The Magic of the Neuro Exam
One of my teachers, Prof Koelmeyer, used to say that the correctly performed neurological examination was one of the highest forms of art. Thanks to a tweet from Cliff Reid, I came across this magical demonstration of the neurological exam posted on YouTube by Dr Michael Ingram.
One wonders if the bow tie, English accent, and the recurrent use of the expression ‘lovely’ are necessary components of the exam… Oh yes, and don’t forget to look for the ‘quizzical eyebrows’ of Horner syndrome.
Of course, you can reduce the 3 minute neuro exam to to 3 seconds by asking your patient to perform a backward flip. If that test is positive I generally say, ‘That’s lovely’ and terminate my examination at that point.
LITFL Links
- Brainstem Rules of 4 (original rules)
- Helpful Brainstem Figures (original figures)
- The rule of 4 of the brainstem (Rules re-imagined)
- Using the Brainstem 1
- Using the Brainstem 2
- The Magic of the Neuro Exam
- Look Left, Look Right (Internuclear Ophthalmoplegia)
- More Befuddling Pupillary Asymmetry (Horner Syndrome)
Chris is an Intensivist and ECMO specialist at the Alfred ICU in Melbourne. He is also a Clinical Adjunct Associate Professor at Monash University. He is a co-founder of the Australia and New Zealand Clinician Educator Network (ANZCEN) and is the Lead for the ANZCEN Clinician Educator Incubator programme. He is on the Board of Directors for the Intensive Care Foundation and is a First Part Examiner for the College of Intensive Care Medicine. He is an internationally recognised Clinician Educator with a passion for helping clinicians learn and for improving the clinical performance of individuals and collectives.
After finishing his medical degree at the University of Auckland, he continued post-graduate training in New Zealand as well as Australia’s Northern Territory, Perth and Melbourne. He has completed fellowship training in both intensive care medicine and emergency medicine, as well as post-graduate training in biochemistry, clinical toxicology, clinical epidemiology, and health professional education.
He is actively involved in in using translational simulation to improve patient care and the design of processes and systems at Alfred Health. He coordinates the Alfred ICU’s education and simulation programmes and runs the unit’s education website, INTENSIVE. He created the ‘Critically Ill Airway’ course and teaches on numerous courses around the world. He is one of the founders of the FOAM movement (Free Open-Access Medical education) and is co-creator of litfl.com, the RAGE podcast, the Resuscitology course, and the SMACC conference.
His one great achievement is being the father of three amazing children.
On Twitter, he is @precordialthump.
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