Neurological examinations

A neurological exam, also called a neuro exam, checks how well different parts of your nervous system are working. Your nervous system includes your brain, spinal cord, nerves and muscles. A neuro exam can help your healthcare team find nervous system conditions and figure out what’s causing them. The exam can take a few minutes or up to an hour or more, depending on your symptoms and what the results show.

Neuro exams can include several types of tests. Your testing may be done by a doctor who specializes in treating nervous system conditions, called a neurologist. During the exam, your healthcare professional may ask about your medical history and perform tests to gauge your physical and mental status. Depending on the results, you may need other testing.

Types of neurological tests

Your healthcare team may conduct one or more of these tests as a part of your neuro exam.

• Mental status exams check your memory, thinking, orientation and mood. You may be asked to solve simple problems or answer questions about the current date and your location.
• Cranial nerve tests look at the nerves that control your senses and movement in the face, mouth and eyes. You may need to read an eye chart or track the examiner’s moving finger with your eyes. Other possible tests include raising and lowering your eyebrows, or naming different smells, sounds or tastes.
• Motor system and strength testing studies muscle strength, muscle tone and involuntary movements to see whether nerves and muscles are working right. Tests include pushing or pulling against the examiner’s hands, squeezing the examiner’s fingers, or moving your limbs as directed.
• Reflex testing checks how your nerves and spinal cord respond to certain actions. The examiner might tap your knees, elbows and ankles with a small rubber hammer to watch for reflexes.
• Sensory system testing looks at your ability to feel touch, pain, vibration, temperature or position. You may be asked to say when you feel a gentle touch or a sharp poke on your skin.
• Coordination and balance tests check how well your brain and nerves control movement and balance. The examiner may ask you to walk or touch your finger to your nose with your eyes closed. You also may be asked to stand still with your eyes closed to check your balance.
• Gait and stance tests help find issues with walking or standing, which may point to nerve or muscle conditions. The examiner may ask you to walk as you typically do or to walk on your toes or heels.

Depending on your test results, you may need some medical imaging tests.

• Electroencephalogram (EEG) measures electrical activity in the brain. It can help find seizures, sleep disorders or other conditions in the brain.
• Electromyography (EMG) tests the health of muscles and the nerve cells that control them. It looks for the causes of muscle weakness or loss of feeling.
• Nerve conduction studies (NCSs) look at how fast and strong signals travel in your nerves.
• Tomodensitogrammes show pictures of the brain or spine to find injuries or tumors.
• IRM gives detailed images of the brain or spinal cord to find injuries or tumors.
• Lumbar puncture, also called a spinal tap, checks the fluid around your brain and spine to look for any issues.
• A positron emission tomography (PET) scan is an imaging test that can help show the metabolic or biochemical function of the body’s tissues and organs. Brain PET scans can be used to check for some brain conditions. Body PET scans can be used to detect types of cancer, which show up as bright spots on PET scans because cancer cells have a higher metabolic rate.

Your healthcare team may do a neuro exam if your symptoms suggest a concern with your nervous system, such as:

• Headaches that are new, severe or increasing in number.
• Blurry vision or other sudden changes in sight.
• Issues with balance and coordination, such as trouble walking straight or falling repeatedly.
• Weakness, numbness or tingling, especially if it happens on only one side of your body.
• Changes in your memory or behavior.
• Slurred speech or trouble talking.
• Seizures.
• Shaking you can’t stop or sudden jerky movements.
• Chronic pain, especially in the head, neck or back or along a nerve.
• Sudden injury to the head, back or neck, such as after an accident.

Healthcare professionals use a neurological exam to:

• Find out why you have symptoms such as weakness, numbness, trouble talking, memory loss, headaches or issues with balance.
• Monitor known nervous system diseases.
• See how treatments are working.

Neuro exams can help healthcare professionals screen for:

• Degenerative diseases such as Parkinson disease or Alzheimer’s disease.
• Autoimmune diseases such as multiple sclerosis.
• Stroke.
• Injuries to the head and spinal cord.
• Diabetes complications.
• Epilepsy.

Most neurological tests are safe and painless. Some, such as EMG lumbar puncture, may cause:

• Headache.
• Brief discomfort or pain.
• Minor bruising or soreness where needles are used.
• Rarely, infection or bleeding at the test site.

Talk with your healthcare team if you have any concerns about your neuro testing.

• Make a list of your symptoms. Questions to answer might include:

  • When did the symptoms start?
  • How often do they occur?
  • What makes the symptoms better or worse?
  • How long do they last, and how severe are they?
• Write down your medical history and any family history of nervous system diseases.
• List all the medicines, vitamins and supplements you take.
• Bring questions to ask your healthcare professional.
• Bring a family member or friend if you want help remembering information.
• Tell your healthcare professional if you have a pacemaker or other medical devices, take blood thinners, or have a bleeding condition.

Before

You may need to change into a hospital gown.

During

The length of a neuro exam varies depending on your symptoms and responses to questions and testing. During the exam:

• Your healthcare professional may ask about your symptoms and medical history.
• You may be asked to do simple tests, such as following the examiner’s finger with your eyes, touching your nose or walking in a straight line.
• Your reflexes, muscle strength, sensation and coordination may be checked.

After

After your neuro exam:

• Your healthcare professional may review your test results and talk with you about what they mean at a follow-up visit.
• You might have mild soreness or bruising if needles were used, but this usually goes away in a few days.
• Depending on the test results, you may need more tests or medical appointments.

Neurological testing can show:

• Whether there is an issue with your nervous system.
• Where the issue is located, such as the brain, spinal cord, nerves or muscles.
• What kind of issue it is, such as a stroke, infection, or nerve disease.
• How serious the concern is and whether it’s getting better or worse.