Clinical meaning
The complete neurological examination systematically evaluates the central and peripheral nervous systems through six domains: mental status (consciousness, orientation, cognition, language), cranial nerves (I-XII), motor system (bulk, tone, strength graded 0-5, pronator drift), sensory system (light touch, pain/temperature, vibration, proprioception), reflexes (deep tendon reflexes graded 0-4+, pathological reflexes), and coordination/gait (cerebellar function, Romberg test). Findings are correlated with neuroanatomical localization: upper motor neuron (UMN) lesions produce spastic paralysis, hyperreflexia, and positive Babinski; lower motor neuron (LMN) lesions produce flaccid paralysis, hyporeflexia, atrophy, and fasciculations. Recognizing patterns guides differential diagnosis and imaging selection.
Diagnosis & workup
Diagnostics & workup: - Mental status: GCS (Eye 1-4, Verbal 1-5, Motor 1-6; total 3-15); orientation (person, place, time, situation); speech (fluent vs nonfluent, comprehension, naming, repetition) - Cranial nerves: I (smell), II (visual acuity, fields, pupil response), III/IV/VI (extraocular movements, pupil size/reactivity), V (facial sensation, jaw clench), VII (facial symmetry -- forehead involvement distinguishes central from peripheral), VIII (hearing, Weber/Rinne), IX/X (gag, palate elevation), XI (sternocleidomastoid/trapezius), XII (tongue protrusion -- deviates TOWARD lesion side) - Motor: strength graded 0 (no contraction) to 5 (full strength against resistance); pronator drift (subtle UMN weakness); muscle tone (spasticity = UMN; flaccidity = LMN; rigidity = extrapyramidal) - Sensory: dermatomal pattern (radiculopathy); glove-stocking pattern (peripheral neuropathy); hemisensory loss (thalamic/cortical lesion); sensory level (spinal cord) - Reflexes: DTRs (biceps C5-6, brachioradialis C5-6, triceps C7, patellar L3-4, Achilles S1-2); Babinski (UMN positive = upgoing toes) - Coordination: finger-to-nose, heel-to-shin (cerebellar dysfunction = dysmetria); rapid alternating movements (dysdiadochokinesia); tandem gait; Romberg (proprioception vs cerebellar)