Adult Neurological exam
The Corona virus has presented Neurologists with a true challenge , having to preform a full Neurological examination from afar, using digital tools.
Despite the difficulty, it is possible to preform a thorough Neurological examination, despite the hardshi, but certain elements must be taken into account that can't be done from afar, such as Ophthalmologic and Vestibular examinations, Sensory losses and slight weaknesses.
The AAN published guidelines for adults, which you can watch in the attached link. Here are the main points.
There are a few important rules:
There is high emphasis on observation
It is important to demonstrate to the patient what you want them to do
Adjust the camera throught the meeting in order to get an impression of body language
If necessary , you can ask to repeat the assignment
If another examiner is present , the NIH STROKE SCALE may be assessed
Don't ask the patient to do anything they are uncomfortable with
Cognitive assessment :
Cognition can be assessed fully by relevant questionnaires.
CN 1 : Not examined
CN 2 : Visual fields can be tested using the screen or by getting help by someone who is with the patient. Pupil size can be assessed if the camera has a high enough definition
CN 3,4,6 : Testing eye movements in all directions
CN 7 : Symmetry of the face
CN 9-12 : Shoulder movements up and down, and tongue movements.
Observ the patient for shaking and unwanted movements
Movement of fingers to thumb
Hand movements while walking
Walking on toes and heels
Standing on one foot
Lower limb drift
Sitting to standing
Standing up from the sitting position without the use of hands
Movement of fingers to the thumb
Openning and closing the fingers
Pronation and supination of the hands
Drumming movement with the fingers and toes
Can only be assessed if there is another person present with the patient in the room.
Ask to assess differences in senstation between the left and right , proximal and distal areas, and response to specific dermotomes if there is an experienced physician with the patient. You can ask to draw a line above the area with no sensation.
Finger to nose test.
Reflexes can't be tested.
Format for documenting the Neurological exam for adults:
In a video meeting:
No blunt cognitive decline,
pupils equal, normal eye movements without nistagmus,
symmetric face, symmetric tongue.
No weakness, symmetric movements of the arms and legs, no pronator drift.
Walking on toes and heels without clear asymmetry.
Weight bearing on left and right feet - normal.
Cerebellum: No impression of ataxia or nistagmus, finger to nose test is normal.
For the full AAN guidelines, click on the following link: