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Introduces self
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Confirms name & age of patient
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Explains & gains consent
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Checks pain/numbness/paraesthesia/handedness
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Exposes patient from waist down
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1
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General inspection for walking aids, deformities, asymmetries, resting
tremor, dyskinesia, ulcers
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1
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Closer inspection for fasciculations, cafe au lait spots, scars,
wasting
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Assesses light touch (comparing both sides and comparing with
sternum) for L1, L2
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Assesses light touch for L3, L4
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Assesses light touch for L5, S1, S2
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Maps out any abnormality
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Offers to test S3, S4
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Assesses or offers sharp touch with neurotip over L1, L2, L3
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Assesses or offers sharp touch with neurotip over L4, L5, S1, S2
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Maps out any abnormality
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Vibration sense on big toe. Ask patient to report when vibration stops
before stopping it manually. Moves proximally if absent.
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Tests proprioception in big toe moving proximally if absent
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Conduct Romberg's test
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Offers to test 2 point discrimination, inattention and temperature
with hot/cold rods
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Thanks patient and offers help to redress
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Washes hands
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Requests full neurological exam
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Summarises appropriately with only key findings
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Offers appropriate differential diagnoses
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Patient global score
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2
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Potential differentials
- Bilateral distal sensory loss (glove and stocking distribution)
- Diabetes/B12 and folate/Drugs etc.