What is a neurological exam?
A neurological exam, also called a neuro exam, is an evaluation of a person's nervous system that can be done in the healthcare
provider's office. It may be done with instruments, such as lights and reflex hammers.
It usually does not cause any pain to the patient. The nervous system consists of
the brain, the spinal cord, and the nerves from these areas. There are many aspects
of this exam, including an assessment of motor and sensory skills, balance and coordination,
mental status (the patient's level of awareness and interaction with the environment),
reflexes, and functioning of the nerves. The extent of the exam depends on many factors,
including the initial problem that the patient is experiencing, the age of the patient,
and the condition of the patient.
Why is a neurological exam done?
A complete and thorough evaluation of a person's nervous system is important if there
is any reason to think there may be an underlying problem, or during a complete physical.
Damage to the nervous system can cause problems in daily functioning. Early identification
may help to find the cause and decrease long-term complications. A complete neurological
exam may be done:
During a routine physical
Following any type of trauma
To follow the progression of a disease
If the person has any of the following complaints:
Change in behavior
Change in balance or coordination
Numbness or tingling in the arms or legs
Decrease in movement of the arms or legs
Injury to the head, neck, or back
What is done during a neurological exam?
During a neurological exam, the healthcare provider will test the functioning of the
nervous system. The nervous system is very complex and controls many parts of the
body. The nervous system consists of the brain, spinal cord, 12 nerves that come from
the brain, and the nerves that come from the spinal cord. The circulation to the brain,
arising from the arteries in the neck, is also frequently examined. In infants and
younger children, a neurological exam includes the measurement of the head circumference.
The following is an overview of some of the areas that may be tested and evaluated
during a neurological exam:
Mental status. Mental status (the patient's level of awareness and interaction with
the environment) may be assessed by conversing with the patient and establishing his
or her awareness of person, place, and time. The person will also be observed for
clear speech and making sense while talking. This is usually done by the patient's
healthcare provider just by observing the patient during normal interactions.
Motor function and balance. This may be tested by having the patient push and pull
against the healthcare provider's hands with his or her arms and legs. Balance may
be checked by assessing how the person stands and walks or having the patient stand
with his or her eyes closed while being gently pushed to one side or the other. The
patient's joints may also be checked simply by passive (performed by the healthcare
provider) and active (performed by the patient) movement.
Sensory exam. The patient's healthcare provider may also do a sensory test that checks
his or her ability to feel. This may be done by using different instruments: dull
needles, tuning forks, alcohol swabs, or other objects. The healthcare provider may
touch the patient's legs, arms, or other parts of the body and have him or her identify
the sensation (for example, hot or cold, sharp or dull).
Newborn and infant reflexes. There are different types of reflexes that may be tested.
In newborns and infants, reflexes called infant reflexes (or primitive reflexes) are evaluated. Each of these reflexes disappears at a certain age as the infant
grows. These reflexes include:
Blinking. An infant will close his or her eyes in response to bright lights.
Babinski reflex. As the infant's foot is stroked, the toes will extend upward.
Crawling. If the infant is placed on his or her stomach, he or she will make crawling
Moro's reflex (or startle reflex). A quick change in the infant's position will cause
the infant to throw the arms outward, open the hands, and throw back the head.
Palmar and plantar grasp. The infant's fingers or toes will curl around a finger placed
in the area.
Reflexes in the older child and adult. These are usually examined with the use of
a reflex hammer. The reflex hammer is used at different points on the body to test
numerous reflexes, which are noted by the movement that the hammer causes.
Evaluation of the nerves of the brain. There are 12 main nerves of the brain, called
the cranial nerves. During a complete neurological exam, most of these nerves are evaluated to help
determine the functioning of the brain:
Cranial nerve I (olfactory nerve). This is the nerve of smell. The patient may be
asked to identify different smells with his or her eyes closed.
Cranial nerve II (optic nerve). This nerve carries vision to the brain. A visual test
may be given and the patient's eye may be examined with a special light.
Cranial nerve III (oculomotor). This nerve is responsible for pupil size and certain
movements of the eye. The patient's healthcare provider may examine the pupil (the
black part of the eye) with a light and have the patient follow the light in various
Cranial nerve IV (trochlear nerve). This nerve also helps with the movement of the
Cranial nerve V (trigeminal nerve). This nerve allows for many functions, including
the ability to feel the face, inside the mouth, and move the muscles involved with
chewing. The patient's healthcare provider may touch the face at different areas and
watch the patient as he or she bites down.
Cranial nerve VI (abducens nerve). This nerve helps with the movement of the eyes.
The patient may be asked to follow a light or finger to move the eyes.
Cranial nerve VII (facial nerve). This nerve is responsible for various functions,
including the movement of the face muscle and taste. The patient may be asked to identify
different tastes (sweet, sour, bitter), asked to smile, move the cheeks, or show the
Cranial nerve VIII (acoustic nerve). This nerve is the nerve of hearing. A hearing
test may be performed on the patient.
Cranial nerve IX (glossopharyngeal nerve). This nerve is involved with taste and swallowing.
Once again, the patient may be asked to identify different tastes on the back of the
tongue. The gag reflex may be tested.
Cranial nerve X (vagus nerve). This nerve is mainly responsible for the ability to
swallow, the gag reflex, some taste, and part of speech. The patient may be asked
to swallow and a tongue blade may be used to elicit the gag response.
Cranial nerve XI (accessory nerve). This nerve is involved in the movement of the
shoulders and neck. The patient may be asked to turn his or her head from side to
side against mild resistance, or to shrug the shoulders.
Cranial nerve XII (hypoglossal nerve). The final cranial nerve is mainly responsible
for movement of the tongue. The patient may be instructed to stick out his or her
tongue and speak.
The patient may be asked to walk normally or on a line on the floor.
The patient may be instructed to tap his or her fingers or foot quickly or touch something,
such as his or her nose with eyes closed.