Examination of the Patient Without Neurologic Symptoms: the Screening Neurologic Examination
PURPOSE OF THE SCREENING NEUROLOGIC EXAMINATION
The purpose of the examination of the patient without neurologic complaints is to look for evidence of unrecognized neurologic disease or the presence of unrecognized neurologic complications in a patient with a chronic systemic illness.
WHEN TO PERFORM THE SCREENING NEUROLOGIC EXAMINATION
A screening neurologic examination (in contrast to the thorough neurologic examination, as described in Chapter 40, Performing a Complete Neurologic Examination) should be performed as part of any comprehensive general medical examination.
NEUROANATOMY OF THE SCREENING NEUROLOGIC EXAMINATION
The basic relevant neuroanatomy underlying each examination element is briefly described in the chapters of Section 2, Neurologic Examination.
EQUIPMENT NEEDED TO PERFORM THE SCREENING NEUROLOGIC EXAMINATION
An ophthalmoscope
A reflex hammer
128-Hz tuning fork
HOW TO PERFORM THE SCREENING NEUROLOGIC EXAMINATION
Implementing the elements below, in the order shown, is one practical method of performing a screening neurologic examination in a typical patient without neurologic symptoms. If any abnormal findings are seen, then more detail should be included and more examination elements should be added, as indicated.
Mental Status
(In the patient without any neurologic complaints or symptoms and in whom there is no suspicion of a disorder of alertness, language, memory or any other aspect of cognition suggested during your history-taking, no formal evaluation of mental status is necessary.)
Examine the Cranial Nerves
1. Look at the resting size and symmetry of the pupils and examine the response of each pupil to light (see Chapter 10, Examination of the Pupils).
2. Perform a funduscopic examination to look at the optic discs (see Chapter 11, Funduscopic Examination); a funduscopic examination should be a routine part of any comprehensive medical examination.