Introduction to the Practice of Medicine 2
NEUROLOGIC EXAM DETAILS FROM NEURO EXAM VIDEO
WASH HANDS
(Patient is seated.)
Cranial Nerves:
1. Visual fields (screening test for CN2 & Visual system: peripheral vision)
A. Examiner is positioned:
a. in front of patient
b. about 2 feet away from patient
c. at eye level with the patient
B. Examiner instructs patient to stare at examiner’s nose (“Don’t move your eyes.”)
C. Examiner stares at patient’s nose
D. Both eyes are examined together (Both eyes are open)
a. Examiner holds out his or her index fingers in the periphery of the patient’s
vision, about 180o apart (e.g., above the patient’s right eye and below the
patient’s left eye), and slightly wiggles one index finger at a time.
b. The patient is asked to identify or point to the moving finger.
c. With the examiner’s fingers in the same position as in (a), both fingers are
wiggled at the same time, and the patient should identify that both are
simultaneously moving.
d. Examiner then “rotates” his or her extended index fingers about 90o from the
initial position (e.g., now above the patient’s left eye and below the patient’s
right eye), and slightly wiggles one index finger at a time.
e. With the examiner’s fingers in the same position as in (c), both fingers are
wiggled at the same time, and the patient should identify that both are
simultaneously moving.
f. Examiner holds his or her index fingers about 180o apart in the temporal visual
fields (e.g., left of patient’s left eye, right of patient’s right eye) in a horizontal
plane.
g. The patient is asked to identify or point to the moving finger.
h. With the examiner’s fingers in the same position as in (e), both fingers are
wiggled at the same time, and the patient should identify that both are
simultaneously moving.
E. Examiner should have his or her finger half way between the patient and his/herself,
and gradually move the wiggling finger more towards the center of vision, until it is
perceived by the patient.
F. Examiner “rotates” his or her index fingers, checking for the visual fields of both
eyes superiorly, inferiorly and temporally.
Any abnormality or problem with this screening test of visual fields, or a complaint of
visual loss, prompts retesting of visual fields one eye at a time (see Addendum later).
Failure of the patient to recognize both simultaneously moving fingers suggests visual
extinction from a parietal lobe lesion.
G:\IPM2\2004-05\Neuro_Exam_details.doc - 1 - Revised: 7/22/04
