The Complete Neurologic Exam

Abstract

The neurologic exam is important because laryngeal dysfunction is often due to a neurological disorder. The neurological exam can clarify the nature and extent of neurological disease that may extend well beyond the larynx. In this chapter we will discuss performance of the neurological exam, the combinations of findings that suggest which neurological subsystems are compromised, and how this leads to diagnosis. The goal of the neurological exam is to use physical findings to identify an anatomic localization for the patient’s symptoms. Accurate localization will help narrow the differential diagnosis and lead to a more concise workup and appropriate treatment plan. The complete neurological examination reviewed in this chapter includes the following components: examination of mental status, cranial nerves, motor system, somatosensory system, reflexes, coordination, and posture/gait. After summarizing each of the components, the neurological exam is discussed in the context of the fundamental neurological disease patterns, including: upper motor neuron (corticospinal) dysfunction, lower motor neuron (peripheral nervous system) dysfunction, cerebellar dysfunction, neuromuscular junction and muscle dysfunction, and extrapyramidal dysfunction.