What happens during a neurological examination?

No preparation is needed on your part. The doctor will try to reach the right diagnosis by testing normal movements and reactions.

Much of what happens in the body is controlled by the nervous system – from breathing and muscle movements to digestion and our sense of touch. A neurological examination can test all of these things, sometimes making it last quite a while. The examinations usually don't hurt but they may sometimes be a little unpleasant.

Neurological examinations follow a clear structure. They always start off with a talk in which the doctor asks you about your symptoms and any other medical conditions you have or had in the past (your medical history). Then they will look for visible signs of a medical condition. That can be noticeable in different ways:

• How you walk
• Your posture
• Your sense of balance
• Any limitations in your movement

The doctor will carry out a short physical examination in which they will listen to your lungs and heart and measure your pulse.

They will then do various tests. The exact procedure and the amount of testing needed will depend on your symptoms and any suspected medical conditions. Every part of the body – from the brain to a leg muscle – could be affected by a neurological condition, so tests could theoretically be carried out in any of those areas. If a person is not (fully) able to answer questions or actively participate in tests on their own, family members or friends can help. Generally speaking, the following nerves and bodily functions are tested:

Everyone has twelve cranial (brain) nerves. They control things like your eye muscles, jaw muscles and tongue. Other cranial nerves include the olfactory nerve (smell), the optic nerve (vision) and the vestibulocochlear nerve (hearing and balance). If someone has a problem with their vision, hearing, sense of smell, sense of taste or speech, they may have a neurological disorder.

Their sense of smell can be tested using specific scents, for example. The doctor holds small tubes that look similar but which are filled with various samples (like coffee, vanilla, cinnamon or soap) under each nostril. You are then supposed to see if you can tell one of the scents from a tube that is empty. Wrinkling your nose and baring your teeth is also part of the examination. That tests whether your facial nerve is working properly. Vision is tested by asking for letters or numbers on a board to be identified, just like eye tests at an ophthalmologist's (eye doctor). The doctor can also use the 'finger test' to see whether your field of vision is limited. Here you are asked to cover one eye while looking straight ahead with the other eye. The doctor moves one of their fingers from the side of your head to the area in front of you that you can see (while you keep looking straight ahead) and asks you to tell them when you can see their finger.

Tests to check your general mobility, fine motor skills and coordination are a further part of neurological examinations. For instance, how well can you move your arms and legs, undo buttons or write? How many steps does it take you to spin around once? How easily can you touch your nose with your finger when your eyes are closed, starting with your arm stretched out? Or how easily can you touch your knee with the heel of the foot on your other leg while lying down, without looking?

Your reflexes are also tested, including the test most people are familiar with that uses a soft hammer to check the reflex in your knee. It involves tapping the patellar tendon, which stretches the tendon and the quadriceps muscle in the thigh a little, causing the quadriceps to contract, suddenly jerking the lower leg upwards.

The doctor usually tests your ability to feel pain by using a needle. They touch your skin with either the sharp or the blunt end of the needle, and you are then asked to guess which end was used. You can test your sense of touch using a soft piece of fabric a brush, or a cotton ball: Can you feel this light touch on your skin?

To test your ability to feel different temperatures, test tubes containing warm and cold water may be held against your skin.

This section includes language and math tests, as well as questions and tests for memory. There are also questions about orientation, which refers to knowing things like what season it is, the date, what you yourself do for a living, or where you currently are. Problems concentrating or long-lasting fatigue and listlessness may be signs of mental health problems.

The vegetative (autonomic) nervous system controls your body's subconscious vital functions, such as your pulse, breathing and the regulation of your body temperature and digestion. That is why a neurological examination includes blood pressure measurement as well as questions about bowel movements and urination.

Depending on the results of the individual tests, more technical examinations may be needed. These could involve, for example, measuring brain waves (electroencephalography, EEG), muscle activity (electromyography, EMG), or nerve conduction (electroneurography, ENG). Imaging techniques like ultrasound, computed tomography (CT) or magnetic resonance imaging (MRI) may also be used. Cerebrospinal fluid may also need to be sampled from the lower part of your spine (lumbar puncture).