One of the first things that will be performed when a patient sees a neurosurgeon is a neurological examination. This evaluation of the nervous system is done in the physician’s office and does not require any special preparation by the patient. The exam helps the doctor determine the patient’s level of function and is a valuable part in diagnosing the patient’s condition.
The nervous system consists of the brain, the spinal cord, and the nerves coming from them. Many parts of the body are controlled by the nervous system. Some of the areas that are tested in a neurological exam include mental status, motor function, balance, coordination, sensation, and reflexes.
This is usually assessed through observation and interaction during routine health questions that are asked. The patient’s awareness of surroundings, attentiveness, clarity of speech, ability to make sense during conversation, memory skills, and mood may be evaluated. The doctor is looking for appropriate eye contact and the patient’s ability to converse in a normal and consistent manner.
The physician may evaluate muscle tone and strength. This can be determined in push-pull testing by having the patient push or pull against the doctor’s hands with their arms and legs. Any tremors, spontaneous movements, rigidity, and muscle atrophy will be noted.
Balance is assessed by observing the patient’s walking gait. Things to note include wobbling and unsteadiness. Can the patient walk a straight line and walk on their toes and heels? Can they stand on one foot without losing their balance? Are they able to stand with eyes closed while gently being pushed to the side?
Touching a finger to the nose with eyes closed tests coordination, as does finger tapping. The doctor will note any left-right disparity. Testing fine motor skills can be done by observing the patient pick up a small object or open a twist off bottle cap.
Sensation is evaluated for responses to pain, temperature, and pressure. Can the patient feel heat or cold? Do they detect a pinprick in the fingers or toes on both sides? Can they feel the vibration from a tuning fork?
Reflexes are tested for automatic responses to stimulation. A reflex hammer can be used to tap different parts of the body including below the knee, the ankles, the elbows, forearms, and biceps. Reactions are assessed on both sides of the body. Reflexes that are diminished or absent indicate a possible problem with the nerve supply.
A neurological exam generally takes just a few minutes to perform. It is sometimes followed by additional diagnostic testing such as x-rays, a CT scan, or an MRI. All of these tools help the physician diagnose the problem and customize a treatment plan.