Identifying whether there is an area of abnormal brain function is the essence of the neurological examination. The neurologist will assess the patient’s mental functions, such as the ability to remember words, calculate, and name objects, and will then systematically test the functioning of the muscles and senses, along with reflexes, walking, and coordination.
A detailed examination is performed to evaluate patterns of weakness or sensory loss, and to detect subtle signs or asymmetries not apparent to an untrained observer. For persons with obvious language or intellectual disorders, a detailed neuropsychological assessment may be performed to help define the deficiencies and suggest appropriate therapies.
A brief screening examination is often done again during follow-up visits to see if there has been any change in neurological function. If the patient has slurred speech, impaired concentration, difficulty walking a straight line with heels touching the toes, jerking eye movements when the eyes are directed toward one side, or trembling when the arms are outstretched, the dosage of antiepileptic drug may need to be reduced.
Follow-up examinations are usually quite brief. After the initial examination, the doctor is only looking for minor changes that may be present, especially if there are no new complaints. Therefore, the doctor’s time is often better spent listening than examining. As a matter of fact, a large part of the exam is performed informally, as the neurologist interacts with and listens to the patient. Careful observation allows the doctor to assess mood, thinking, language, eye and facial movements, strength, coordination, gait and many other features.