The neurological examination ought to be primarily hypothesis-driven, i.e. its function is to increase or decrease the likelihoods of hypotheses generated during history-taking. For example, performing the Dix-Hallpike examination is of interest when the history suggests benign paroxysmal positional vertigo but of highly dubious value in all other circumstances.

Non-withstanding, it is sometimes difficult to obtain a good history in the emergency setting. For this reason, one can justify routinely performing a ”screening neurological examination” on patients presenting with suspected neurological deficits. What should be part of this examination is debatable. In principle, a screening test ought to be sensitive. Many traditional tests that are part of ”routine” neurological examinations have poor sensitivity, e.g. the plantar response test (Babinski) and the pronator drift have poor sensitivity for upper motor neuron lesions. Examining the face for sensation and testing for hearing without specialized equipment are tests that rarely provides useful clinical information beyond that reported during the history.

We propose here a Screening Neurological Examination suited to the emergency setting where the focus is on time-sensitive conditions (i.e. not on diagnosing Parkinson’s disease). Level of consciousness and dysphasia are not present given that they will have been identified during the history taking or resuscitation phase.

 

  1. Cranial Nerves
  • Visual fields and neglect
  • Pupillary size and reactivity to light
  • Eye movements
  • Facial movements
  • Soft palate elevation
  • Tongue movements

 

  1. Motor
  • Shoulder abduction (proximal arm strength)
  • Finger spreading (distal arm strength)
  • Rising from sitting (proximal leg strength)
  • Walking on toes and heels

 

  1. Sensation
  • Touch-hands
  • Pinch-hands
  • Touch-feet
  • Pinch-feet

 

  1. Reflex
  • Biceps or triceps reflex
  • Patella reflex

 

  1. Coordination
  • Finger-nose test
  • Heel-shin test
  • Romberg