AANN Core Curriculum, 7th Edition, Ch. 5 Assessment: Digital Version-Chapter 5

Chapter 5

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Neurological assessment detects nervous system dysfunction, localizes disease, identifies urgent deterioration, and monitors treatment. It may be brief, focused, or comprehensive. Findings guide care, functional planning, and patient and family education. Assessments should account for age, development, disability, culture, medications, substances, and other illnesses.<br /><br />History gathers the chief complaint, symptom progression, medical and surgical history, medications and allergies, substance use, social and family history, and relevant review of systems. Physical examination covers consciousness and cognition, eyes, cranial nerves, motor and sensory function, coordination, gait, and reflexes. Consciousness is especially sensitive to neurological change; document observed behavior and responses to verbal or tactile stimulation, using consistent tools such as the Glasgow Coma Scale or FOUR score. Assess cognition only when the patient is sufficiently alert.<br /><br />Eye examination includes acuity, visual fields, pupils, eye movements, and funduscopy. Abnormal findings may help localize lesions or indicate conditions such as optic nerve disease, brainstem injury, or raised intracranial pressure. Motor assessment examines symmetry, tone, strength, involuntary movements, coordination, and gait. Sensory testing compares sides and body regions, mapping deficits where appropriate. Reflex findings can help distinguish upper from lower motor neuron dysfunction.<br /><br />Coma assessment documents the stimulus required and the response, including movement, pupils, brainstem reflexes, eye movements, breathing patterns, and vital signs. Patterns may suggest structural or metabolic causes and help localize injury. Brain-death evaluation requires a formal protocol and exclusion of confounding conditions.<br /><br />Pediatric examinations adapt techniques to developmental stage and rely on caregiver history, growth and developmental milestones, observation, and age-appropriate responses; some reflexes are normal only during specific periods of infancy. In older adults, slower processing, reduced strength, sensory changes, and altered reflexes may occur with aging, but abnormal findings should not be attributed to age alone. Medication effects, illness, and other treatable causes must also be considered.

Keywords

neurological assessment

nervous system dysfunction

history taking

physical examination

consciousness assessment

Glasgow Coma Scale

cranial nerves

motor and sensory function

coma evaluation

pediatric neurology