The Seven Stages of a Neurological Exam
The neurological exam is a critical evaluation of different aspects of the
brain and central nervous system. When completed, the neurologist compares the
patient’s medical history with results from the neurological exam to arrive at a
diagnosis. The seven stages include:
1. Mental Status
- How aware and responsive is the patient to the
environment and his/her senses?
- Evaluation of appearance and general behavior
- Evaluation of mood
- How does the individual process information?
- Is the patient oriented to time, place and person?
- Can they pay attention?
- Can they remember objects after a period of time?
- Can they repeat sentences?
- Can they copy a three-dimensional drawing?
- Tests for speech and language function.
- Can they think abstractly, make correct judgments, and reveal their
thoughts when asked a question?
2. Cranial Nerves (Set of 12 nerves that relay
messages between the brain, head and neck, and control motor and sensory
functions, including vision, smell, and movement of the tongue and vocal cords).
- Eyelid strength and function
- Visual function
- Peripheral vision
- Pupil’s response to light
- Ability for the eye muscle to move
- Strength of face muscles
- Gag reflex
- Tongue and lip movements
- Ability to smell, taste and hear
- Sensations in the face, head, and neck
3. Motor System (brain and spinal cord motor
- Examination of muscles for atrophy, twitching,
- Strength evaluation in all major muscle groups
- Scratch heel to toe. Normally, patients’ toes curl downward.
4. Sensory System (Tests
sensation by stimulating receptors in the skin, muscles and tendons)
- Evaluate sensations for pain, temperature,
pressure, position, with eyes open and eyes closed.
5. Deep Tendon Reflexes
(tests involuntary actions in response to stimuli sent to the central nervous
- Specific muscle tendons tapped with soft rubber hammer to see if muscle
6. Brain coordination for
voluntary movement, coordination and posture
- Patient will be asked to move fingers from nose to
neurologist’s finger, going back and forth
- Tap fingers together quickly in coordination, or
move hands one on top of the other, back and forth.
- Patient is asked to rub one heel up and down smoothly over opposite
Orientation to posture
Ability to walk heel to toe, turn quickly
Ability to walk on toes, heels, run