NEUROLOGICAL SYSTEM EXAMINATION
Introduction
The nervous system, with its central and peripheral divisions, maintains and controls all body
functions by its voluntary and autonomic responses. Neurological assessment therefore involves
testing a wide range of human body activities such as cognitive and behavioural elements, motor,
sensory and autonomic functions; which are also tested in other systemic examination. Where
such overlaps occur, this procedure manual makes references to areas where similar information
can be found to avoid duplication of similar content.
Requirements
1. Penlight
2. Tongue blade
3. Sterile needles
4. Tuning forks
5. Familiar objects: coins, keys, paper clip
6. Cotton wisp
7. Sharp objects that are sterile: pins, needles, monofilament thread
8. Reflex (Tendon) hammer
9. Vials of aromatic substances-coffee, orange, peppermint, cloves
10. Test tubes of hot and cold water for temperature sensation testing
11. Snellen’s chart
12. Ophthalmoscope
Procedure: Mental Status Assessment
Mental status assessment is a process that begins from the time a patient enters the examination
room up to the time the patient leaves the consultation room.
Procedure
Observation in the following areas:
1. Appearance:
a. Dressing
b. Grooming
c. Personal hygiene
Note:
▪ Personal hygiene and grooming may deteriorate in depression, schizophrenia and
dementia.
▪ Excessive neatness and attention to personal looks and fastidiousness may be seen in
obsessive compulsive disorders.
▪ One-sided neglect may result from a lesion in the opposite parietal cortex.
2. Level of consciousness:
1
, a. Level of consciousness means a person’s alertness and state of awareness of the
environment.
b. Attention is the ability to concentrate or focus over a time or one task or activity.
Inattentive or distractible person whose consciousness is impaired has difficulty in
giving history or responding to questions.
c. Memory can be either:
i. Short term memory (recent) refers to memory over an interval of minutes,
hours or days.
ii. Long term memory (remote) refers to memory over intervals of years.
d. Orientation refers to people’s awareness of whom or what they are in relation to
time, place and other people.
Orientation depends on both memory and attention.
3. Speech:
a. What and how a patient speaks can reflect his / her mental status. Note the
characteristics of the speech in terms of:
i. Quantity – is the patient talkative or relatively silent? Are comments
spontaneous or only responsive to direct questions?
Slow speech may be a sign of depression, while rapid and loud speech
may signify manic syndrome.
A rushing stream of ideas with some connection or without logical
connection may signify a mental disorder described as – Flight of ideas.
ii. Articulation of words – are words spoken clearly and distinctively?
1. Dysarthria refers to a defect in the muscular control of the speech
apparatus (lips, tongue, palate or pharynx). Words may be nasal,
slurred or indistinct but the language remains intact. This disorder
can be seen in motor lesions of the central or peripheral nervous
system like Parkinsonism and cerebellar disease.
iii. Aphasia refers to a disorder in speaking or understanding language
1. Neologism refers to usage of strange words
2. Word salad refers to real words strung together oddly
3. Hesitancies and gaps in the flow and rhythm of words
4. Circumlocutions is where phrases or sentences are substituted with
a word the person can not think off. For example: ‘What you write
with’ instead of ‘Pen’.
5. Paraphrasias refers to a speech where words are malformed; for
example “I write with a den” instead of “I write with a pen”.
Note: All these suggest aphasia. Some patients may have so much
difficulty in talking and understanding such that history taking is
impossible.
4. Emotional status – make an assessment of the patients mood i.e.:
a. Is there a general impression of happiness, distress or depression?
b. Emotionally distressed or disturbed individuals often experience abnormal sleep
patterns and therefore inquire about sleep habits.
2
, 5. Behaviour / Actions – Note the following:
a. Patient’s body posture and ability to relax
b. Observe pace, range and character of movements. Do they seem to be under
voluntary control?
c. Are certain parts of the body immobile?
d. Do posture and motor activity change with topics and discussions or with
activities or people around the patient?
e. Specific postures or behaviour patterns seen with different moods:
i. Tense posture, restlessness and fidgetiness in anxiety
ii. Crying, pacing, and hand wringing in agitated depression
iii. Hopeless slumped posture and slowed movements in depression
iv. Singing, dancing and expansive movements during manic episodes
3
Introduction
The nervous system, with its central and peripheral divisions, maintains and controls all body
functions by its voluntary and autonomic responses. Neurological assessment therefore involves
testing a wide range of human body activities such as cognitive and behavioural elements, motor,
sensory and autonomic functions; which are also tested in other systemic examination. Where
such overlaps occur, this procedure manual makes references to areas where similar information
can be found to avoid duplication of similar content.
Requirements
1. Penlight
2. Tongue blade
3. Sterile needles
4. Tuning forks
5. Familiar objects: coins, keys, paper clip
6. Cotton wisp
7. Sharp objects that are sterile: pins, needles, monofilament thread
8. Reflex (Tendon) hammer
9. Vials of aromatic substances-coffee, orange, peppermint, cloves
10. Test tubes of hot and cold water for temperature sensation testing
11. Snellen’s chart
12. Ophthalmoscope
Procedure: Mental Status Assessment
Mental status assessment is a process that begins from the time a patient enters the examination
room up to the time the patient leaves the consultation room.
Procedure
Observation in the following areas:
1. Appearance:
a. Dressing
b. Grooming
c. Personal hygiene
Note:
▪ Personal hygiene and grooming may deteriorate in depression, schizophrenia and
dementia.
▪ Excessive neatness and attention to personal looks and fastidiousness may be seen in
obsessive compulsive disorders.
▪ One-sided neglect may result from a lesion in the opposite parietal cortex.
2. Level of consciousness:
1
, a. Level of consciousness means a person’s alertness and state of awareness of the
environment.
b. Attention is the ability to concentrate or focus over a time or one task or activity.
Inattentive or distractible person whose consciousness is impaired has difficulty in
giving history or responding to questions.
c. Memory can be either:
i. Short term memory (recent) refers to memory over an interval of minutes,
hours or days.
ii. Long term memory (remote) refers to memory over intervals of years.
d. Orientation refers to people’s awareness of whom or what they are in relation to
time, place and other people.
Orientation depends on both memory and attention.
3. Speech:
a. What and how a patient speaks can reflect his / her mental status. Note the
characteristics of the speech in terms of:
i. Quantity – is the patient talkative or relatively silent? Are comments
spontaneous or only responsive to direct questions?
Slow speech may be a sign of depression, while rapid and loud speech
may signify manic syndrome.
A rushing stream of ideas with some connection or without logical
connection may signify a mental disorder described as – Flight of ideas.
ii. Articulation of words – are words spoken clearly and distinctively?
1. Dysarthria refers to a defect in the muscular control of the speech
apparatus (lips, tongue, palate or pharynx). Words may be nasal,
slurred or indistinct but the language remains intact. This disorder
can be seen in motor lesions of the central or peripheral nervous
system like Parkinsonism and cerebellar disease.
iii. Aphasia refers to a disorder in speaking or understanding language
1. Neologism refers to usage of strange words
2. Word salad refers to real words strung together oddly
3. Hesitancies and gaps in the flow and rhythm of words
4. Circumlocutions is where phrases or sentences are substituted with
a word the person can not think off. For example: ‘What you write
with’ instead of ‘Pen’.
5. Paraphrasias refers to a speech where words are malformed; for
example “I write with a den” instead of “I write with a pen”.
Note: All these suggest aphasia. Some patients may have so much
difficulty in talking and understanding such that history taking is
impossible.
4. Emotional status – make an assessment of the patients mood i.e.:
a. Is there a general impression of happiness, distress or depression?
b. Emotionally distressed or disturbed individuals often experience abnormal sleep
patterns and therefore inquire about sleep habits.
2
, 5. Behaviour / Actions – Note the following:
a. Patient’s body posture and ability to relax
b. Observe pace, range and character of movements. Do they seem to be under
voluntary control?
c. Are certain parts of the body immobile?
d. Do posture and motor activity change with topics and discussions or with
activities or people around the patient?
e. Specific postures or behaviour patterns seen with different moods:
i. Tense posture, restlessness and fidgetiness in anxiety
ii. Crying, pacing, and hand wringing in agitated depression
iii. Hopeless slumped posture and slowed movements in depression
iv. Singing, dancing and expansive movements during manic episodes
3
