Medically Fit For Exams
Medically Fit For Exams

General neurological screening examination


  • Wash your hands and introduce yourself
  • Check the patient’s name and DOB
  • Explain the examination and gain consent



  • Romberg’s test:
    • Ask the patient to stand in front of you with their feet together and close their eyes
    • Place your hands near to their shoulder in case they topple, observe for unsteadiness
    • Most people will wobble a little
  • Tandem gait:
    • Ask the patient to walk heel-to-toe towards you
  • Dorsiflexion/plantarflexion power:
    • Ask the patient to walk on tip-toes (plantarflexion)
    • Ask the patient to walk on their heels (dorsiflexion)
  • Pronator drift:
    • Ask the patient to hold their hands out straight in front of them with palms up and fingers straight, and close their eyes
    • Left hemisphere lesion = right drift
    • Neglect = contralateral side may totally fall away
  • Light touch AND finger-nose test:
    • Ask the patient to keep their eyes closed and touch their nose with one finger from each hand (you touch the finger you want them to use)
  • Fine movement test, test of pyramidal function/cerebellar dysfunction:
    • Ask the patient to open their eyes and wiggle their fingers as if playing the piano
    • Impaired in upper motor neuron diseases and Parkinson’s disease
  • Dysdiadochokinesis, test for ataxia:
    • Ask the patient to tap the palm of their hand alternatively with the palm and back of the other hand
    • Switch hands
    • Difficulty suggests ataxia/cerebellar dysfunction
  • Tone/cogwheeling:
    • Take the patient’s hand and elbow in yours, ask them to relax and flex the elbow, shoulder, pronate/supinate and circumflex the wrist (this is where cogwheeling may be felt)
  • Facial nerve AND pupil reflex:
    • Ask the patient to screw their eyes up tightly
    • When they open their eyes, look for constriction of the pupil to light
  • Facial nerve and muscles:
    • Ask the patient to give a toothy grin
    • Look for symmetry
  • Hypoglossal nerve:
    • Ask the patient to stick their tongue out and wiggle it
  • Visual neglect and visual fields:
    • Ask the patient to look straight at your face and point to the fingers that are moving – move one, then the other, then both. Do this enough times to cover the four visual quadrants
    • If there is any difficulty, test visual fields as you would for an eye exam, asking the patient to cover one eye and moving your finger in from the peripheries
  • H test of oculomotor ability:
    • Ask the patient to keep their head pointing straight towards yours and follow your finger with their eyes. Make an ‘H’ shape in the air
    • CNIII, CNIV and CNVI are rare
    • Occipital lesion may cause saccadic/jumpy eye movements rather than smooth tracking
  • Ask the patient lay on the couch to check their reflexes:
    • Brachioradialis
    • Biceps
    • Triceps
    • Patella
    • Achilles
    • Babinski
  • Test vibration sense or light touch of the feet
  • State that you would like to carry out fundoscopy
  • State that you would like to carry out a blood pressure check, especially in the older patient or patients with headaches
  • State that you would like to continue a full body examination to check for primary neoplasms, especially of the breast and lungs

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