Manual The Four-Minute Neurologic Exam

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The neurologic examination. Emerg Med Clin No Amer ; This chapter provides a concise and easy to read overview of the neurologic exam written by an emergency medicine physician with a focus on those components relevant to care in the emergency department.

Goldberg S. The four-minute neurologic exam. MedMaster, Inc, Miami, This small paperback book is an excellent resource for the neuro exam.


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Each section has captions noting the key component of the exam of the particular system under discussion. Mayo Clinic and Mayo Foundation. Clinical examinations in neurology. Mosby Year Book This is a comprehensive text that is not always easy to read but which provides an indepth discussion of all components of the neuro exam. Localization in clinical neurology.

The Four-Minute Neurologic Exam (Made Ridiculously Simple)

Little, Brown, and Company This textbook a worthwhile reference book when detailed explanations of various neurologic findings are needed. Parsons M. Color atlas of clinical neurology. This is a wonderful atlas and excellent reference book for the emergency department. The text accompanying the pictures and diagrams is clear and easy to read.

Neurological examination

This book makes some of the difficult concepts in neurology easy to understand. After that part, the actual exam takes about 30 minutes. Based on what we learn, we form theories about what may be causing the symptoms. Mental status. As you can imagine, the way we do this is highly dependent on her age. For older children, we ask them to follow directions or answer questions.

For younger children, we watch how they interact with their parents. Motor function and balance. If your child is old enough, we may ask her to:.

Four-minute Neurologic Exam - Stephen Goldberg - Google книги

We may check how her joints move. Sensory perception. If your child is older, we examine her reflexes by gently tapping a small, soft reflex hammer on different points on her body.

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Cranial nerves. There are 12 main nerves of the brain, called the cranial nerves, each of which has a number. During a complete neurological exam, we evaluate most of them, but we may choose to concentrate on certain areas, depending on her symptoms. Yes — newborns and infants have a special series of reflexes that we can test, including:.

Right after the exam. Test one eye at a time. Ask the patient to read his I. Then have him count how many fingers you are holding up 6 inches in front of him. Test peripheral vision one eye at a time, too. Cover one eye and instruct the patient to look at your nose. Move your index fingers to check the superior and inferior fields one at a time. Ask the patient to note any movement in the peripheral visual fields. Also, check where the eyelid falls on the pupil.


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  • If it droops, note that the patient has ptosis. To assess the trochlear nerve, instruct the patient to follow your finger while you move it down toward his nose. If a patient has a problem with this nerve, it usually involves the forehead, cheek, or jaw—the three areas of the trigeminal nerve. Check sensation in all three areas, using a soft and a dull object. Check sensation of the scalp, too. Test the motor function of the temporal and masseter muscles by assessing jaw opening strength. Ask the patient to look toward each ear.

    Then have him follow your fingers through the six cardinal fields of gaze.


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    • Observe the patient for nystagmus or twitching of the eye. Assess the patient for facial symmetry. Have him wrinkle his forehead, close his eyes, smile, pucker his lips, show his teeth, and puff out his cheeks. Both sides of the face should move the same way.

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      When the patient smiles, observe the nasolabial folds for weakness or flattening. Cranial nerves IX and X, which innervate the tongue and throat pharynx and larynx , are checked together. Assess the sense of taste on the back of the tongue. The uvula should be in the midline, and the palate should rise.

      Ask the patient to raise his shoulders against your hands to assess the trapezius muscle.