Synopsis
Perform and communicate a hypothesis-led but sufficiently complete neurological examination that detects emergencies, establishes a reproducible baseline and supports anatomical localisation.
- Begin before touch: note alertness, interaction, speech, posture, spontaneous movement, asymmetry, involuntary movements, respiratory effort, walking aids and how the patient transfers.
- Confirm identity, explain the purpose, seek consent, offer a chaperone where appropriate, expose only what is necessary and adapt positioning, hearing, vision and communication support to the patient.
- Use a fixed core sequence—mental status, cranial nerves, upper limbs, lower limbs, coordination, gait and relevant special tests—but expand or reorder it when physiology or the presenting problem demands.
Key red flags
Impaired attention, orientation, language, memory, praxis, visuospatial awareness or behaviour can be diffuse or focal. Establish whether the patient can engage before interpreting complex commands, cortical sensation or apparent limb weakness.
Investigation priorities
Quantify arousal, attention and focal higher-function abnormalities before interpreting the remainder of the examination.
Management branches
New face, arm, leg, speech, visual, neglect, gaze, balance or brainstem dysfunction of sudden or uncertain onset.
- Perform ABCDE and glucose, document last known well and rapidly test conscious level, language, gaze, fields, face, all limbs, sensation, coordination and neglect using a stroke-pathway framework.
- Activate local stroke imaging and specialist review immediately; do not extend the bedside examination with low-yield manoeuvres when this would delay CT, angiography or transfer.