Introduction to the neurologic examination

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The neurologic examination begins with careful observation of the patient entering the examination area and continues during history taking. The patient should be assisted as little as possible, so that difficulties in function can become apparent. The patient’s speed, symmetry, and coordination while moving to the examining table are noted, as are posture and gait. The patient’s demeanor, dress, and responses provide information about mood and social adaptation. Abnormal or unusual speech, use of language, or praxis; neglect of space; unusual posturing; and other disorders of movement may be apparent before formal testing.
As information is obtained, a skilled examiner may include certain components of the examination and exclude others based on a preliminary hypothesis about the anatomy and pathophysiology of the problem. If the examiner is less skilled, complete neurologic screening is done.
The neurologic examination includes the following:

Mental status
Cranial nerves
Motor system
Muscle strength
Gait, stance, and coordination
Sensation
Reflexes
Autonomic nervous system

Although a detailed neurologic examination can take considerable time, the fundamentals can be completed in about 4 min and can detect deficits in any of the major components. Abnormal findings trigger a more detailed examination of that component.