WordNet

the act of examining something closely (as for mistakes) (同)scrutiny
the act of giving students or candidates a test (as by questions) to determine what they know or have learned (同)testing
a set of questions or exercises evaluating skill or knowledge; "when the test was stolen the professor had to make a new set of questions" (同)exam, test
of or relating to or used in or practicing neurology; "neurological evidence" (同)neurologic

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〈C〉(…の)『試験』《+『in』(『on』)+『名』ofを用いない》 / 〈U〉〈C〉(…の)『調査』,検討《+『into』(『of』)+『名』》 / 〈C〉〈U〉『診察』,診断 / 〈C〉詩験問題[用紙];詩験答案[用紙]

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出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2015/05/13 20:06:57」(JST)

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A neurological examination is the assessment of sensory neuron and motor responses, especially reflexes, to determine whether the nervous system is impaired. This typically includes a physical examination and a review of the patient's medical history,^[1] but not deeper investigation such as neuroimaging. It can be used both as a screening tool and as an investigative tool, the former of which when examining the patient when there is no expected neurological deficit and the latter of which when examining a patient where you do expect to find abnormalities.^[2] If a problem is found either in an investigative or screening process then further tests can be carried out to focus on a particular aspect of the nervous system (such as lumbar punctures and blood tests).

In general, a neurological examination is focused on finding out whether there are lesions in the central and peripheral nervous systems or there is another diffuse process that is troubling the patient.^[2] Once the patient has been thoroughly tested, it is then the role of the physician to determine whether these findings combine to form a recognizable medical syndrome or neurological disorder such as Parkinson's disease or motor neurone disease.^[2] Finally, it is the role of the physician to find the cause for why such a problem has occurred, for example finding whether the problem is due to inflammation or is congenital.^[2]

Indications

A neurological examination is indicated whenever a physician suspects that a patient may have a neurological disorder. Any new symptom of any neurological order may be an indication for performing a neurological examination.

Patient's history

A patient's history is the most important part of a neurological examination^[2] and must be performed before any other procedures unless impossible (i.e., the patient is unconscious certain aspects of a patient's history will become more important depending upon the complaint issued).^[2] Important factors to be taken in the medical history include:

Time of onset, duration and associated symptoms (e.g., is the complaint chronic or acute)^[3]
Age, gender, and occupation of the patient^[2]
Handedness (right- or left-handed)
Past medical history^[2]
Drug history^[2]
Family and social history^[2]

Handedness is important in establishing the area of the brain important for language (as almost all right-handed people have a left hemisphere, which is responsible for language). As patients answer questions, it is important to gain an idea of the complaint thoroughly and understand its time course. Understanding the patient's neurological state at the time of questioning is important, and an idea of how competent the patient is with various tasks and his/her level of impairment in carrying out these tasks should be obtained. The interval of a complaint is important as it can help aid the diagnosis. For example, vascular disorders (such as strokes) occur very frequently over minutes or hours, whereas chronic disorders (such as Alzheimer's disease) occur over a matter of years.^[2]

Carrying out a 'general' examination is just as important as the neurological exam, as it may lead to clues to the cause of the complaint. This is shown by cases of cerebral metastases where the initial complaint was of a mass in the breast.^[2]

List of tests

Specific tests in a neurological examination include the following:

Category	Tests	Example of writeup
Mental status examination	The assessment of consciousness, often using the Glasgow Coma Scale (EMV) Mental status examination, often including the abbreviated mental test score (AMTS) or mini mental state examination (MMSE) Global assessment of higher functions Intracranial pressure is roughly estimated by fundoscopy; this also enables assessment for microvascular disease.	"A&O x 3, short and long-term memory intact"
Cranial nerve examination	Cranial nerves (I-XII): sense of smell (I), visual fields and acuity (II), eye movements (III, IV, VI) and pupils (III, sympathetic and parasympathetic), sensory function of face (V), strength of facial (VII) and shoulder girdle muscles (XI), hearing (VII, VIII), taste (VII, IX, X), pharyngeal movement and reflex (IX, X), tongue movements (XII). These are tested by their individual purposes (e.g. the visual acuity can be tested by a Snellen chart).	"CNII-XII grossly intact"
Motor system	Muscle strength, often graded on the MRC scale 0 to 5^[4] (i.e., 0 = Complete Paralysis to 5 = Normal Power). grades 4−, 4 and 4+ maybe used to indicate movement against slight, moderate and strong resistance respectively. Muscle tone and signs of rigidity. Examination of posture Decerebrate Decorticate Hemiparetic Resting tremors Abnormal movements Seizure Fasciculations Tone Spasticity Pronator drift Rigidity Cogwheeling (abnormal tone suggestive of Parkinson's disease) Gegenhalten – is resistance to passive change, where the strength of antagonist muscles increases with increasing examiner force. More common in dementia.	"strength 5/5 throughout, tone WNL"
Deep tendon reflexes	Reflexes: masseter, biceps and triceps tendon, knee tendon, ankle jerk and plantar (i.e., Babinski sign). Globally, brisk reflexes suggest an abnormality of the UMN or pyramidal tract, while decreased reflexes suggest abnormality in the anterior horn, LMN, nerve or motor end plate. A reflex hammer is used for this testing.	"2+ symmetric, downgoing plantar reflex"
Sensation	Sensory system testing involves provoking sensations of fine touch, pain and temperature. Fine touch can be evaluated with a monofilament test, touching various dermatomes with a nylon monofilament to detect any subjective absence of touch perception. Sensory Light touch Pain Temperature Vibration Position sense Graphesthesia Stereognosis, and Two-point discrimination (for discriminative sense) Extinction Romberg test – 2 out of the following 3 must be intact to maintain balance: i. vision ii. vestibulocochlear system iii. epicritic sensation	"intact to sharp and dull throughout"
Cerebellum	Cerebellar testing Dysmetria Finger-to-nose test Ankle-over-tibia test Dysdiadochokinesis Rapid pronation-supination Ataxia Assessment of gait Nystagmus Intention tremor Staccato speech	"intact finger-to-nose, gait WNL"

Interpretation

The results of the examination are taken together to anatomically identify the lesion. This may be diffuse (e.g., neuromuscular diseases, encephalopathy) or highly specific (e.g., abnormal sensation in one dermatome due to compression of a specific spinal nerve by a tumor deposit).

General principles: ^[5]

Looking for side to side symmetry: one side of the body serves as a control for the other. Determining if there is focal asymmetry.
Determining whether the process involves the peripheral nervous system (PNS), central nervous system (CNS), or both. Considering if the finding (or findings) can be explained by a single lesion or whether it requires a multifocal process.
Establishing the lesion's location. If the process involves the CNS, clarifying if it is cortical, subcortical, or multifocal. If subcortical, clarifying whether it is white matter, basal ganglia, brainstem, or spinal cord. If the process involves the PNS then determining whether it localizes to the nerve root, plexus, peripheral nerve, neuromuscular junction, muscle or whether it is multifocal.

A differential diagnosis may then be constructed that takes into account the patient's background (e.g., previous cancer, autoimmune diathesis) and present findings to include the most likely causes. Examinations are aimed at ruling out the most clinically significant causes (even if relatively rare, e.g., brain tumor in a patient with subtle word-finding abnormalities but no increased intracranial pressure) and ruling in the most likely causes.^{[citation needed]}

References

^ Nicholl DJ, Appleton JP (May 29, 2014). "Clinical neurology: why this still matters in the 21st century". J Neurol Neurosurg Psychiatr. Online first. doi:10.1136/jnnp-2013-306881. PMID 24879832.
^ ^a ^b ^c ^d ^e ^f ^g ^h ⁱ ^j ^k ^l Fuller, Geraint (2004). Neurological Examination Made Easy. Churchill Livingstone. p. 1. ISBN 0-443-07420-8.
^ Oommen, Kalarickal. "Neurological History and Physical Examination". Retrieved 2008-04-22.
^ Medical Research Council (1976). "Medical Research Council scale. Aids to examination of the peripheral nervous system. Memorandum no. 45.".
^ Murray ED, Price BH. "The Neurological Examination." In: Comprehensive Clinical Psychiatry, First Edition. Stern TA, Rosenbaum JF, Fava M, Rauch S, Biederman J. (eds.) Philadelphia: Mosby/Elsevier. April 25, 2008. ISBN 0323047432. ISBN 978-0323047432

External links

Neurological examination demonstrated with videos
Overview at University of California, San Diego
Overview at University of Toronto
neuro/632 at eMedicine - "Neurological History and Physical Examination"
Glasgow Coma Scale
Simplified Motor Score

UpToDate Contents

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1. 成人における詳細な神経学的検査 the detailed neurologic examination in adults
2. 新生児の神経学的検査 neurological examination of the newborn
3. 幼児および小児における精密な神経学的評価 detailed neurologic assessment of infants and children
4. 成人における精神状態検査 the mental status examination in adults
5. 筋緊張低下および脱力を呈する幼児に対するアプローチ approach to the infant with hypotonia and weakness

English Journal

Evaluation and management of nonsyndromic craniosynostosis.

Ursitti F, Fadda T, Papetti L, Pagnoni M, Nicita F, Iannetti G, Spalice A.Source.Department of Pediatrics, Child Neurology Division, University of Sapienza, Rome, Italy .Department of Neurosurgery, Maxillofacial Division, University of Sapienza, Rome, Italy.
Acta paediatrica (Oslo, Norway : 1992).Acta Paediatr.2011 Sep;100(9):1185-94. doi: 10.1111/j.1651-2227.2011.02299.x. Epub 2011 May 5.
Craniosynostosis (craniostenosis) is premature fusion of the sutures of the cranial vault. Several factors can affect the growth of the cranial vault during embryonic life and after birth, leading to different types of craniosynostosis; these can be classified on the basis of the specific sutures th
PMID 21457300

The relationship between lumbosacral plexopathy and pelvic fractures.

Jang DH, Byun SH, Jeon JY, Lee SJ.SourceFrom the Department of Rehabilitation, Asan Medical Center, University of Ulsan College of Medicine (D-HJ, JYJ); and Department of Rehabilitation Medicine, Dankook University College of Medicine, Seoul, Korea (SHB, SJL). Drs. Jang and Byun are co-first authors who contributed equally to this work.
American journal of physical medicine & rehabilitation / Association of Academic Physiatrists.Am J Phys Med Rehabil.2011 Sep;90(9):707-12.
OBJECTIVE: : This study aimed to investigate the relationship between lumbosacral (LS) plexopathy and pelvic fracture in patients with pelvic fractures only.DESIGN: : This study is a retrospective review of patients with pelvic trauma from 1997 to 2007. All patients underwent radiologic examination.
PMID 21681066

Japanese Journal

Cervical flexion myelopathy in a patient showing apparent long tract signs: A severe form of Hirayama disease

Sakai Kenji,Ono Kenjiro,Okamoto Yoshiyuki,Murakami Hideki,Yamada Masahito
Joint Bone Spine 78(3), 316-318, 2011-05
… Neurological examination revealed atrophy and weakness in the right hand and forearm, pyramidal signs in the right lower extremity, and disturbance of superficial sensation in the lower left half of the body. …
NAID 120002772028

術中言語機能検査システム IEMASの開発と臨床への適用

櫻井康雄,村垣善浩,岡田芳和,南部恭二郎,伊関洋
東京女子医科大学雑誌 81(1), 32-40, 2011-02-25
… ,そこで我々は、この問題を解決するため、術中言語機能検査システム IEMAS(Intraoperative Examination Monitor for Awake Surgery)を開発した。 …
NAID 110008426934

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リンク元	「神経学的診察法」「神経学的診察」「神経学的検査」「神経学的検査法」
関連記事	「examination」「neurological」「neurologic」