Neuro Physical Exam

1. Mental Status
2. Cranial Nerves
3. Motor System
4. Sensation
5. Reflexes
   

MENTAL STATUS

• Level of Conciousness
• Orientation
• Executive functioning
  

CRANIAL NERVES

1. CN 1 - Olfactory Nerve
   
2. CN 2 - Optic Nerve
   
• Test visual fields and acuity
  
3. CN 3 - Oculomotor Nerve
• Eye movement - diplopia, strabismus, ptosis, mydriasis, droopy eyelid
  
4. CN 4 - Trochlear Nerve
• Eye movement - damage leads to eye not moving downwards or inwards (superior oblique muscle)
  
5. CN 5 - Trigeminal Nerve
• Facial sensation
  
6. CN 6 - Abducens Nerve
• Eye movement - damage leads to eye not moving outwards (lateral rectus muscle)
  
7. CN 7 - Facial Nerve
• Facial movement
  
8. CN 8 - Vestibulocochlear Nerve
• Vestibular nerve - balance, rotary nystagmus
  
• Cochlear nerve - hearing
  
9. CN 9 - Glossopharyngeal Nerve
• Sensory information from tongue and oropharynx
• Unilateral deviation of uvula (deviation is towards intact nerve)
  
• Difficulty swallowing
  
10. CN 10 - Vagus Nerve
• Hoarse voice (superior laryngeal nerve), dysphagia
  
11. CN 11 - Accessory Nerve
• Trapezius, SCM
  
12. CN 12 - Hypoglossal Nerve
• Tongue deviation towards side of damage
  

MOTOR

Strength

• 0 = no contraction
• 1 = visible muscle twitch but no movement of the joint
• 2 = weak contraction insufficient to overcome gravity
• 3 = weak contraction able to overcome gravity but no additional resistance
• 4 = weak contraction able to overcome some resistance but not full resistance
• 5 = normal; able to overcome full resistance

Gait

Coordination

• Rapid alternating movements
• Finger-to-nose
• Heel-to-shin

Pronator Drift

SENSATION

Dermatomes




REFLEXES

Reflex Grading

• 0 = absent
• 1 = reduced (hypoactive)
• 2 = normal
• 3 = increased (hyperactive)
• 4 = clonus

Tendon Reflex Levels

• C5-6 - biceps and brachioradialis
• C6-7 - triceps
• L3-4 - knee jerk
• S1-S2 - ankle jerk