Components of a Basic Screening Neurological Exam

Mental Status: A MMSE is performed if after you have done a thorough history, either of the following criteria are met: Patient is elderly or has a condition such as MS or epilepsy that is often associated with cognitive dysfunction Patient, patient’s family, patient’s PCP, or you have a concern that the mental status is abnormal (i.e. you note that the pt has problems recalling and communicating the details of their hx.

You should always have an extra MMSE handy. A Copy of the MMSE can be obtained at: http://www.chcr.brown.edu/MMSE.PDF More detailed testing is based on whether or not there are any significant findings.

Cranial Nerves: VA OU, Fundascopic Exam OU, pupils, direct, consensual, and accommodation, visual fiels, EOMs Facial sensation to light touch (corneal only if impaired MS or complaint/ findings referable). Forced eye closure and cheek expansion against resistance. Hearing to Finger rub (Weber. Rinne only if there is a complaint/ findings)

Ahh (palate)(gag only if there is a complaint/ findings) or the phonation or articulation are off. Tonge protrusion. SCM and Trap strength

Motor: Inspection and tone are checked if there is concern for motor deficits. Otherwise for the sreening exam, just check Pronator Drift and then serially: Deltoids, biceps, triceps, wrist ext, wrist flex, finger ext, finger flexion, grips, ability to arise from a chair with out arms, quads, hamstrings, Hip aBducters, Hip aDducters, tib ant, gastrocs, great toe ext. More detailed testinfg is based on complaint/ findings.

DTRs: Patellar, Achilles, plantar, triceps, biceps, and brachioradialis. Again, there are more based on complaint/ findings. Sensory:

Touch Bilaterally on arms, trunk, and legs, light touch on toes, Vibration on toes, Distal to proximal Pin Prick in the Lower Extremities. More detailed testing is performed if there are abnormalities or if the patient has sensory complaints Coord/ Gait:

RAM (rapid finger tapping and toe tapping Bilaterally) F-N-F and H-K-S

Romberg Standard, heel. toe and tandem gaits

Again, More detailed testing is performed if there are abnormalities or if the patient has coordination or gait complaints.