The rapid neurologic examination, part 1: History, mental status, cranial nerves

On approaching a patient with a neurologic complaint, look for abnormal postures and bodily asymmetries. Careful history taking puts the patient's complaint in context and gives direction to the clinical investigation. Remember that a change in the character of an existing condition requires assessment as a new complaint. The mental status evaluation, at a minimum, considers the patient's level of alertness and orientation, including speech and comprehension. Distinguish delirium, dementia, and psychosis, and do not make a psychiatric diagnosis until organic causes have been excluded. Cranial nerves (CNs) II to VIII are most pertinent to the neurologic screening examination. The evaluation of CNs II, III, IV, and VI is particularly important in patients with headache or visual disturbances and suspected intracranial lesions.