The neurologic examination, properly performed, yields clinical information that is essential to the evaluation and management of the patient. The amount of information obtained from the examination alone often exceeds that which is obtained through extensive diagnostic testing. The challenge for the emergency physician is to perform a directed examination in a timely fashion that is tailored to meet the needs of the individual patient. An understanding of basic neuroanatomy and related pathophysiology is necessary to help the clinician use his skills efficiently.

There are multiple reasons supporting the need for an accurate and timely neurologic evaluation. (1) In patients where symptoms suggest the possibility of related neurologic findings, the examination serves as a screening tool. (2) A systematic evaluation facilitates communication between the emergency physician and consultants. (3) The examination provides the baseline for which future examinations will be compared. (4) For an increasing number of pathologies, early recognition and treatment have the potential to prevent or ameliorate lifelong disability; for example, the initiation of thrombolytic treatment in an acute cerebrovascular accident (CVA). Specific goals of the neurologic examination include an overall assessment of the patient's mental status and a differentiation between organic and functional causes of the clinical condition. If the cause is determined to be organic, then localization of the pathology to the brain (with further localization defined by area of vascular supply), brain stem, spinal cord, or peripheral nerve will aid the clinician in subsequent management and disposition.

This article reviews the neurologic examination, emphasizing the key components necessary for the emergency physician. The first section discusses the indications for a limited versus a complete examination, followed by a section describing the individual components of the neurologic examination, highlighting their clinical relevance. Special considerations for the comatose patient and the patient suspected of having a nonorganic cause are also covered. Last, the importance of careful documentation is discussed.