Neurological Examination:

Patient is conscious, coherent oriented to person, time and place, in pleasant

mood, no slurring of speech, is able to follow simple commands, can do simple
calculations, able to recall 3 out of 3 objects, able to know the former president of
the Philippines, able to answer the situation given to him with good judgment.

GCS Score = 15
Eye Opening spontaneous (4)
Verbal Response oriented and converses (5)
Motor Response obeys command (6)

Cranial Nerves

I Olfactory- Patient is able to distinguish the smell of coffee and alcohol on both
nostrils.

II Optic- Patient is unable to read a 12 sized arial font even at 1 meter close but is
able to
count the upraised finger correctly.

III(Oculomotor), IV(Trochlear) & VI(Abducens)- There is no limitation in extraocular

muscle movement. Patient is able to follow the six cardinal gazes. No nystagmus.
Both pupils are round and respond to direct and consensual light stimuli, which
constrict to about 3 mm. Ptosis is absent.

V Trigeminal nerve- Patient is able to distinguish different kinds of sensation in the

facial area. Muscles of mastication does not show atrophy. There is positive corneal
reflex. A normotonic & symmetrical muscle tension can be observed upon clenching
of teeth.

VII Facial Nerve- Patient is able to identify sweet and bitter taste or able to
distinguish different kinds of taste sensation in the anterior 2/3 of the tongue. Left
and right facial movements are intact. There is also symmetrical muscle tension
upon closing the eyes. Able to demonstrate normal tone and force in the muscle of
facial expression.

VIII Acoustic nerve- Patient is unable to repeat words whispered to her and there is
no lateralization of
sound on both ears on Webers test. Air conduction is greater than the bone
conduction in Rinnes test.
IX (Glossopharyngeal) & X (Vagus)- Uvula is in the midline. Palate symmetrically
rises upon saying aah. Gag reflex is intact.

XI Spinal Accessory nerve- No fasciculations, tremors or atrophy noted. She is able

to shrug her shoulders equally and bow his head with resistance. Able to rotate his
head against resistance. Muscles are normotonic.

XII Hypoglossal nerve- Tongue is in the midline, symmetrical when protruded.

Deviation upon protrusion and retraction are absent. No fasciculations and
involuntary movements observed.

Motor Testing

Patient is able to stand on both feet together. She is able to walk with
assistance in a slow manner due to paresis of left lower extremity. There is no
atrophy, fasciculation and tremor upon inspection. Right side has good muscle tone.

Muscle strength:
RIGHT LEFT
UPPER EXTREMITY (+) 5 (+) 4
LOWER EXTREMITY (+) 5 (+) 3

Deep Tendon and Pathologic reflexes

Tests for biceps, triceps, knee and ankle reflexes are all normal with grading
of (2+) except on left knee and ankle noted with a grading of (1+), somewhat
diminished, low normal
Patient is negative for Babinski, Chaddock reflex and Openheim signs.

Sensory Exam
Intact and equal levels of sensation for pain, crude touch and position
sensation on both upper and lower extremities are observed. Stereognosis and
graphesthesia are present and normal. Rhombergs test is negative.

Coordination
Patient is able to bilaterally execute finger to nose test smoothly. Able to
perform alternating pronation and supination but not in a rapid manner. She is able
to perform tandem walking , heel to shin test at both sides in a slow manner due to
paresis of left lower extremity. Dysmetria, dysdiadochokinesia and intentional
tremor are absent.

Meningeal Signs
Patient is negative for Kernigs and Brudzinski sign. Nuchal rigidity is absent.