What happens during a neurological examination?

An examination with a specialist in neurology serves to detect diseases of the nervous system. These include diseases as diverse as stroke, Parkinson’s, chronic migraine, meningitis, epilepsy or multiple sclerosis. You may, for example, express paralysis in the arms or legs, dizziness or speech problems, muscle weakness, sensory disturbances or confusion.

A neurological examination, therefore, involves a whole series of tests, such as muscle strength, coordination, and memory. A review of the eyes may also be included.

How do you prepare for the investigation?

Preparation is not necessary. To be able to make the correct diagnosis, the doctor checks the regular movements and reactions. Since the nervous system controls all processes virtually in the body, from respiration to muscle movement to digestion and touch, neurological examination is sometimes time-consuming. It is usually not painful but can be a little uncomfortable.

How is the examination performed?

A neurological examination follows a clear course. It always begins with a conversation in which the doctor, among other things, asks for complaints and previous illnesses (anamnesis). Then it is checked if there are external signs of disease. This can be, for example, the way to go, recognize the posture, balance or restriction of movement. In a short physical exam, the doctor listens to the lungs and heart and measures the pulse.

Various tests follow this, the effort and process depend on the suspected disease. Basically, from the brain to the leg muscle all areas of the body can be neurologically examined, which may be affected by nervous disorders. If a patient is unable, or only partially able, to answer questions and actively participate in the tests, relatives or friends can help. As a rule, the following nerves and body functions are tested:

cranial nerves

Every human being has twelve cranial nerves. For example, they control the muscles of the eyes, the jaw or the tongue. There is also an olfactory, visual, auditory and balance nerve. Impaired vision, hearing, smelling, tasting or speaking may indicate a nervous condition.

The sense of smell is tested with certain fragrances. For this purpose, the doctor keeps neutral tubes with samples of, for example, coffee, vanilla, cinnamon or soap individually under each nostril. The fragrance is then to be distinguished from a blank. Even nose humping or teeth bleeding is part of the examination, so the facial nerve is checked. As with the ophthalmologist, vision can be examined by recognizing letters or characters on reading boards. Also, the doctor can check with a finger test if the visual field is limited. One eye is covered by hand, and the other looks straight ahead. Then the doctor moves a finger from outside into the area that you can see without moving the eye and asks when the finger can be seen.

Motor skills and coordination

The general mobility, excellent motor skills, and coordination are another part of the investigation. How well can you move your arms and legs, open or write button closures? How many steps are needed to turn around on your axis? How safe do you do with your eyes closed and your fingers crossed over your nose, or do you touch the other knee while lying down with your heel? An examination of the reflexes is also part of the study, for example by the known knocking with the reflex hammer on the hamstring: Here, the hamstring and the thigh extensor muscle are stretched, the muscle contracts reflexively and the lower leg shoots up.

Sensitivity (sensitivity)

Whether the sensation of pain and touch is disturbed, the doctor usually determines with a soft cloth and a needle. To test the sensation of heat and cold, for example, test tubes with cold and warm water are held against the skin.

Cognitive skills, memory, and psyche

This area includes language and computational tests, as well as questions and quizzes on mind and orientation, such as the time of year, the date, occupation or current location. Concentration problems, but also ongoing fatigue and lack of drive can point to mental issues.

Autonomic Nervous System

The automatic or vegetative nervous system controls the unconscious, vital bodily processes such as the heartbeat, the respiration, the regulation of the body temperature or the digestion. Therefore, for example, in addition to the blood pressure measurement and questions about bowel movements and urination are part of a neurological examination.

Are additional examinations necessary?

Depending on the result of the individual tests, technical studies are included, for example, a measurement of the brain waves (EEG), muscle activity (electromyography, EMG for short) or nerve conduction (electroneurography, ENG for short). Imaging techniques are also possible, such as an ultrasound examination, computed tomography (CT) or magnetic resonance imaging (MRI). Sometimes the removal of nerve water in the lower part of the spine (lumbar puncture) is necessary.


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