Neurology Basics: Neurological Exams

Written by Volker K. H. Sonntag, MD

Many people associate a neurological exam with patients who are paralyzed, have suffered a stroke, or who have problems sleeping. Although this is true, assessing a patient’s neurological function is important to diagnosing and treating spinal problems too. A general neurological examination provides the physician with valuable insight into the patient’s brain, spinal cord, nerves, and muscles.

The process of diagnosing the precise cause of back pain, can be a difficult. Back pain can result from muscular strain, degenerative spine disease (eg, degenerative disc disease), wear and tear (eg, osteoarthritis), anatomical defects, nerve compression, trauma, and a broad range of other disorders.

In some instances, the spine specialist could be compared to a detective who compiles clues and physical evidence to prove a case. The spine specialist gathers clues from patient history, physical examination, imaging studies and/or other tests, and a neurological assessment to confirm a diagnosis.

Evaluating Symptoms
The spine specialist asks several questions about the patient in general and their symptoms. The list below is not all-inclusive. Depending on the patient and their symptoms, additional questions may be posed.

Gait and Balance
Walking, or gait, simply means the way a person walks: rhythmical pattern and speed. Walking is a complex process involving different reflexes stimulated by the nervous system and the person’s awareness of where they are in space (termed ‘proprioception’), which is important for balance. The physician may ask the patient to walk across the room, turn and come back, walk heel to toe, on their toes and heels, hop in place on each foot, and/or rise from a sitting position. The physician observes any listing, erratic movement, or loss of rhythm. These movements may also indicate weakness and difficulty with balance.

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Neurological Exams: Sensory Nerves and Deep Tendon Reflexes