When reporting a physical examination of the Central Nervous System (CNS), the

format typically includes the following sections:

1. General Appearance:
- Describe the patient’s overall appearance, behavior, and level of consciousness.
- Note any abnormal findings such as signs of distress, abnormal movements, or
altered mental status.

2. Cranial Nerves:
- Assess the function of each cranial nerve individually and document any
abnormalities.
- Include tests for visual acuity, extraocular movements, facial symmetry,
hearing, taste, and sensation.

3. Motor System:
- Evaluate muscle strength and tone in all extremities.
- Note the presence of any abnormal movements, such as tremors or involuntary
jerks.
- Check for coordination, gait, and balance.

4. Sensory System:
- Assess sensory perception, including light touch, temperature, pain, vibration,
and proprioception.
- Document any areas of hypoesthesia (reduced sensation) or hyperesthesia
(increased sensitivity).

5. Reflexes:
 - Test deep tendon reflexes, such as the biceps, triceps, patellar, and Achilles
reflexes.
- Assess plantar reflex (Babinski sign).
- Note any abnormalities, such as exaggerated or absent reflexes.

6. Coordination and Cerebellar Function:

- Evaluate fine motor skills, finger-to-nose and heel-to-shin coordination, and
rapid alternating movements.
- Observe for any signs of dysmetria (inability to perform precise movements),
dysdiadochokinesia (inability to perform rapid alternating movements), or
intention tremor.

7. Mental Status and Cognitive Function:

- Assess the patient’s orientation to time, place, and person.
- Evaluate memory, attention, language, and executive function.
- Document any signs of cognitive impairment or abnormal thought processes.

8. Meningeal Signs (if indicated):

- Perform a thorough examination for signs of meningeal irritation, including
neck stiffness, Kernig’s sign, and Brudzinski’s sign.
- Note any abnormal findings suggestive of meningitis or other meningeal
pathology.
The physical examination of the central nervous system (CNS) plays a crucial role
in diagnosing and assessing various neurological conditions. It involves a
comprehensive evaluation of the brain, spinal cord, and associated structures. This
write-up will provide an overview of the key components and techniques used in
the physical examination of the CNS.

1. Mental Status Examination:

The examination usually begins with an assessment of the patient’s mental status.
This includes evaluating their level of consciousness, orientation, attention,
memory, language skills, and overall cognitive function. It helps in detecting any
cognitive impairment, delirium, or psychiatric disorders.

2. Cranial Nerve Examination:

The 12 cranial nerves are assessed individually to evaluate their function. This
assessment includes testing visual acuity, visual fields, pupillary reflexes, eye
movements, facial sensation and movements, hearing, taste, and swallowing
reflexes. Abnormalities in any of these areas may indicate the involvement of
specific cranial nerves.

3. Motor Examination:
The motor examination involves evaluating muscle strength, tone, coordination,
and reflexes. The healthcare provider may assess the patient’s ability to perform
specific movements, such as walking, finger tapping, or heel-to-shin test. Muscle
strength is graded using the Medical Research Council (MRC) scale, which ranges
from 0 (no movement) to 5 (normal strength). Reflexes, such as the deep tendon
reflexes (e.g., knee jerk reflex), are tested to assess the integrity of the spinal cord
and peripheral nervous system.

4. Sensory Examination:
The sensory examination aims to assess the patient’s ability to perceive different
sensory modalities, including touch, pain, temperature, vibration, and
proprioception. This can be done through various tests, such as light touch,
pinprick, temperature discrimination, and joint position sense. The healthcare
provider will compare the patient’s responses on both sides of the body to identify
any asymmetry or abnormalities.

5. Coordination and Balance:

The examination of coordination and balance evaluates the patient’s ability to
perform fine motor tasks and maintain balance. It includes tests such as finger-
nose-finger test, rapid alternating movements (e.g., pronation-supination), and
Romberg test. These tests help assess the integrity of the cerebellum and vestibular
system.

6. Gait Examination:
The gait examination assesses the patient’s ability to walk, including their posture,
balance, and coordination. The healthcare provider may observe the patient’s gait
pattern, look for any abnormalities, and assess their ability to perform tandem
walking (walking heel-to-toe). Abnormalities in gait can provide important clues
about CNS dysfunction.

7. Fundoscopic Examination:
The fundoscopic examination examines the optic disc and retinal vessels using an
ophthalmoscope. It helps detect any abnormalities related to increased intracranial
pressure, optic nerve pathology, or retinal vascular diseases.

8. Additional Tests:
Depending on the clinical presentation and suspected pathology, additional tests
may be performed. These may include imaging studies such as computed
tomography (CT) scan or magnetic resonance imaging (MRI) of the brain or spine,
electroencephalogram (EEG) to assess brain electrical activity, or lumbar puncture
to analyze cerebrospinal fluid.

An example
Case Write-Up: 25-Year-Old Male – Findings in CNS Examination

Patient Profile:
The patient is a 25-year-old male who presents with complaints of recurrent
headaches, dizziness, and difficulty concentrating for the past six months. He
denies any history of trauma, seizures, or neurological disorders. There is no
family history of neurological conditions. The patient’s medical and surgical
history is unremarkable.

Physical Examination:
Upon conducting a thorough physical examination of the central nervous system
(CNS), the following findings were observed:

1. Mental Status Examination:

The patient appears alert and oriented to time, place, and person. Cognitive
function, including attention and memory, appears intact. There are no signs of
delirium or psychiatric disorders.

2. Cranial Nerve Examination:

- Visual Acuity: The patient demonstrates 20/20 vision in both eyes.
- Visual Fields: No visual field defects or abnormalities are observed.
- Pupillary Reflexes: Pupils are equal in size, round, and reactive to light.
- Eye Movements: Extraocular movements are intact, with no limitations or
nystagmus.
- Facial Sensation and Movements: Facial sensation is intact bilaterally. The patient
is able to symmetrical smile, frown, and close both eyes tightly.
- Hearing: Normal hearing is observed bilaterally.
- Taste: The patient reports normal taste perception.
- Swallowing Reflexes: The gag reflex and swallowing reflexes are intact.

3. Motor Examination:
- Muscle Strength: The patient exhibits normal muscle strength in all muscle
groups, graded at 5/5 according to the Medical Research Council (MRC) scale.
- Muscle Tone: No abnormalities in muscle tone are detected.
- Coordination: The patient demonstrates intact coordination during finger-nose-
finger test and rapid alternating movements.
- Reflexes: Deep tendon reflexes, such as the knee jerk reflex, are normal and
symmetrical bilaterally.

4. Sensory Examination:
- Touch: The patient has intact ability to perceive light touch bilaterally.
- Pain: No abnormalities in pain perception are noted.
- Temperature: The patient demonstrates normal discrimination between hot and
cold stimuli.
- Vibration: Vibration sense is intact bilaterally.
- Proprioception: Joint position sense is normal for all limbs.

5. Coordination and Balance:

The patient exhibits normal coordination and balance during the finger-nose-finger
test, pronation-supination movements, and Romberg test. No abnormalities in gait
are observed.

6. Gait Examination:
The patient walks with a normal gait pattern, maintaining balance and
coordination. Tandem walking is performed without any difficulties.

7. Fundoscopic Examination:
The fundoscopic examination reveals a normal optic disc and retinal vessels
bilaterally. No signs of increased intracranial pressure or optic nerve pathology are
observed.

Based on the physical examination findings, the patient’s mental status, cranial
nerves, motor function, sensory function, coordination, balance, and fundoscopic
findings are all within normal limits. Further diagnostic investigations, such as
brain imaging (e.g., MRI or CT scan), should be considered to explore other
possible causes for the patient’s symptoms of recurrent headaches, dizziness, and
difficulty concentrating. Additionally, a complete medical history and additional
laboratory tests may be required to rule out other potential underlying conditions.
Close follow-up and consultation with a neurologist are recommended to guide
further management and treatment.

Example 2
Case Write-Up: 25-Year-Old Male – Findings in CNS Examination

Patient Profile:
The patient is a 25-year-old male who presents with complaints of recurrent
headaches, dizziness, and difficulty concentrating for the past six months. He
denies any history of trauma, seizures, or neurological disorders. There is no
family history of neurological conditions. The patient’s medical and surgical
history is unremarkable.

Physical Examination:
Upon conducting a thorough physical examination of the central nervous system
(CNS), the following findings were observed:

1. Mental Status Examination:

The patient appears alert and oriented to time, place, and person. Cognitive
function, including attention and memory, appears intact. There are no signs of
delirium or psychiatric disorders.

2. Cranial Nerve Examination:

- Visual Acuity: The patient demonstrates 20/20 vision in both eyes.
- Visual Fields: No visual field defects or abnormalities are observed.
- Pupillary Reflexes: Pupils are equal in size, round, and reactive to light.
- Eye Movements: Extraocular movements are intact, with no limitations or
nystagmus.
- Facial Sensation and Movements: Facial sensation is intact bilaterally. The patient
is able to symmetrical smile, frown, and close both eyes tightly.
- Hearing: Normal hearing is observed bilaterally.
- Taste: The patient reports normal taste perception.
- Swallowing Reflexes: The gag reflex and swallowing reflexes are intact.

3. Motor Examination:
- Muscle Strength: The patient exhibits normal muscle strength in all muscle
groups, graded at 5/5 according to the Medical Research Council (MRC) scale.
- Muscle Tone: No abnormalities in muscle tone are detected.
- Coordination: The patient demonstrates intact coordination during finger-nose-
finger test and rapid alternating movements.
- Reflexes: Deep tendon reflexes, such as the knee jerk reflex, are normal and
symmetrical bilaterally.

4. Sensory Examination:
- Touch: The patient has intact ability to perceive light touch bilaterally.
- Pain: No abnormalities in pain perception are noted.
- Temperature: The patient demonstrates normal discrimination between hot and
cold stimuli.
- Vibration: Vibration sense is intact bilaterally.
- Proprioception: Joint position sense is normal for all limbs.

5. Coordination and Balance:

The patient exhibits normal coordination and balance during the finger-nose-finger
test, pronation-supination movements, and Romberg test. No abnormalities in gait
are observed.

6. Gait Examination:
The patient walks with a normal gait pattern, maintaining balance and
coordination. Tandem walking is performed without any difficulties.

7. Fundoscopic Examination:
The fundoscopic examination reveals a normal optic disc and retinal vessels
bilaterally. No signs of increased intracranial pressure or optic nerve pathology are
observed.
8. Summary:
Based on the physical examination findings, the patient’s mental status, cranial
nerves, motor function, sensory function, coordination, balance, and fundoscopic
findings are all within normal limits. Further diagnostic investigations, such as
brain imaging (e.g., MRI or CT scan), should be considered to explore other
possible causes for the patient’s symptoms of recurrent headaches, dizziness, and
difficulty concentrating. Additionally, a complete medical history and additional
laboratory tests may be required to rule out other potential underlying conditions.
Close follow-up and consultation with a neurologist are recommended to guide
further management and treatment.