The neurological exam checks each part of the nervous system in a fixed order. Putting the findings together tells you where the problem is before any scan.
Mental status
Level of consciousness, orientation, attention, speech and memory test the cerebral hemispheres. Trouble finding or understanding words points to the dominant hemisphere, usually the left.
Cranial nerves
The twelve cranial nerves test the brainstem, from smell and vision down to swallowing and tongue movement. A cranial nerve deficit with weakness on the opposite side of the body suggests a brainstem lesion.
Motor and reflexes
Inspect for wasting, then test tone, power (graded 0 to 5) and reflexes. The pattern separates upper from lower motor neuron problems.
Sensation, coordination and gait
Test touch, pain, vibration and position sense, then the cerebellum with finger-to-nose and heel-to-shin. Watching the patient walk is one of the most useful tests of the whole system.
| Part | Tests | Example |
|---|---|---|
| Mental status | Cerebral hemispheres | Orientation, speech |
| Cranial nerves | Brainstem | Pupils, facial movement |
| Motor | Motor pathways, nerves, muscles | Power 0 to 5, reflexes |
| Sensory | Sensory pathways | Pinprick, vibration |
| Coordination | Cerebellum | Finger-to-nose |
At the bedside
Compare left with right at every step, because asymmetry matters more than any single finding. Sudden weakness, facial droop or speech trouble is a stroke until proven otherwise.
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Written by Making Synapses. Topic reference: OpenStax, Anatomy and Physiology 2e (no text adapted).