The 3 Minute Neurological Examination is an excellent screening neurological examination which is executed with nearly impeccable skill in two minutes flat. The explanation section, which follows the demonstration, is excellent too!
Tests/commands performed are:
- With eyes closed: Romberg test (proprioception).
- With eyes opened: tandem gait (heel-to-toe walking).
- Walk on tip toes (power test of plantar flexion).
- Walk on heels (power test of dorsiflexion).
- With eyes closed: test for pronator drift (pyramidal tracts, test for neglect).
- Finger-to-nose test (light touch (!), cerebellar function).
- With eyes opened: “play the piano” (pyramidal function).
- Rapid tapping or alternating movements (test for ataxia).
- With eyes closed: “screwing” eyelids shut tightly (Cranial Nerve VII, upper)
- With eyes opened: observe pupillary reflex in response to eyes opening (CN II, III).
- Grin (Cranial Nerve VII, lower).
- Stick tongue out (Cranial nerve XII).
- Rapid tongue movements (test for pseudobulbar palsy).
- Visual fields by confrontation (Cranial Nerve II).
- Eye movements (Cranial Nerves III, IV & VI).
- Reflexes (supinators, biceps, patellar, ankle jerk).
- Babinski (pyramidal tract).
- Funduscopy (bilaterally, in twelve seconds flat!).
Hat tip to Life in the Fast Lane.
The demonstration was performed by Dr. Giles Elrington who wrote in the comment section below:
I am the neurologist who is in this video from 1997…. I am pleased some people like it, initially I was worried it was heretical but it has been much better received than I feared. Yes I saw her optic discs (if fundoscopy is difficult, just practice repeatedly; dogs make useful subjects!). Ankle reflexes elicited this way was for modesty. I should have done the visual fields congruously (upper with upper, lower with lower. I often add a quick check for cogwheel rigidity plus synkinesis.
From comment section (below)
This was wonderful! I have 40 min. to complete the OSCE so this two minute neuro exam will help shorten the time.
Anne Marie
Thank you, Anne Marie, for your comment.
I used this 2-minute neuro exam in clinical practice. It really works!
Good luck with your OSCE!
How would you recommend documenting this in patient notes?
I’m sorry, Jeremy, for my delayed response.
I don’t know the answer to your question. I noticed that neurologists seem to document neurological findings better. I haven’t found a good write-up of a normal neurological examination.
I will let you know and post if I come across something!
Mark
Hi Jeremy, I am still on the lookout for a good “normal” neurologic examination report. I will post one if and when I can find one!
As a medical student who loves the physical exam and tries to find every opportunity to improve in that area (especially the neuro and MSK exams), this is a fantastic video!
One question, when doing a brief undilated fundoscopic exam like the physician in the video does in 2 seconds flat, what all can you really find? Honestly, I just go in and once I see a sharp disk margin, I’m done, no papilledema, good to go. Am I missing any important screening findings by not spending lots of time scanning the periphery?
Thanks!
Thank you for your thoughtful two part question, Mickey.
Undiluted funduscopy is very much an operator dependent skill. Some practitioners are really good at it, while others are not. And while I don’t know the neurologist in the video personally, I surmise that his demonstration is genuine, at least when it comes to evaluating for papilledema.
If one needs to look for anything other than papilledema, then a dilated funduscopy would be a much better option.
I hope this helps!
Very helpful! Thank you!
You are very welcome, Mikey!
Can this test be performed by a layman ? I ask because in rural areas in this part of the world that’s all that’s available.
It can be performed by almost anyone (with practice). However, I’d probably recommend that people should try to contact a doctor if they are concerned about the possibility of having a neurological problem.
I am the neurologist who is in this video from 1997. It was made professionally for Zeneca as Zomig promo. Mike Ingram put it on YouTube – search on my name and you will find it. I am pleased some people like it, initially I was worried it was heretical but it has been much better received than I feared. Yes I saw her optic discs (if fundoscopy is difficult, just practice repeatedly; dogs make useful subjects!). Ankle reflexes elicited this way was for modesty. I should have done the visual fields congruously (upper with upper, lower with lower. I often add a quick check for cogwheel rigidity plus synkinesis.
Thank you very much, Dr. Elrington, for making this terrific video, and congratulations on a job very well done!
Terrific, this is my new neuro exam! No CN IX, X, XI, XII. Not needed for screening neuro?
I often add a quick tongue protrusion but it only exceptionally rarely helps. I suggest that in ambulant outpatients, cranial nerve examination is largely of the eyes. Thank you for your kind comments.