Exame Neurológico de rastreio

[Lucas Silva]

A SCREENING NEUROLOGIC EXAMINATION — Practicing
physicians usually do not have the time to perform complete neurologic
examinations on all patients. They must be able to perform a rapid
examination that screens for most common abnormalities. The results of
this screening examination can be used together with the history to
decide whether certain components of the examination must be conducted
in more detail.
For screening purposes in patients without
neurologic complaints, the following neurologic examination is generally
adequate and can be completed in five minutes or less.

• Mental
  status — Test patients for orientation to person, place, and time. Make
  sure they can follow at least one complicated command, taking care not
  to give them any nonverbal cues. If their responses are appropriate and
  they are able to relate a detailed and coherent medical history, no
  further mental status testing is necessary (unless they have cognitive
  complaints).
  
• Cranial
  nerves — Test visual fields in one eye, both pupillary responses to
  light, eye movements in all directions, facial strength, and hearing to
  finger rub.
  
• Motor
  system — Test strength in the following muscles bilaterally: deltoids,
  triceps, wrist extensors, hand interossei, iliopsoas, hamstrings, ankle
  dorsiflexors. Test for a pronator drift. Test finger tapping,
  finger-to-nose, and heel-knee-shin performance. Test tandem gait and
  walking on the heels.
  
• Reflexes — Test plantar responses and biceps, triceps, patellar, and ankle reflexes bilaterally.
  
• Sensation
  — Test light touch sensation in all four distal limbs, including double
  simultaneous stimulation. Test vibration sense at the great toes.
  

This
examination must be expanded when an asymmetry or other abnormality is
found. As an example, if the triceps muscle is weak in one arm, other
muscles innervated by the radial nerve must be tested, as well as other
muscles in the distribution of the C7 nerve root. The examination must
also be expanded to focus upon patients' specific complaints. Patients
complaining of memory loss, for example, need thorough mental status
testing even if their performance on the screening examination is
perfectly normal.

Referências:
UpToDate - The detailed neurologic examination in adults