Clinical Neurology
Neurological Exam · Lesions · Development · Cerebral Palsy
CLINICAL NEUROLOGY
Integrated Study Guide
Chapter 3 — Neurological Examination
Chapter 4 — Lesions of the CNS and PNS
Chapter 5 — Psychomotor Development and Developmental Delay
Chapter 6 — Infantile Cerebral Palsy
Academic summary with comparative tables and university-level assessment questionnaire
University Study Material — Clinical Neurology
, Clinical Neurology
Neurological Exam · Lesions · Development · Cerebral Palsy
Chapter 3 — Neurological Examination
The neurological examination is an organised set of manoeuvres that allow the clinician to assess
the functionality of the nervous system at different levels. Its primary goal is to detect and
topographically localise lesions in order to direct complementary investigations accurately. The
correct approach requires a systematic evaluation from head to toe, always examining both
sides of the body, since asymmetry of findings is often the most diagnostically significant
observation.
Essential equipment: torch, reflex hammer, ophthalmoscope, 128 Hz tuning fork, needle, hot
! and cold water tubes.
Higher Cerebral Functions
These are assessed on first contact with the patient, partly during history taking, and explored
further with specific manoeuvres:
• Level of consciousness: wakefulness, somnolence, obtundation, stupor, coma.
• Attention: ability to maintain eye contact and conversation with progressively complex
commands.
• Orientation: person, time and place. Questions: name, date, city.
• Language: verbal fluency, comprehension (simple and complex commands), coherence
and articulation.
• Memory: immediate, recent (what they ate today) and remote (events from previous
weeks).
• Calculation and abstraction: simple arithmetic, counting backwards in sevens,
interpretation of proverbs.
• Praxis: ability to execute learned motor patterns on verbal command.
The 12 Cranial Nerves
N Name Main function Examination manoeuvre
e
r
v
e
I Olfactory Smell Recognisable odours (coffee)
through each nostril separately
II Optic Visual acuity and visual Confrontation testing; pupillary
field light reflex
II Oculomot Ocular motility; H-pattern finger tracking; direct
I, or nerves parasympathetic and consensual pupillary reflex
I pupillary response
V
,
V
I
V Trigeminal Facial sensation; Light touch on face; jaw closure
mastication against resistance; corneal
University Study Material — Clinical Neurology
Neurological Exam · Lesions · Development · Cerebral Palsy
CLINICAL NEUROLOGY
Integrated Study Guide
Chapter 3 — Neurological Examination
Chapter 4 — Lesions of the CNS and PNS
Chapter 5 — Psychomotor Development and Developmental Delay
Chapter 6 — Infantile Cerebral Palsy
Academic summary with comparative tables and university-level assessment questionnaire
University Study Material — Clinical Neurology
, Clinical Neurology
Neurological Exam · Lesions · Development · Cerebral Palsy
Chapter 3 — Neurological Examination
The neurological examination is an organised set of manoeuvres that allow the clinician to assess
the functionality of the nervous system at different levels. Its primary goal is to detect and
topographically localise lesions in order to direct complementary investigations accurately. The
correct approach requires a systematic evaluation from head to toe, always examining both
sides of the body, since asymmetry of findings is often the most diagnostically significant
observation.
Essential equipment: torch, reflex hammer, ophthalmoscope, 128 Hz tuning fork, needle, hot
! and cold water tubes.
Higher Cerebral Functions
These are assessed on first contact with the patient, partly during history taking, and explored
further with specific manoeuvres:
• Level of consciousness: wakefulness, somnolence, obtundation, stupor, coma.
• Attention: ability to maintain eye contact and conversation with progressively complex
commands.
• Orientation: person, time and place. Questions: name, date, city.
• Language: verbal fluency, comprehension (simple and complex commands), coherence
and articulation.
• Memory: immediate, recent (what they ate today) and remote (events from previous
weeks).
• Calculation and abstraction: simple arithmetic, counting backwards in sevens,
interpretation of proverbs.
• Praxis: ability to execute learned motor patterns on verbal command.
The 12 Cranial Nerves
N Name Main function Examination manoeuvre
e
r
v
e
I Olfactory Smell Recognisable odours (coffee)
through each nostril separately
II Optic Visual acuity and visual Confrontation testing; pupillary
field light reflex
II Oculomot Ocular motility; H-pattern finger tracking; direct
I, or nerves parasympathetic and consensual pupillary reflex
I pupillary response
V
,
V
I
V Trigeminal Facial sensation; Light touch on face; jaw closure
mastication against resistance; corneal
University Study Material — Clinical Neurology
