Related Subjects:
|Neurological History taking
|Cortical functions
|Motor System
|Sensory System
|Mental state Examination
|Speech and Language Exam
|Cranial nerves and examination
|Assessing Cognition
🧠 Neurological diagnosis is 90% history + focused examination. Always tailor your exam to the clinical context (outpatient, acute unit, HDU/ICU). The key: localise the lesion, identify the cause, and decide management.
🔑 Introduction
- Exam varies depending on setting (clinic vs emergency vs ITU).
- Always link findings to neuroanatomy – e.g. bilateral leg weakness rarely from a single stroke.
- In OSCEs, you’ll often be asked to perform a focused part (cranial nerves, coordination, etc.) rather than the whole exam.
📝 Core Components
- Higher functions (cognition, language, behaviour)
- Motor (tone, power, reflexes, coordination)
- Sensory (light touch, pain, proprioception)
- Visual (acuity, fields, fundus)
- Cerebellar (coordination, gait, dysarthria)
- Cranial nerves
- Peripheral nerves
👀 Higher Level Assessment
- Observation: Alertness, eye contact, orientation.
- Appearance: Grooming, clothing, neglect (e.g. hemineglect in stroke).
- Behaviour: Inappropriate actions, disinhibition, aggression, neglect.
- Look for subtle clues: flat affect (frontal lesion), labile mood (pseudobulbar palsy).
💤 Comatose Patient – Glasgow Coma Scale (GCS)
- Developed 1970s to guide neurosurgical referral.
- Score trends 📉 are more important than single values.
- Interpret in context – e.g. an aphasic stroke may score low but remain alert.
- GCS Components: Eye opening (E), Verbal (V), Motor (M). Max = 15, Min = 3.
😵 Assessing Confusion
- Start with GCS (confused but rousable patients should score >12).
- Distinguish between dysphasia (language disorder) vs delirium (fluctuating attention + disorientation).
- Ask simple orientation Qs: name, age, DOB, date/time, location.
- Confusion in elderly = poor prognostic sign (often delirium → ↑ mortality).
🧾 Mental Test Score (MTS)
- Quick bedside tool (10 points):
- Age (1), Time (nearest hour) (1)
- Address recall (e.g. “42 West Street”) (1)
- Year (1), Location (hospital/home) (1)
- Recognise 2 people (1)
- DOB (day + month) (1)
- Historic date (WW1 start) (1)
- Current monarch/PM (1)
- Count backwards 20 → 1 (1)
📊 Alternative Cognitive Assessment
- Mini-Mental State Examination (MMSE) 📝 – more detailed tool covering orientation, attention, recall, language, visuospatial ability.
- Other modern options: MoCA (Montreal Cognitive Assessment) for early dementia screening.
