Complete Neurological Examination Guide (How to Examine the Nervous System)

Описание: 🔷 INTRODUCTION

The *Neurological Examination* is the *cornerstone of clinical neurology**. Unlike other systems, neurology relies heavily on **bedside examination, pattern recognition, and anatomical localization* rather than investigations alone. A well-performed neurological examination can often **localize the lesion even before imaging**, differentiate **central vs peripheral pathology**, and narrow down the **etiological diagnosis**.

This video provides a *COMPLETE, SYSTEMATIC, EXAM-ORIENTED, and CLINICALLY RELEVANT guide* to performing the neurological examination — exactly the way it is expected in **MBBS practicals, OSCEs, DNB/DM Neurology exams, MRCP, PLAB, USMLE**, and real-world clinical practice.

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🔷 WHO IS THIS VIDEO FOR?

This video is meticulously designed for:

🩺 *MBBS students* (final year & internship)
🧠 *MD / DNB Medicine residents*
🧠 *DM / DrNB Neurology trainees*
📚 *OSCE / Viva / Clinical exam aspirants*
👩‍⚕️ *Practicing physicians & neurologists*
🎓 *Medical educators & examiners*

Whether you are *learning neurology for the first time* or **refining your examination skills for postgraduate exams**, this video will serve as a **one-stop masterclass**.


🧩 1. GENERAL OBSERVATION & HIGHER MENTAL FUNCTIONS

Level of consciousness (GCS, AVPU)
Orientation (time, place, person)
Attention & concentration
Memory (immediate, recent, remote)
Language:

Fluency
Comprehension
Repetition
Naming
Speech abnormalities:

Dysarthria
Aphasia (Broca, Wernicke, Global, Conduction)
Frontal lobe functions:

Judgment
Insight
Executive functions
Frontal release signs

📌 *Clinical relevance:* Dementia, stroke, frontal lobe syndromes, delirium, aphasia.

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🧩 2. CRANIAL NERVE EXAMINATION (CN I – XII)

Each cranial nerve is examined with:

*Anatomy*
*Method of examination*
*Normal vs abnormal findings*
*Clinical correlation*

Covered in detail:

Olfactory nerve (CN I)
Optic nerve (CN II): visual acuity, fields, fundus
Oculomotor, Trochlear, Abducens (CN III, IV, VI)
Trigeminal nerve (CN V)
Facial nerve (CN VII – UMN vs LMN palsy)
Vestibulocochlear nerve (CN VIII)
Glossopharyngeal & Vagus (CN IX, X)
Spinal accessory (CN XI)
Hypoglossal (CN XII)

📌 *Localization pearls:* Brainstem syndromes, cavernous sinus, skull base lesions.

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🧩 3. MOTOR SYSTEM EXAMINATION

A *must-master section* for exams.

Includes:

Muscle bulk (atrophy, hypertrophy, fasciculations)
Muscle tone:

Spasticity
Rigidity
Paratonia
Hypotonia
Muscle power (MRC grading)
Pronator drift
Involuntary movements:

Tremor
Chorea
Dystonia
Myoclonus
Upper motor neuron vs lower motor neuron signs

📌 *Clinical relevance:* Stroke, myelopathy, motor neuron disease, Parkinsonism, neuropathy, myopathy.

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🧩 4. REFLEX EXAMINATION

Deep tendon reflexes:

Biceps
Triceps
Supinator
Knee
Ankle
Superficial reflexes:

Abdominal
Cremasteric
Plantar response
Primitive (frontal release) reflexes:

Grasp
Snout
Palmomental
Glabellar tap

📌 *Interpretation:* UMN vs LMN vs peripheral neuropathy vs radiculopathy.

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🧩 5. SENSORY SYSTEM EXAMINATION

Systematic evaluation of:

Primary sensations:

Pain
Temperature
Touch
Posterior column sensations:

Vibration
Proprioception
Cortical sensations:

Stereognosis
Graphesthesia
Two-point discrimination

📌 *Localization:* Peripheral nerve, root, spinal cord (anterior vs posterior column), thalamus, cortex.

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🧩 6. CEREBELLAR EXAMINATION

Finger-nose test
Heel-knee-shin
Dysdiadochokinesia
Intention tremor
Rebound phenomenon
Gait ataxia
Scanning dysarthria
Nystagmus

📌 *Clinical relevance:* Stroke, alcohol-related cerebellar degeneration, MS, tumors.


🧩 7. GAIT & POSTURAL REFLEXES

Normal gait
Spastic gait
Parkinsonian gait
Cerebellar gait
Sensory ataxic gait
Hemiplegic gait
Pull test
Romberg test

📌 *Key differentiation:* Ataxia vs Parkinsonism vs frontal gait disorders.

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🧩 8. AUTONOMIC NERVOUS SYSTEM (ANS) EXAMINATION

Orthostatic blood pressure
Heart rate variability
Autonomic symptoms
Clinical relevance in:

Diabetes
MSA
Parkinson disease
Neuropathies

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🎯 EXAM-ORIENTED HIGHLIGHTS

✔ How examiners *expect you to present findings*
✔ *Common mistakes* candidates make
✔ *Short-cut screening tests* in OPD
✔ *How to verbalize findings in viva*
✔ *Localization-based reasoning*

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