Table 2.3 The 5-min neuro exam
Feature evaluated How to check
General health
General appraisal of overall
assessment
appearance
Vital signs
What to look for and questions to ask
Does the patient look acutely ill?
Abnormal vital signs (e.g., elevated
temperature, hypotension, tachycardia) often suggest systemic illness
General neuro
assessment
Observe the patient walking, if
they are able to do so. Also
observe sitting/lying posture
in patients who are unable to
get out of bed
For patients who are able to walk: does
the patient move symmetrically, with
similar movements of the arms and
legs on both sides of the body? Does
the patient walk with her feet close
together, turn easily, and walk in a
straight line OR do you see signs of
imbalance?
For patients observed when sitting: do
they easily sit upright or do they tend
to lean or fall to one side? Do they
hold their arms and legs in a similar
posture and move them symmetrically
while sitting?
Cognitive
assessment
This should be performed
as part of the history
Was the patient able to complete
paperwork during their intake,
showing an ability to read, write, and
manipulate a pen? Can the patient
speak fluently with good use of
language? Can the patient tell a
coherent story? Does the patient
answer your questions well OR is she
confused, disoriented, lethargic, or
easily distracted?
Eye grounds/
fundoscopic
evaluation
Fundoscopic examination
Look for papilledema to suggest
increased intracranial pressure.
Vascular constriction or nicking or
the presence of hemorrhages or
yellowish exudates suggests
hypertension.
Venous pulsations, when present, are a
sign of normal intracranial pressure;
venous pulsations may be absent
when pressure is normal or abnormal
Cranial nerve
assessment
Cranial nerve testing can be
mainly performed during
history taking.
Check visual fields by asking
the patient to look at your
nose while you wiggle
fingers held with your arms
held out at the side and
placed about equal distance
between you and the patient
Watch the patient’s eye and facial
movements for symmetry while the
patient is talking to you.
Assuming you don’t have a problem with
your visual fields, both you and the
patients should be similarly able to
see fingers wiggling on both sides
during visual field testing
(continued)
Feature evaluated How to check
What to look for and questions to ask
Extremity testing Observe the patient’s resting
Patients who equally position and move
for strength
posture and casual moveboth arms and legs will usually have a
and sensation
ments during history taking.
normal motor screening examination.
Test muscles in both the
If you see differences during casual
proximal and distal arm and
observation, spend more time
leg on both sides for
carefully testing strength and reflexes.
strength. Tap reflexes at the
Look for evidence of symmetrical
elbows and knees. Stroke the
responses to both motor and sensory
bottom of the foot for a
testing. An up going toe on Babinski
Babinski response.
testing may suggest an upper motor
Lightly stroke both sides with
neuron (e.g., brain or spinal cord)
your fingers and an open
lesion and the need for additional
safety pin to test sensation.
testing.
Watch patients as they reach for and
manipulate items in their environment
to notice fine motor skills and
coordination