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Infection, trauma, and congenital disorders can all lead to significant signs, as identified through the neurological exam. It is important to differentiate between an acute event, such as stroke, and a chronic or global condition such as blunt force trauma. Responses seen in the neurological exam can help. A loss of language function observed in all its aspects is more likely a global event as opposed to a discrete loss of one function, such as not being able to say certain types of words. A concern, however, is that a specific function—such as controlling the muscles of speech—may mask other language functions. The various subtests within the mental status exam can address these finer points and help clarify the underlying cause of the neurological loss.
Watch this video for an introduction to the neurological exam. Studying the neurological exam can give insight into how structure and function in the nervous system are interdependent. This is a tool both in the clinic and in the classroom, but for different reasons. In the clinic, this is a powerful but simple tool to assess a patient’s neurological function. In the classroom, it is a different way to think about the nervous system. Though medical technology provides noninvasive imaging and real-time functional data, the presenter says these cannot replace the history at the core of the medical examination. What does history mean in the context of medical practice?
The neurological exam is a clinical assessment tool to determine the extent of function from the nervous system. It is divided into five major sections that each deal with a specific region of the CNS. The mental status exam is concerned with the cerebrum and assesses higher functions such as memory, language, and emotion. The cranial nerve exam tests the functions of all of the cranial nerves and, therefore, their connections to the CNS through the forebrain and brain stem. The sensory and motor exams assess those functions as they relate to the spinal cord, as well as the combination of the functions in spinal reflexes. The coordination exam targets cerebellar function in coordinated movements, including those functions associated with gait.
Damage to and disease of the nervous system lead to loss of function. The location of the injury will correspond to the functional loss, as suggested by the principle of localization of function. The neurological exam provides the opportunity for a clinician to determine where damage has occurred on the basis of the function that is lost. Damage from acute injuries such as strokes may result in specific functions being lost, whereas broader effects in infection or developmental disorders may result in general losses across an entire section of the neurological exam.
Watch this video that provides a demonstration of the neurological exam—a series of tests that can be performed rapidly when a patient is initially brought into an emergency department. The exam can be repeated on a regular basis to keep a record of how and if neurological function changes over time. In what order were the sections of the neurological exam tested in this video, and which section seemed to be left out?
Coordination and gait were tested first, followed by mental status, motor, sensory, and reflexes. There were no specific tests of the cranial nerves.
Watch this video for an introduction to the neurological exam. Studying the neurological exam can give insight into how structure and function in the nervous system are interdependent. This is a tool both in the clinic and in the classroom, but for different reasons. In the clinic, this is a powerful but simple tool to assess a patient’s neurological function. In the classroom, it is a different way to think about the nervous system. Though medical technology provides noninvasive imaging and real-time functional data, the presenter says these cannot replace the history at the core of the medical examination. What does history mean in the context of medical practice?
History is the report from the patient, or others familiar with the patient, that can assist in diagnosis and formulation of treatment and care—essentially the result of an interview with the patient.
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