The rapid neurologic examination, Part 2: Movement, reflexes, sensation, balance. Know the signs that lead to the site of the pathologic process

Asymmetric weakness is an important localizing finding in the neurologic evaluation. Symmetric hyperreflexia or hyporeflexia alone is not diagnostic; compare reflexes between sides of the body and between upper and lower extremities. The extensor plantar response (Babinski's reflex) suggests an upper motor neuron lesion. The sensory examination also looks for asymmetry and determines whether both light touch and pinprick sensation are intact. Double simultaneous stimulation, looking for extinction of response on one side, can uncover subtle sensory deficits. Evaluation of coordination and balance considers the inputs of cerebellar, vestibular, motor, sensory, and proprioceptive systems.