Nuero Exam & Assessment
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Jeffrey S. Nicholl, M.D.
- Age, gender, handedness.
- Chief Complaint.
- HPI: Duration, description, severity, location, onset, precipitating or exacerbating factors, ameliorating factors, associated symptoms, new or recurrent, risk factors.
- PMH (with specific emphasis on the past neurologic history)
- Medications, current and past.
- Family History
- Social History
- Review of Systems (with an emphasis on the neurologic review of systems: headache, dizziness, decreased visual or auditory acuity, diplopia, dysphasia, dysarthria, dysphagia, nausea/vomiting, focal numbness or weakness, bladder or bowel problems (retention or incontinence), ataxia.)
- Mental Status Examination: Level of consciousness and orientation, Memory (3 or 5 words at five minutes, long-term memory), Concentration (digit span, serial 7’s, spell world backwards), Language (fluency, comprehension, repetition), Praxis (demonstrate an action), Visual-spatial construction (copy or clock face).
- Cranial Nerves: I- smell; II- visual acuity, visual fields, fundoscopic examination, light reflex; III, IV, VI- extraocular movements in all six cardinal positions, light reflex; V- facial sensation, strength of masticatory muscles, jaw jerk; VII- facial movement (upper and lower), taste on the anterior 2/3 of the tongue; VIII- auditory acuity, nystagmus; IX, X- gag reflex, palatal movement, deviation of uvula, hoarseness; XI- strength of the SCM and trapezius muscles; XII- tongue deviation, atrophy, fasiculations.
- Motor: pronator drift, weakness, tremor, fasicualtion, atrophy, abnormal tone, abnormal involuntary movements, DTR’s, plantar responses.
- Sensory: light touch, temperature/pinprick, vibration/proprioception, graphesthesia/stereognosis/double simultaneous stimulation, two-point discrimination.
- Cerebellar: finger-to-nose, heel-to-shin.
- Stance: eyes open, eyes closed.
- Gait: heel-walking, toe-walking, tandem gait.
- General: VS, neck, heart.