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. What tests you have will depend on why you're having the exam. In general, they will check your:

• Mental status. This includes testing your ability to think and recall information such as the date and time. It can also involve questions about your mental health. If you have problems with your thinking, memory, or mental health, it could mean that the nerves that control these activities are damaged.
• Ability to smell, hear, and see. Each of these senses is controlled by one or more of your cranial nerves. There are 12 of these nerves, and together they control your eyes, nose, face, tongue, throat, shoulders, and certain organs. If you have problems with any of these nerves, your senses may stop working the way they usually do.
• Muscle movements, balance, and coordination. These activities are controlled by motor nerves, and if any of them are damaged you may struggle to walk or move certain muscles.
• Reflexes. These are your body's automatic movements in response to certain triggers. For example, if your knee is tapped with a rubber hammer, your lower leg will jerk on its own. If certain reflexes don't happen the way they usually do, it could mean you have some nerve damage, especially in your spinal cord.
• Ability to sense temperatures, pain, and vibrations. You can sense each of these because of your sensory nerves. If, for example, you aren't able to tell if something is hot or cold, it may mean these nerves aren't working the way they should.
• Breathing, heartbeat, digestion, and other processes that happen without thinking. Autonomic nerves control these activities.

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 if an injury has damaged part of the nervous system and how serious the damage may be
• Help find out whether a nervous system disorder is causing certain symptoms
• Monitor a known nerve condition or see if treatment is helping

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

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)
• Changes in muscle size
• Sexual problems such as having difficulty getting or keeping an erection
• 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. During these tests, your provider may check your mental status, senses, and autonomic functions.

To check your mental status, your provider may ask you to:

• Tell them the date, time, and where you are
• Remember a list of items
• Name various objects
• Repeat words
• Draw specific shapes

They may also perform a mental health screening to check for any mental health problems, which can be a sign of nervous system disorders.

To check your ability to smell, taste, hear, see, walk, and keep your balance, your provider may have you:

• Sniff certain smells, such as coffee and vanilla, and identify what they are
• Try to talk while you stick out your tongue
• Walk in a straight line, placing one foot directly in front of the other
• Touch your finger to your nose with your eyes closed
• Describe what you feel while your provider gently touches your skin with different objects, such as a dull needle or a cotton swab

To check your body's autonomic functions and reflexes, your provider may:

• Take your blood pressure
• Measure your heartbeat
• Check how your eyes respond to light
• Tap your knee with a rubber hammer to see if your leg jerks on its own

If your provider is checking the nerve function of your newborn or infant, they may test certain reflexes that disappear within the first few months of life. These reflexes include:

• Babinski reflex, which is when an infant's toes will extend and fan out when the bottom of their foot is stroked
• Moro's (or startle) reflex, which is when an infant throws their arms outward, opens their hands, and throws their head back when there's a quick change in their position
• Palmar grasp, which is when an infant's fingers or toes curl around a finger
• Stepping reflex, which is when an infant makes stepping motions when the soles of their feet touch a surface
• Rooting reflex, which is when an infant turns their head and makes sucking movements with their mouth whenever someone touches their cheek

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?

The results of a neuro exam can tell you and your provider:

• Whether there's an issue with your nervous system
• Where any issue might be located
• What kind of issue it is (for example, whether it's being caused by nerve disease)
• How serious the issue is

If the results of any part of your neurological exam are not normal, your provider will probably order more tests. This is because the results of a neuro exam alone are not usually enough to diagnose a condition. The additional tests your provider orders 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.