Neuro Exam or Neurological Test - Evaluation Requirements and Types of Tests Conducted

What Is a Neuro Exam?

A neurological examination is a set of comprehensive tests conducted to evaluate an individual's level of neurological functioning. The brain, spinal cord, and nerves combined form the body’s nervous system. It controls, monitors, and regulates all cognitive functions, muscular activities, and senses. Additional activities like balancing, coordination, and walking also come under this. Any functional impairment to the brain and spinal cord affects one of the above functions. Hence by evaluating the level of performance during a neuro test, one can easily identify functional abnormalities involving the brain and spinal cord.

When Is a Neuro Exam Performed?

Early identification of neurological disorders can prevent major long-term consequences. This is why one should undergo a neuro exam if an underlying problem is suspected. The doctor may conduct the evaluation as a part of the routine, while the follow-up of a known condition or following trauma affecting the brain and spinal cord. It is performed to evaluate several conditions like:

• The trouble with concentration and memory.

• Frequent headaches.

• Muscle weakness.

• Tingling or numbness on some body parts.

• Sensory disturbances.

• Poor coordination.

• Difficulty communicating.

• Changes with eyesight.

• Possible brain damage from trauma or other reasons.

• Parkinson’s disease.

• Slurred speech and tremors.

• Multiple sclerosis.

• Delirium and changes in behavior.

• Spinal muscular atrophy.

• Prolonged high fever and seizure attacks.

What Does a Neuro Exam Consist of?

The extent of evaluation and type of tests performed depends on the age, general health, and condition of the patient, as well as the initial problem. A complete neurological examination consists of the following set of evaluations:

1. Mental status (cognition).

2. Cranial nerves.

3. Motor function.

4. Reflexes.

5. Sensation.

6. Coordination.

7. Gait and walking.

How Are the Cognitive Functions Evaluated?

It tests the time-place-person awareness of the individual. One tests memory, concentration, level of alertness, and general awareness through a set of questions about oneself and those involving specific abilities. One may be asked to draw or write something, recall a past memory, and comprehend some data. This also includes language tests on fluency to speak in a normal rhythm sensibly. Speech issues may be indicative of conditions like aphasia, stroke, and other brain disorders.

How Are the Cranial Nerve Functions Evaluated?

There are twelve pairs of cranial nerves emerging from the brain spread over different parts of the body. They control vital functions of the body. This is why evaluation of cranial nerve function is an essential part of the neuro exam. Listing below is the type of tests conducted for each nerve and its function:

1. Olfactory Nerve - It is connected with the sense of smell. Hence one may be asked to identify a specific smell without looking at the object.

2. Optic Nerve - It is connected to vision. The doctor will examine the eyes, and check if the pupils are dilated or constricted, range of vision, etc.

3. Oculomotor Nerve - Movements of the eye are tested, along with changes in pupil size and focusing ability.

4. Trochlear Nerve - The test involves downward, inward, and outward eye movements.

5. Trigeminal Nerve - Feeling and sensation in different areas of the face are tested with light touches and pressure. The chewing strength of the mouth muscles is also checked.

6. Abducens Nerve - The patient is asked to follow the path of a moving finger or a light source to evaluate eye movements.

7. Facial Nerve - It is connected with muscles creating facial expressions. Hence one tests the strength and control of facial muscles. The ability to identify different tastes is evaluated too.

8. Vestibulocochlear Nerve - It is connected with hearing and balancing. Hearing is tested with the help of a tuning fork. Tests are conducted to evaluate the balancing abilities as well.

9. Glossopharyngeal Nerve - One evaluates the strength and movements of the tongue, taste sensations, and saliva production. The doctor may ask one to move the tongue from side to side. One also tests the gag reflex by touching the back of the throat.

10. Vagus Nerve - Controls vital functions of the body like regulating heart rate and breathing. One tests the ability to swallow, gag reflex, and ability to identify the tastes at the back of the tongue.

11. Accessory Nerve - Controls the neck and shoulder muscles. The doctor tests its function by asking the participant to shrug the shoulders and turn the head from side to side against mild resistance.

12. Hypoglossal Nerve - It is mainly connected with tongue movements. Hence the patient is asked to speak and to stick out the tongue.

How Are the Motor Functions Evaluated?

Motor function evaluation includes tests that do and do not require active involvement from the participant. All tests in this category evaluate the strength, muscle tone, and ability to move:

• Muscle tone is checked by asking the individual to relax and gently move the arms and legs.

• The strength of each muscle group in the body is evaluated and rated on a scale of zero to five. A score of five indicates the nerves and muscles are fully functional and active. A score of zero indicates the total weakness of the concerned group of muscles.

• One also looks for involuntary movements, if any. They can be indicative of underlying neurological diseases.

How Are the Reflexes Evaluated in a Neuro Test?

Reflexes are completely involuntary types of responses one’s body makes towards various stimulations. The pattern of reflexes elicited from each test helps the doctor identify diseases of the brain, spinal cord, and nerves. The following reflexes are examined:

• Corneal Reflex - How one blinks when an object is brought closer to the eye.

• Deep Tendon Reflex - Tested by tapping on the tendons (tissue that attaches a muscle to a bone) with a reflex hammer to make the muscle connected to it jerk. A diminished reflex, as well as an exaggerated reflex, is considered abnormal.

How Are Sensory Functions Evaluated?

The doctor evaluates one’s ability to detect sensation at various parts of the body with the eyes closed or while looking away. A wide range of sensory stimuli is used for testing on all parts of the body, varying from delicate and sharp touches, vibrations, positions, and temperatures. This helps detect spinal diseases and peripheral neuropathy conditions. Doctor checks if one can identify and distinguish:

• Light touches something delicate as cotton.

• Sharpness by touching with something sharp but not dangerous.

• Response to varying temperatures like hot to cold.

• Vibrations from a tuning fork.

• Identify the change in position while gently repositioning the fingers and toes.

How Are the Coordination Abilities Evaluated?

The doctor will ask the participant to perform a set of tasks that requires neurologic coordination, such as:

• Quick alternating movements like flipping the hand, palm up and down.

• Quickly touch the tip of the nose and then the doctor's hand.

• Running the heel of one leg over the shin of the other leg.

• Touch and take away the thumb and index finger of both hands simultaneously.

How Is the Gait (Walking) Evaluated?

An individual's gait is controlled by several factors, such as muscle strength, vision, balance, coordination, and sensations, which makes it a complex activity. Apart from observing the participant's gait while entering the room, the doctor will ask one to perform some specific tasks like:

• Walking with one foot in front of the other.

• The doctor might ask to stand up, eyes closed, and both feet kept close together (Romberg test). If one has trouble doing this activity, it shows issues with the balancing centers of the brain.

Conclusion:

The above given is a detailed list of neurological evaluations. However, depending on the feasibility, the level of evaluation may require necessary modifications. For instance, a patient in the coma stage may not respond to reflexes. Same way, most components of the motor examination do not apply to a patient suffering from paralysis. All in all, the neurological examination is designed in such a way that functions of every area of the nervous system are covered in the evaluation. Following up with imaging studies and lab tests, the doctor can efficiently diagnose the underlying disease condition.