Focused Examination in Acute Neurological Disease
| Domain | Tests |
|---|---|
| Conscious level | Glasgow Coma Scale score/AVPU scale |
| Higher mental function | Orientation? Registration? Attention/concentration? Recall/memory? Language? Object recognition (visual/tactile)? Verbal fluency? Executive function? Follows (increasingly complex) commands? Visuospatial function? Calculation? |
| Meninges | Neck stiffness? Kernig's? Photophobia? Rash? Temperature? |
| Extrapyramidal | Tremor? Rigidity? Bradykinesia? Gait? Postural instability? Chorea? Hemiballismus? |
| Cerebellum | Nystagmus? Dysarthria? Dysmetria? Intention tremor? Dysdiadokokinesis? Ataxia? |
| Cranial nerves | II – acuity, fields, fundi, pupils |
| III/IV/VI – eye movements, ptosis, fatigability? | |
| V/VII – facial sensation and movements, including jaw | |
| VIII – hearing, vestibular function | |
| IX/X – palatal elevation/cough/speech/swallow | |
| XI – shoulder elevation/head turn | |
| XII – tongue inspection/protrusion/strength | |
| Limbs | Inspection – wasting? Fasciculations? Dyskinesia? Drift? Rash? |
| Tone – hypotonic/hypertonic? Spastic? Rigid? | |
| Power – proximal versus distal? Symmetric? MRC grade? Fatigable? Functional/collapsible weakness? | |
| Deep tendon reflexes – asymmetric? Absent? Present with reinforcement? Reduced? Normal? Brisk? | |
| Plantar response – flexor? Extensor? Mute? | |
| Gait – ataxic/wide based? Foot drop? Spastic? Parkinsonian? | |
| Coordination – finger nose, heel shin, dysdiadokokinesis? | |
| Sensation – distribution affected? Modality affected (pin-prick, temperature, vibration, light touch, proprioception)? | |