A neurological exam is a group of questions and tests to check for disorders of your nervous system. It's sometimes called a "neuro" exam.

Your nervous system includes your:

• Brain and spinal cord, which are also called your central nervous system
• Peripheral nerves that carry signals back and forth between your central nervous system and all parts of your body, including your skin, muscles, and organs

Your nervous system plays a role in almost every part of your health and well-being. Because it controls so many body processes, a neurological exam has many different types of tests. The tests you have will depend on why you're having the exam. There are nerve tests to check for problems with your:

• Muscle movement, balance, and coordination. These activities are controlled by nerves called motor nerves.
• Breathing, heartbeat, digestion, and other processes that happen without thinking. Autonomic nerves control these activities.
• Sense of touch, smell, hearing, and vision. Sensory nerves carry this information from your senses to your brain.
• Thinking and memory. Certain parts of your brain control these and other types of complex mental activity, including your emotions.

A neurological exam may be used to:

• Check the health of your nervous system during a routine checkup.
• Help find out whether a nervous system disorder is causing certain symptoms. There are hundreds of disorders that affect the brain and nerves. Some examples include:
  • Degenerative nerve diseases, such as certain types of dementia and Parkinson's disease
  • Diabetic nerve problems
  • Epilepsy
  • Headache disorders, such as migraines and cluster headaches
  • Meningitis
  • Multiple sclerosis
• Help find out if an injury has damaged part of the nervous system and how serious the damage may be.
• Monitor a known nerve condition and/or see if treatment is helping.

You may need a neurological exam if you have symptoms that may be from a nervous system disorder. Because your nerves affect every part of your body, nervous system disorders can cause many different types of symptoms, including:

• Pain in your back, neck, head, or along a nerve, such as sciatica
• Tremors
• Weak or stiff muscles
• Problems with balance and/or coordination
• Numb or tingling skin
• Changes in any of your senses (hearing, vision, taste, smell, and touch)
• Slurred speech
• Confusion or other changes in mental ability
• Seizures

You may also need a neurological exam if you have had an injury that may have damaged your peripheral nerves, spinal cord, or caused a traumatic brain injury (TBI).

A neurological exam is often done by a neurologist. A neurologist is a doctor who specializes in diagnosing and treating disorders of the nervous system. Certain other providers may also do a neurological exam.

The exam is usually done in a provider's office. If you've had a serious injury, the exam may be done in the emergency room or in the hospital.

First, the provider will usually:

• Ask questions about any symptoms you may have
• Ask about your medical history
• Do a physical exam, including checking your heart and lungs

Next, the provider will do specific tests to check how different parts of your nervous system are working. The tests you have will depend on your symptoms. The tests may check your:

• Mental status. This includes your memory, problem-solving ability, alertness, and mood. During a mental status exam, you may answer questions about the date, time, and where you are. You may also be asked to remember a list of items, name objects, repeat words, and/or draw specific shapes.
• Cranial nerves. These 12 nerves connect your brain with your eyes, ears, nose, face, tongue, throat, shoulders, and certain organs. The provider will test the nerves that may be involved with your symptoms. For example, to test your sense of smell, you may be asked to sniff certain smells and identify what they are. If you're having speech problems, you may be asked to try to talk while you stick out your tongue.
• Coordination, balance, and walking. These tests check how well your nervous system controls your muscle movements. You may be asked to walk in a straight line, placing one foot directly in front of the other. Other tests include checking your handwriting and having you touch your finger to your nose with your eyes closed.
• Reflexes. A reflex is your body's automatic movement in response to certain triggers. For example, if your knee is tapped with a rubber hammer, your lower leg will jerk on its own. There are many types of reflexes that are tested in different ways. Reflex tests show how well nerves between your spinal cord and muscles are working.
• Sensory nerves. The provider may test how well you can feel touch, hot and cold temperatures, vibrations, and pain. These tests involve gently touching part of your skin with different objects, such as a dull needle or a cotton swab. You will be asked to describe what you can feel.
• Autonomic nervous system. A neurological exam tests the part of your nervous system that controls your breathing, heart rate, digestion, and other processes that happen without thinking. Examples of these tests include checking your blood pressure and heartbeat. Another test checks how your eyes respond to light.

You don't need any special preparations for a neurological exam.

There is no risk to having a neurological exam.

If the results of any part of your neurological exam are not normal, your provider will probably order more tests to help make a diagnosis. The tests will depend on what type of condition your provider thinks you could have. They may include:

• Blood and/or urine tests
• Imaging tests, such as an MRI
• Cerebrospinal fluid (CSF) testing, also called a lumbar puncture
• Biopsy
• Electroencephalography (EEG) or electromyography (EMG), which use small electric sensors to measure brain activity and nerve function

If you have questions about your results, talk with your neurologist or other provider.

Nervous system disorders and mental health problems can have similar symptoms. For example, problems paying attention could be a symptom of either type of disorder. So in certain cases, your provider may do a mental health screening before or after a neurological exam.

If imaging tests show there may be a brain tumor, a biopsy is usually done. One of the following types of biopsies may be used:

• Stereotactic biopsy: When imaging tests show there may be a tumor deep in the brain in a hard to reach place, a stereotactic brain biopsy may be done. This kind of biopsy uses a computer and a 3-dimensional (3-D) scanning device to find the tumor and guide the needle used to remove the tissue. A small incision is made in the scalp and a small hole is drilled through the skull. A biopsy needle is inserted through the hole to remove cells or tissues so they can be viewed under a microscope by a pathologist to check for signs of cancer.
• Open biopsy: When imaging tests show that there may be a tumor that can be removed by surgery, an open biopsy may be done. A part of the skull is removed in an operation called a craniotomy. A sample of brain tissue is removed and viewed under a microscope by a pathologist. If cancer cells are found, some or all of the tumor may be removed during the same surgery. Tests are done before surgery to find the areas around the tumor that are important for normal brain function. There are also ways to test brain function during surgery. The doctor will use the results of these tests to remove as much of the tumor as possible with the least damage to normal tissue in the brain.

The pathologist checks the biopsy sample to find out the type and grade of brain tumor. The grade of the tumor is based on how the tumor cells look under a microscope and how quickly the tumor is likely to grow and spread.

The following tests may be done on the tumor tissue that is removed:

• Immunohistochemistry: A laboratory test that uses antibodies to check for certain antigens (markers) in a sample of a patient’s tissue. The antibodies are usually linked to an enzyme or a fluorescent dye. After the antibodies bind to a specific antigen in the tissue sample, the enzyme or dye is activated, and the antigen can then be seen under a microscope. This type of test is used to help diagnose cancer and to help tell one type of cancer from another type of cancer.
• Light and electron microscopy: A laboratory test in which cells in a sample of tissue are viewed under regular and high-powered microscopes to look for certain changes in the cells.
• Cytogenetic analysis: A laboratory test in which the chromosomes of cells in a sample of brain tissue are counted and checked for any changes, such as broken, missing, rearranged, or extra chromosomes. Changes in certain chromosomes may be a sign of cancer. Cytogenetic analysis is used to help diagnose cancer, plan treatment, or find out how well treatment is working.

For some tumors, a biopsy or surgery cannot be done safely because of where the tumor formed in the brain or spinal cord. These tumors are diagnosed and treated based on the results of imaging tests and other procedures.

Sometimes the results of imaging tests and other procedures show that the tumor is very likely to be benign and a biopsy is not done.