Definition:
A neurological examination assesses the brain, spinal cord, cranial
nerves, peripheral nerves, motor & sensory function, reflexes, and
cerebellar coordination to diagnose neurological disorders.
Mnemonic: "C.N.S. = Check Nervous System"
1. COMPONENTS OF CNS EXAMINATION
- Mental Status
- Cranial Nerves
- Motor System
- Sensory System
- Reflexes
- Cerebellar Function
Mnemonic: "M.C.M.S.R.C. = Mind, Cranial, Motor, Sensory,
Reflexes, Coordination"
2. MENTAL STATUS EXAMINATION
(ABCT)
- Appearance → Hygiene, Posture, Facial Expression.
- Behavior → Mood, Eye Contact, Body Movements.
- Cognition → Orientation, Memory, Attention, Intelligence.
- Thought Process → Logical Thinking, Hallucinations, Delusions.
Mnemonic: "A.B.C.T. = Appearance, Behavior, Cognition,
Thought"
3. LEVELS OF CONSCIOUSNESS (GCS -
GLASGOW COMA SCALE)
- Eye Opening (E) → Spontaneous (4), To Speech (3), To Pain (2), None (1).
- Verbal Response (V) → Oriented (5), Confused (4), Inappropriate Words (3), Incomprehensible Sounds (2), None (1).
- Motor Response (M) → Obeys Commands (6), Localizes Pain (5), Withdraws (4), Abnormal Flexion (3), Abnormal Extension (2), None (1).
Mnemonic: "E.V.M. = Eyes, Verbal, Motor" (Total Score:
3-15)
4. CRANIAL NERVES EXAMINATION
(I-XII)
I – Olfactory (Smell)
- Test: Identify Coffee, Perfume.
- Disease: Loss in Head Injury, Parkinson’s.
II – Optic (Vision)
- Test: Visual Acuity, Visual Fields, Fundoscopy.
- Disease: Optic Neuritis, Glaucoma.
III, IV, VI – Oculomotor,
Trochlear, Abducens (Eye Movements)
- Test: Cardinal Gaze, Light Reflex, Ptosis.
- Disease: Diplopia, Ptosis, Nystagmus.
Mnemonic: "LR6 SO4, Rest 3" (Lateral Rectus - CN6,
Superior Oblique - CN4, Others - CN3)
V – Trigeminal (Facial Sensation,
Jaw Movements)
- Test: Touch Face, Corneal Reflex, Clench Jaw.
- Disease: Trigeminal Neuralgia.
VII – Facial (Facial Expression,
Taste)
- Test: Smile, Close Eyes, Raise Eyebrows, Taste (Anterior 2/3).
- Disease: Bell’s Palsy, Stroke.
VIII – Vestibulocochlear
(Hearing, Balance)
- Test: Weber & Rinne, Balance Test.
- Disease: Vertigo, Hearing Loss.
IX, X – Glossopharyngeal &
Vagus (Swallowing, Gag Reflex)
- Test: Say "Ahh", Gag Reflex, Uvula Deviation.
- Disease: Dysphagia, Hoarseness.
XI – Spinal Accessory (Neck
Muscle Strength)
- Test: Shrug Shoulders, Turn Head.
- Disease: Weakness in SCM, Trapezius.
XII – Hypoglossal (Tongue
Movements)
- Test: Stick Tongue Out, Move Side-to-Side.
- Disease: Deviation Towards Weak Side.
Mnemonic: "Oh Oh Oh To Touch And Feel Very Green Vegetables
AH!"
5. MOTOR SYSTEM EXAMINATION
Assess:
- Muscle Bulk & Tone → Wasting, Rigidity.
- Muscle Strength → Check Against Resistance.
- Involuntary Movements → Tremors, Chorea.
- Deep Tendon Reflexes (DTRs).
Mnemonic: "B.T.S.M. = Bulk, Tone, Strength, Movements"
6. SENSORY SYSTEM EXAMINATION
Tests:
- Pain & Temperature → Spinothalamic Tract
- Light Touch & Vibration → Dorsal Column
- Proprioception (Joint Position Sense) → Dorsal Column
Mnemonic: "S.P.L.P. = Spinothalamic (Pain), Light Touch,
Proprioception"
7. REFLEXES (DTRs – Deep Tendon
Reflexes)
Grading:
0 – Absent
1+ – Diminished
2+ – Normal
3+ – Brisk
4+ – Very Brisk
Common Reflexes & Spinal Levels:
- Biceps (C5-C6)
- Triceps (C7-C8)
- Patellar (L3-L4)
- Achilles (S1-S2)
- Babinski’s Sign → UMN Lesion (Toe Upgoing).
Mnemonic: "B.T.P.A. = Biceps, Triceps, Patellar,
Achilles"
8. CEREBELLAR FUNCTION TESTS
Coordination Tests:
- Finger-Nose Test (Dysmetria in Ataxia).
- Heel-to-Shin Test (Cerebellar Lesions).
- Rapid Alternating Movements (Dysdiadochokinesia in Ataxia).
Gait Tests:
- Normal Walking.
- Tandem Walking (Heel-Toe).
- Romberg’s Test (Balance with Eyes Closed → +Ve in Sensory Ataxia).
Mnemonic: "F.H.R.T. = Finger-Nose, Heel-Shin, Rapid Movements,
Tandem Walk"
FINAL REVISION WITH MNEMONICS
- CNS Components = "M.C.M.S.R.C." (Mental, Cranial, Motor, Sensory, Reflexes, Coordination)
- Mental Exam = "A.B.C.T." (Appearance, Behavior, Cognition, Thought Process)
- GCS = "E.V.M." (Eyes, Verbal, Motor Response)
- Cranial Nerves = "Oh Oh Oh To Touch And Feel Very Green Vegetables AH!"
- Motor System = "B.T.S.M." (Bulk, Tone, Strength, Movements)
- Sensory Pathways = "S.P.L.P." (Spinothalamic, Pain, Light Touch, Proprioception)
- Reflexes = "B.T.P.A." (Biceps, Triceps, Patellar, Achilles)
- Cerebellar Tests = "F.H.R.T." (Finger-Nose, Heel-Shin, Rapid Movements, Tandem Walk)
