This document summarizes the examination of various systems and functions in neurology. It describes the examination of higher functions, cranial nerves 1-12, motor and sensory systems, autonomic nervous system, and mental state. For each cranial nerve, it provides details on origin, function, signs of damage, and specific tests. It also describes assessments of memory, speech, orientation, consciousness, behavior, and other mental functions. The overall summary is of a full neurological examination protocol.

1. DrPuneet Kaur

2. Examination Of
 Higher Functions
 Cranial nerves
 Motor system(incl reflexes)
 Sensory system
 Autonomic nervous system

3.  Mental state
 Memory
 Speech

4. Two cerebral Hemisphere:
1.Dominant or Cerebral Hemisphere
-categorization and symbolization
2.Representational Hemisphere
-spatiotemporal relations
Hemisphere specialisation related
to handedness

5.  Appearance and Behavior
 Emotional state
 Delusions and Hallucination
 Orientation in Place andTime
 Level Of Consciousness
 Intelligence

6.  Dress
 Personal Hygiene
 General Grooming
 Facial tics
 Verbal or physical aggression

7.  Mood : facial expression (reflective
of depression, mania, anxiety,
schizophrenia)
 Sleep and dreams : insomnia , sleep
disturbing dreams

8. Delusion : false and unshakeable
beliefs which continue to be held
despite evidence to contrary.
Hallucination : False impressions
referring to organs of special
sense(hearing , smell , vision etc) for
which no cause can be found.

9. Disorientation :
Organic Brain Disease
Schizophrenics
Hysterical states

10.  Stupor-Patient shows some response,
example to painful stimuli
 Coma-makes no psychologically
meaningful response to external
stimulus or to internal need

11.  Approximate from occupation and
educational qualifications
 Formal testing: calculating ability , serial
subtraction, copying a complex figure etc

12.  Recent or short term memory
 Remote or long term memory
Retrograde amnesia for events
immediately before brain concussion

13.  Aphasias
 Dysarthria

14.  Sensory or Fluent aphasia
Lesion inWernicke area-area 22,sensory speech
centre(Posterior end of the superior temporal
gyrus in the dominant hemisphere)
Symptoms:-speech not disturbed but the
person talks excessively that makes little sense
-Pure word blindness or anomic aphasia

15. Motor or non fluent aphasia
Lesion in the Broca’s area-area 44,motor
speech centre(inferior frontal gyrus of
dominant hemisphere)
Symptoms:-Loss of articulate speech or
inability to write or both
-person is dumb and speech is slow
-words are hard to come by limited to 2-3
words

16. Global aphasia:result of loss of both
Wernicke’s and Broca’s area

18. There is difficulty in spoken speech.

19.  12 pairs of cranial nerves
 Some are afferent(sensory)
 Some are efferent(motor)
 Some are mixed nerves

21.  Origin : From the olfactory
epithelium
 Function: Pure sensory nerve
concerned with olfaction (smell)
 Paralysis:-Anosmia
 Test:-Clove oil presented to each
nostril separately

23. Anosmia : complete absence of smell
Parosmia : is alteration in the
character of smell
Hypoosmia :reduction in the sense of
smell

24.  Origin :From the Retina
 Function: Pure sensory nerve-transmission of
visual sensations to brain
 Test-Visual acuity
-Field of vision
-Color vision
-Examination of fundus(Opthalmoscopy)

25.  Near vision: Jaeger’s chart
 Distant vision: Snellen’s chart

27. Optical: state of image forming
mechanism of eye
Retinal factors: acuity maximal at
the fovea centralis
Stimulus factors : size of object
and distance from eye,color of
object

28.  Confrontation tests
 Perimetry
 Red pin test

31.  Yarn (spun thread) matching test or
Holmgreins skeins of colored wool
test
 Ishihara charts
 Edridge green lantern

33.  Origin: from a series of nuclei which
begins in the floor of the sylvian
aqueduct extending upto the fourth
ventricle
 Function: Mixed nerves-innervate
the eye muscles and bring sensation
from proprioceptors in eye muscles

34. Test
1.Look for ptosis ,squint,nystagmus
2.Test for ocular movement
3.Examination of Pupil

36.  Origin : From the lateral surface of Pons at
about its middle
 Function: It is a mixed nerve with sensory,
motor and secreto-motor components
 3divisions-Opthalmic
-Maxillary
- Mandibular

38.  Opthalmic division-loss of cut. sensation
-loss of corneal reflex
 Maxillary division-loss of palatal reflex
-loss of cut.sensation
 Mandibular division-loss of sensation
-weakness of muscles of
mastication

39.  Touch, pain,pressure,temperature over the
face
 Corneal reflex-Touch the cornea with a wisp
of cotton-subject blinks

40.  Clench teeth-masseter and temporalis stand
out with equal prominence on each side
 Open mouth : jaw will deviate to paralysed
side-pushed by healthy external pterygoid

41.  Origin: From the Pons , lateral to that of the
sixth nerve nucleus
 Function:Mixed nerve
Motor fibre-all the muscle of face and scalp
except levator palpebrae superioris
Stylohyoid
Buccinator
Stapedius muscle

42. Sensory fibres-taste sensation from
ant. 2/3 of tongue
Secreto-motor fibres-supplies lacrimal
gland , sublingual and submandibular
salivary gland(all salivary gland except
the parotid gland)

43.  Loss of facial expression
 Furrows over forehead smoothen out
 Hyperacusis
 Loss of taste-ant 2/3 of tongue
 Xeropthalmia,decreased salivation

44.  Smile or show upper teeth
 Close his eyes against resistance
 Whistle
 Inflation of cheeks
 Loudness of sound
 Taste :ant 2/3
 Schirmer’s test for lacrimation

46.  Origin : From the groove in between the
junction of Pons and Medulla.
 Function:Pure sensory nerve supplying the
Vestibular and cochlear portion of ear

47.  Vertigo
 Nystagmus
 Lossof hearing

48.  Romberg’s sign
Stand with feet together and close his eyes
 Barany’s caloric test
Water at 7 degree celsius above and below
normal body temperature

49.  Watch test
 Tuning fork test : Rinne’s ,
Weber’s ,
Schwabach
 Audiometry

52.  Origin:5-6 rootlets to upper part of medulla
oblongata
 Function : Mixed nerve
Motor fibres supply stylopharyngeus ms
Sensory fibre to posterior 1/3 portion of tongue
And mucus membrane of pharynx
Secretomotor fibres supply the parotid gland

53.  Loss of taste from post. 1/3 of
tongue
 Decreased salivary secretion

54.  Taste sensation in Post. 1/3 of
tongue
 Palatal reflex

55.  Origin:Attached by 8-10 rootlets to the lateral
aspect of medulla oblongata below the origin
of 9th nerve
 Function: mixed nerve
Motor to involuntary ms of respiration,heart
and part of GIT & voluntary ms of pharynx,
larynx and soft palate
Sensory to GIT upto right 2/3 of colon &mucus
memb. of pharynx, larynx and soft palate.

56.  Regurgitation of fluids through nose
 Nasal tone in voice
 Hoarse and deep voice

57.  Soft palate movement
 Laryngoscopy

59.  Origin :Cranial part and spinal part
 Function: Pure motor nerve
Supplies Sternocleidomastoid and
Trapezius

60.  Move the head
 Shrug shoulder

62.  Origin: From lowermost part of medulla
oblongata
 Function :Pure motor nerve
Supplies all Ms of tongue.

63.  Defective articulation
 Deviation of tongue

64.  Tongue protrusion-deviation