NEUROLOGY CLERKSHIP

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NEURO EXAM AND ASSESMENT

Jeffrey S. Nicholl, M.D.

1. Age, gender, handedness.
2. Chief Complaint.
3. HPI: Duration, description, severity, location, onset, precipitating or exacerbating factors, ameliorating factors, associated symptoms, new or recurrent, risk factors.
4. PMH (with specific emphasis on the past neurologic history)
5. Medications, current and past.
6. Allergies
7. PSH
8. PPsyH
9. Family History
10. Social History
11. Review of Systems (with an emphasis on the neurologic review of systems: headache, dizziness, decreased visual or auditory acuity, diplopia, dysphasia, dysarthria, dysphagia, nausea/vomiting, focal numbness or weakness, bladder or bowel problems (retention or incontinence), ataxia.)
12. Mental Status Examination: Level of consciousness and orientation, Memory (3 or 5 words at five minutes, long-term memory), Concentration (digit span, serial 7’s, spell world backwards), Language (fluency, comprehension, repetition), Praxis (demonstrate an action), Visual-spatial construction (copy or clock face).
13. Cranial Nerves: I- smell; II- visual acuity, visual fields, fundoscopic examination, light reflex; III, IV, VI- extraocular movements in all six cardinal positions, light reflex; V- facial sensation, strength of masticatory muscles, jaw jerk; VII- facial movement (upper and lower), taste on the anterior 2/3 of the tongue; VIII- auditory acuity, nystagmus; IX, X- gag reflex, palatal movement, deviation of uvula, hoarseness; XI- strength of the SCM and trapezius muscles; XII- tongue deviation, atrophy, fasiculations.
14. Motor: pronator drift, weakness, tremor, fasicualtion, atrophy, abnormal tone, abnormal involuntary movements, DTR’s, plantar responses.
15. Sensory: light touch, temperature/pinprick, vibration/proprioception, graphesthesia/stereognosis/double simultaneous stimulation, two-point discrimination.
16. Cerebellar: finger-to-nose, heel-to-shin.
17. Stance: eyes open, eyes closed.
18. Gait: heel-walking, toe-walking, tandem gait.
19. General: VS, neck, heart.