complaints, it
usually suffices to simply test one proximal and one distal muscle on each side,
such as the deltoids (or biceps) and the interossei bilaterally.
8. Test the strength of a few lower extremity muscles (see Chapter 26, Examination of Lower Extremity Muscle Strength). In
a simple screening examination, simply test one proximal and distal muscle on
each side, such as the hip flexors (or the extensors at the knees) and the foot
dorsiflexors bilaterally.
a simple screening examination, simply test one proximal and distal muscle on
each side, such as the hip flexors (or the extensors at the knees) and the foot
dorsiflexors bilaterally.
Examine Sensory Function
9. Test vibration sense in the toes (see Chapter
30, Examination of Vibration and Position Sensation).
30, Examination of Vibration and Position Sensation).
Examine Cerebellar Function
10. Test the finger-to-nose maneuver (see Chapter
34, Testing of Upper Extremity Cerebellar Function).
34, Testing of Upper Extremity Cerebellar Function).
Examine the Muscle Stretch
Reflexes
Reflexes
11. Test the biceps jerks, triceps jerks, knee jerks, and ankle
jerks (see Chapter 37, Examination of the Muscle Stretch
Reflexes).
jerks (see Chapter 37, Examination of the Muscle Stretch
Reflexes).
Examine for the Babinski Response
12. Test for the Babinski response on each foot (see Chapter 38, Testing for the Babinski Response).
Examine the Gait
13. If you haven’t already informally observed the patient walking
into the examination room, watch the patient walk a few steps (see Chapter 39, Examination of Gait).
into the examination room, watch the patient walk a few steps (see Chapter 39, Examination of Gait).
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NORMAL FINDINGS
Normal findings for each component of the neurologic examination
are discussed in the chapters of Section 2, Neurologic
Examination.
are discussed in the chapters of Section 2, Neurologic
Examination.
ABNORMAL FINDINGS
Abnormal findings for each component of the neurologic examination
are discussed in the chapters of Section 2, Neurologic
Examination. Any abnormalities found on a screening examination of a
patient without neurologic symptoms should be interpreted with caution; it’s
usually best to err on the side of conservatism and try not to overinterpret
subtle isolated findings.
are discussed in the chapters of Section 2, Neurologic
Examination. Any abnormalities found on a screening examination of a
patient without neurologic symptoms should be interpreted with caution; it’s
usually best to err on the side of conservatism and try not to overinterpret
subtle isolated findings.