NEUROLOGY - LOCALIZATION + BEDSIDE EXAM

YEAR 3 | PAGE 32A - SYMPTOM -> TEMPO -> EXAM -> ANATOMIC LEVEL -> SYNDROME -> TEST

THE CORE HABIT: LOCALIZE BEFORE YOU LABEL

Neurology becomes manageable when every case starts with location. Before naming a disease, decide whether the problem is cortex, subcortex, brainstem, cerebellum, spinal cord, root/plexus, peripheral nerve, neuromuscular junction or muscle. Then use tempo and syndrome pattern to decide the likely mechanism and next test.

A. NEUROLOGIC FIRST-PASS WORKFLOW

Step	What to do	What it prevents
1. Define the syndrome + tempo	Focal deficit, altered cognition, seizure, headache, weakness, sensory loss, dizziness/ataxia or abnormal movement? Sudden, subacute, relapsing or progressive?	Prevents mixing vascular, infectious, inflammatory, toxic/metabolic and degenerative processes.
2. Mental status + language	Level of consciousness, attention, orientation, memory, naming/repetition/comprehension, neglect and behavior.	Separates diffuse encephalopathy from dominant/nondominant cortical dysfunction.
3. Cranial nerves	Pupils/vision, eye movements, face, hearing, palate/voice, tongue and bulbar function.	Finds brainstem/cavernous/orbital/cranial-nerve patterns and dangerous airway/swallow problems.
4. Motor + reflexes	Bulk, tone, pronator drift, power pattern, DTRs, plantar response and fatigability.	Distinguishes UMN vs LMN vs NMJ vs muscle.
5. Sensory + coordination + gait	Map modality and distribution; test proprioception, cerebellar function, Romberg and gait.	Identifies sensory level, peripheral pattern, dorsal-column/cerebellar disease and functional impact.
6. Localize + choose one decisive test	State anatomic level/side and the dangerous alternative; then select the test that can change urgent management.	Prevents reflex CT/MRI ordering without a localization question.

B. LOCALIZATION PATTERN TABLE

Level	Clues that point there	Classic discriminator
Cortex	Aphasia, neglect, gaze preference, cortical sensory loss, seizure, visual-field defect.	Higher cortical sign + contralateral deficit.
Brainstem	Cranial-nerve finding with long-tract motor/sensory signs; dysarthria/diplopia/vertigo may coexist.	Crossed face-body findings or multiple cranial nerves.
Cerebellum	Dysmetria, intention tremor, truncal/limb ataxia, nystagmus, scanning dysarthria.	Coordination failure out of proportion to weakness.
Spinal cord	Bilateral UMN signs below lesion, sensory level, sphincter dysfunction; segmental LMN signs at lesion possible.	Sensory level + long-tract pattern.
Root / plexus / peripheral nerve	LMN weakness with dermatomal, plexus or named-nerve sensory pattern; pain may be prominent.	Distribution follows peripheral anatomy, not a cortical map.
NMJ / muscle Stanford Medicine 25 - Neurology Exam Video Gallery Geeky Medics - Upper Limb Neurological Examination (updated) Geeky Medics - Lower Limb Neurological Examination (updated) 2026/27 clerkship-expanded edition - verify school and official exam updates before testing	NMJ: fluctuating/fatigable weakness with preserved sensation. Muscle: usually proximal weakness, preserved sensation.	Reflex/sensory pattern + fatigability or CK/myopathic pattern.