The Neurologic Examination

The Neurologic Examination

Jean Khoury

Andrew N. Russman

The neurologic examination is the essential tool to localize clinical findings within the nervous system, to develop a differential diagnosis, and to guide management. Early recognition of neurologic diseases is important because of the frequent association between time and clinical outcomes. The need for efficiency may result in the need for a focused evaluation before completion of a more detailed neurologic examination.

The history generally directs the clinician toward certain diagnoses. Evaluating mental status, the cranial nerves (CNs), motor and sensory function, reflexes, coordination, and gait will further narrow the differential. Observing the patient’s gaze direction and noting other cortical functions (speech, neglect, apraxias, agnosias) are often diagnostic, whereas ongoing monitoring is often needed to recognize full expression of the patient’s condition.

It is one thing to examine a patient when they are cooperating, but it becomes quite complex when they are lethargic, obtunded, or comatose. In these situations, the goal of the examiner is to look for specific signs that will help localize the lesion to provide targeted care. For example, a blown pupil will identify impending herniation, whereas abnormal breathing patterns and vital signs may suggest brainstem involvement and increased intracranial pressure (ICP).

The neurologic examination will guide the management of a patient with a neurologic emergency, including diagnostic testing, emergent treatments (ie, thrombolysis and thrombectomy for ischemic stroke), and specialty consultation.

Jun 23, 2022 | Posted by in EMERGENCY MEDICINE | Comments Off on The Neurologic Examination

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