www.emtldr.com

It is not uncommon to be told that "A Full Neuro examination was unremarkable", when in reality only a cursory examination of power/sensation has been performed. It is very uncommon to perform a detailed neuro examination in the emergency department. The one exception to this is for patients with suspected Multiple Sclerosis. Even the screener below is not exactly a 'full' neuro exam, but it covers enough to provide a snapshot for documentation purposes. Edit as appropriate with positive findings and delete lines that are unapplicable (eg. if vibration wasnt tested because a tuning fork couldnt be found!)

Screening For MS Template:

No cord disease suspected (column)[decussation]
Normal proprioception and vibration sensation to great toe and ankle. (dorsal column)[medulla]
No weakness to distal limbs, hands and feet. (lat corticospinal) [medulla] *See below for details
Cold sensation and sharp touch intact to toes. (lat spinothalamic) [spinal cord]
Able to sit up and maintain posture easily. (ant corticospinal) [spinal cord]
No UMN tract signs (no muscle spasticity or rigidity. no hyper-reflexia. babinski’s sign negative. good balance. no repetitive/alternating movements)
No issues with bladder dysfunction or constipation.
Lhermittes sign not present (no shock down legs on neck flexion)

No evidence of optic neuritis:
No loss of visual acuity
No central scotoma on field testing.
No visual field defects
No pain on eye movement
No gross difficulty with color perception.
Pt does not report features suspicious of Uhthoff’s phenomena (vision not affected by exercise or hot bath/shower).

No evidence of CNS/cerebellar/brainstem disease:
No objective diplopia or evidence of 3rd, 4th, 6th nerve palsy (movement in “H” pattern does not produce diplopia)
No visual field defects (II).
No internuclear opthalmoplegia (eye that does not cross midline on medial gaze)
No suspicion of vestibular neuronitis (no vertigo and nausea/vomiting, no nystagmus)
No cerebellar signs (ambulant with normal gait, heel/shin, finger/nose, and hand clap test unremarkable)
No facial nerve palsy (bell’s palsy)
Speaking normally with no difficulty swallowing. (XII IX)
No loss of smell (I)
No loss of sensation to face or difficulty chewing (V)
Able to shrug against resistance uneventfully (XI)

No evidence of cerebral demise
Compos mentis. Alert and oriented. Conversant. Not confused.
No evidence of intellectual demise
No depression. No seizures. No dysphasia.

Limb Examination is Normal
*Sensation tested with ice pack.
Normal sensation to:
– Lateral Arm (C5)
– Lateral Forearm (C6)
– Middle Finger (C7)
– Little Finger (C8)
– Medial Arm (T1)
– perianal (S3-S5)
– back of thigh (S2) and Leg (S1)
– medial (L4) and lateral (L5) leg
– anterior groin / thigh (L1-L3)
Normal power on:
– Elbow Flexors (C5)
– Wrist Extensors (C6)
– Elbow Extensors (C7)
– Finger Flexors/Extensors (C8)
– Finger Abduction of Little Finger (T1)
– Hip Flexion (L2)
– Knee Extensors (L3)
– Ankle Dorxiflesion (L4)
– Great toe extensors (L5)
– Ankle plantar flexion (S1)
Normal Reflexes:
– biceps reflex (C5/C6)
– patella reflex (femoral n. L2/L3/L4)

Multiple Sclerosis Primer