Neurological examination may be a detailed assessment of the nervous system, following up a specific symptom or suspected disease, or a survey of the system, as part of a routine general examination. A detailed neurological examination can be time consuming and exhausting for a patient, and information obtained from a tired, fatigued, uncooperative or ill patient can be misleading. Initial examination should therefore be targeted on the suspected abnormality, such as a peripheral nerve injury, returning one or more times to complete the observations. Follow-up of neurological findings is critical when abnormalities have been found or are suspected.
Diseases may affect single cortical areas, spinal tracts or peripheral nerves, but lesions often involve more than one pathway. Localisation of the disease is helped by a precise history. However, it is important to keep an open mind, as it is easy to follow a wrong lead as to the level of a lesion, and be blinkered about the possibility of disease at other levels or at multiple sites.
One gains an overall impression of neurological function from the patient’s gait, posture and speech. Examination of the current mental state includes psychiatric assessment, but a few simple tests should be applied. These include orientation in time and place (what are the day and date, where are you), short and long term memory (repeat three to five words or numbers and request again after a short interval; birthday, place of birth, anniversaries); general knowledge, (names of presidents, ministers, capitals); mathematical skills (take 7’s from 100); interpretation of proverbs.
Detailed examination of the peripheral nervous system includes assessment of the cranial nerves, followed by examination of motor and sensory function of the rest of the body. In this text, the cranial nerves are linked to their special sensory organs, and are considered with the head and neck (page 27); this section considers the assessment of somatic function.