Neurological Exam

What is a neurological exam?

A neurological exam is a group of questions and tests to check for disorders of your nervous system. It's sometimes called a "neuro" exam.

Your nervous system includes your:

• Brain and spinal cord, which are also called your central nervous system
• Peripheral nerves that carry signals back and forth between your central nervous system and all parts of your body, including your skin, muscles, and organs

Your nervous system plays a role in almost every part of your health and well-being. Because it controls so many body processes, a neurological exam has many different types of tests. The tests you have will depend on why you're having the exam. There are nerve tests to check for problems with your:

• Muscle movement, balance, and coordination. These activities are controlled by nerves called motor nerves.
• Breathing, heartbeat, digestion, and other processes that happen without thinking. Autonomic nerves control these activities.
• Sense of touch, smell, hearing, and vision. Sensory nerves carry this information from your senses to your brain.
• Thinking and memory. Certain parts of your brain control these and other types of complex mental activity, including your emotions.

Other names: neuro exam

What is it used for?

A neurological exam may be used to:

• Check the health of your nervous system during a routine checkup.
• Help find out whether a nervous system disorder is causing certain symptoms. There are hundreds of disorders that affect the brain and nerves. Some examples include:
  • Degenerative nerve diseases, such as certain types of dementia and Parkinson's disease
  • Diabetic nerve problems
  • Epilepsy
  • Headache disorders, such as migraines and cluster headaches
  • Meningitis
  • Multiple sclerosis
• Help find out if an injury has damaged part of the nervous system and how serious the damage may be.
• Monitor a known nerve condition and/or see if treatment is helping.

Why do I need a neurological exam?

You may need a neurological exam if you have symptoms that may be from a nervous system disorder. Because your nerves affect every part of your body, nervous system disorders can cause many different types of symptoms, including:

• Pain in your back, neck, head, or along a nerve, such as sciatica
• Tremors
• Weak or stiff muscles
• Problems with balance and/or coordination
• Numb or tingling skin
• Changes in any of your senses (hearing, vision, taste, smell, and touch)
• Slurred speech
• Confusion or other changes in mental ability
• Seizures

You may also need a neurological exam if you have had an injury that may have damaged your peripheral nerves, spinal cord, or caused a traumatic brain injury (TBI).

What happens during a neurological exam?

A neurological exam is often done by a neurologist. A neurologist is a doctor who specializes in diagnosing and treating disorders of the nervous system. Certain other providers may also do a neurological exam.

The exam is usually done in a provider's office. If you've had a serious injury, the exam may be done in the emergency room or in the hospital.

First, the provider will usually:

• Ask questions about any symptoms you may have
• Ask about your medical history
• Do a physical exam, including checking your heart and lungs

Next, the provider will do specific tests to check how different parts of your nervous system are working. The tests you have will depend on your symptoms. The tests may check your:

• Mental status. This includes your memory, problem-solving ability, alertness, and mood. During a mental status exam, you may answer questions about the date, time, and where you are. You may also be asked to remember a list of items, name objects, repeat words, and/or draw specific shapes.
• Cranial nerves. These 12 nerves connect your brain with your eyes, ears, nose, face, tongue, throat, shoulders, and certain organs. The provider will test the nerves that may be involved with your symptoms. For example, to test your sense of smell, you may be asked to sniff certain smells and identify what they are. If you're having speech problems, you may be asked to try to talk while you stick out your tongue.
• Coordination, balance, and walking. These tests check how well your nervous system controls your muscle movements. You may be asked to walk in a straight line, placing one foot directly in front of the other. Other tests include checking your handwriting and having you touch your finger to your nose with your eyes closed.
• Reflexes. A reflex is your body's automatic movement in response to certain triggers. For example, if your knee is tapped with a rubber hammer, your lower leg will jerk on its own. There are many types of reflexes that are tested in different ways. Reflex tests show how well nerves between your spinal cord and muscles are working.
• Sensory nerves. The provider may test how well you can feel touch, hot and cold temperatures, vibrations, and pain. These tests involve gently touching part of your skin with different objects, such as a dull needle or a cotton swab. You will be asked to describe what you can feel.
• Autonomic nervous system. A neurological exam tests the part of your nervous system that controls your breathing, heart rate, digestion, and other processes that happen without thinking. Examples of these tests include checking your blood pressure and heartbeat. Another test checks how your eyes respond to light.

Will I need to do anything to prepare for a neurological exam?

You don't need any special preparations for a neurological exam.

Are there any risks to the exam?

There is no risk to having a neurological exam.

What do the results mean?

If the results of any part of your neurological exam are not normal, your provider will probably order more tests to help make a diagnosis. The tests will depend on what type of condition your provider thinks you could have. They may include:

• Blood and/or urine tests
• Imaging tests, such as an MRI
• Cerebrospinal fluid (CSF) testing, also called a lumbar puncture
• Biopsy
• Electroencephalography (EEG) or electromyography (EMG), which use small electric sensors to measure brain activity and nerve function

If you have questions about your results, talk with your neurologist or other provider.

Learn more about laboratory tests, reference ranges, and understanding results.

Is there anything else I need to know about a neurological exam?

Nervous system disorders and mental health problems can have similar symptoms. For example, problems paying attention could be a symptom of either type of disorder. So in certain cases, your provider may do a mental health screening before or after a neurological exam.