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The detailed neurologic examination in adults

Douglas Gelb, MD
Section Editor
Michael J Aminoff, MD, DSc
Deputy Editor
Janet L Wilterdink, MD


Most of the information necessary to localize a lesion in patients with neurologic complaints can be obtained by taking a careful history. Even features that are usually considered to be examination findings can be deduced if the right questions are asked. As an example, to investigate temperature sensation, patients can be asked whether they have any problems detecting water temperature. With regard to fine touch discrimination, patients can be asked whether they have problems pulling the correct coin or other objects out of their pockets. Position sense can be explored by asking whether patients have problems knowing where their feet are on the car accelerator and brake pedals.

Nevertheless, some important information can be learned only by examining the patient. Furthermore, the information obtained from a history depends upon the reliability of the informant. It is essential to have an independent source of information when the informant is a poor observer, has trouble communicating, or for some reason provides misleading information; the neurological examination serves this purpose.

There is no clear consensus among experts regarding the optimal order of performing or presenting the neurologic examination or its components (eg, the motor examination). The order used in this topic is my preferred order for presenting the results of the patient's neurologic examination. It is important that clinicians have a sequence of their choosing that they use consistently.

Components of the standard neurologic examination are found in Table 1 and discussed in detail in this review (table 1). The text is adapted, with permission, from Reference 1 [1].

The examination of comatose patients is discussed separately. (See "Stupor and coma in adults", section on 'General examination'.)

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Literature review current through: Nov 2017. | This topic last updated: Sep 07, 2012.
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