Aa
What is a COMPLETE neuro exam?
I am beginning to think I haven't really had one. I thought I was, but when reading some of the recent posts on here I am thinking I am mistaken.
Here is what usually happens for physical exam:
check reflexes in knee, elbow and somewhere else on my arm (can't remember)
check muscle strength: push/pull on legs and arms
walk across room, consists of about 5 steps one-way
follow finger with eyes
That's it.
Am I not getting a complete exam? What else should be being done?
Thanks,
Addi
Hi JM- Welcome to the group.
Limboland is not a fun place to be. Did your neuro say you have carpal tunnel? Is he planning any further tests or follow-up?
Kyle
Limboland is not a fun place to be. Did your neuro say you have carpal tunnel? Is he planning any further tests or follow-up?
Kyle
I am sorry for your frustration. Many of us take a long while to get a diagnosis. Waiting months to see a neurologist is part of it. I had to wait 8 months to see my MS Specialist. In the beginning the neurologists only spent 15 minutes with me. Did he want you to follow up? You can always get a second opinion. I had to when I was going through the diagnosis process.
Alex
Alex
What a nightmare. I recently got into a neurologist here in Washington after waiting 3 months. The original doctor I saw wasn't even my regular PCP. I went in because my arms had been falling asleep while I was sleeping at night or even just doing regular everyday things. I feel as if the first Doc sent me to the neuro just to get me out of the office. They both just focused mainly on my arms. I feel like they could see past just that. I am also dealing with fatigue, confusion, zapping pains in my fingers, involuntary upper body, mostly my arms spasms and shooting pains down my legs mostly my right leg. The neuro spent less than 20 minutes with me. did the reflex tests, but not the foot one, made me walk down the hall, however i was wearing baggy sweats due to the fact that it was everything I had to get out of bed that morning. I am at a loss and I am sure most of us are. I hope we all get the right Dx soon. I am in search of a 2nd opinion, but am in fear of wasting more time and money just to get a lame Dx again of oh you have Carpal tunnel.... Let me tell you folks I have been a stay at home Mom for the last 14 years, how in the world do I have just capal tunnel????
I don't know when a 5 minute neuro exam is ever appropriate, especially when a patient has neurological symptoms but aren't yet diagnosed. But even when they are dx'ed, how can a neuro assess disease progression by doing 5 minute follow ups? They need to measure the same functions again in future consultations in order to compare against how the patient did the last time. Even when the patient is stable and not complaining of symptoms, there are clinical signs a neuro may pick up on (abnormal reflexes, Babinski, nystagmus, etc) that may go unnoticed to the patient and not affecting their current functioning, but still should be documented for future comparison in order to assess degree and rate of progression.
I stop short of say lazy neuros are to blame - though some may well be just that. Giving them the benefit of the doubt, perhaps they have more patients than they can reasonably handle. This is probably true for the majority of physicians. All the more reason to speak up and request a thorough assessment, politey but assertively. Bring a list of a complete neuro exam for assessing for MS and its mimics, and take it out if it appears the neuro is cutting it short. If they aren't cooperative, ask them why they don't see the need. They have only so much time and in my experience will focus that time on the squeaky wheels, rightly or wrongly.
Further, if at some point following a 5 minute exam you have the opportunity to see what they billed your insurance for (am directing this at my friends south of the border), make sure they didn't overbill. Some members of this forum have discovered fraudulent billing by their physicians by reviewing what was charged to their insurer.
I stop short of say lazy neuros are to blame - though some may well be just that. Giving them the benefit of the doubt, perhaps they have more patients than they can reasonably handle. This is probably true for the majority of physicians. All the more reason to speak up and request a thorough assessment, politey but assertively. Bring a list of a complete neuro exam for assessing for MS and its mimics, and take it out if it appears the neuro is cutting it short. If they aren't cooperative, ask them why they don't see the need. They have only so much time and in my experience will focus that time on the squeaky wheels, rightly or wrongly.
Further, if at some point following a 5 minute exam you have the opportunity to see what they billed your insurance for (am directing this at my friends south of the border), make sure they didn't overbill. Some members of this forum have discovered fraudulent billing by their physicians by reviewing what was charged to their insurer.
JJ - That neuro does sound like a twit! It really bothers me to hear of so many neuro nightmares. It is just unbelievable! It really is rather frightening to know that these so-called specialists have such disregard for so many people who go to them for answers. And, it is even more frightening to see how many people get a diagnosis many years down the road of the very disease that the twit neuros tossed aside as "in the head".
They are playing with our quality of life. ;0( And, they very well could be the cause of the disease progressing without treatment.
I, for one, plan on contacting the 2 neuros that disregarded me whenever I get a diagnosis. I plan on doing it level-headed and as emotionless as I possibly can. The way I look at it is that if it makes that neuro think twice before doing it to someone else, then it will have been worth the few minutes it will take to write them a letter. Maybe it will help someone else down the road not to experience what we have.
They may very well just toss the letter aside and go on with their tritty practices, but at least I will have tried.
I came to this reasoning due to a situation with my current neuro. I had only seen him twice. On the first visit, he notes neuro signs. On the second visit he told me to pull up my boot straps. While the saying became a joke in my home in a lot of different ways, it still affected me in a great way. And, with him being the "specialist" and me not knowing which way was up, I did try to pull my boot straps up.
I didn't feel like I could mow the lawn on a pretty hot day. But I pulled up my boot straps and gave it a try. I ended up collapsing and my 14 year old daughter and my 60 year old mother had to get me out of the front yard.
I didn't feel like I could climb a small ladder to get on my roof to hang x-mas lights. Pulled up my boot straps and gave it a try. I got stuck on the roof and couldn't get down.
Okay, try the safer things then.
One day I was having a whole lot of trouble walking. When this happens it is not uncommon for my legs to "quit working". I was at home so I pushed myself and kept walking instead of getting my wheelchair. I ended up falling in the living room and could not get up. My neighbors had to come get me up and carry me to my bed. It was humiliating.
There were other instances, too. Then my thick skull decided that enough was enough. I threw away my boot strap theory...and played it safe instead.
Currently I am in a flare that is two months strong. I have been to the ER three times. Due to the need to see a neuro NOW and not really having much choice, I ended up back in the office of boot strap guy.
I was first seen by the resident doc. He saw signs during his neuro exam. I told him about the boot straps when he asked how come I hadn't been seen in a year. He told the neuro what I said. When the neuro came in, I told him about how him telling me that had worked out for me. Of course, he denied "saying such a thing to a person with an obvious neuro disorder". But, I could see in his eyes that this bothered him.
So, moral of that story....my speaking up to him made him think. One down....hundreds to go. lol I decided to stick with boot strap neuro. I hope I don't regret it. ;0/
Ken - I am seeing that there are full neuro exams and mini exams. I wonder what determines which one you get?
Thanks, everyone, for helping me out with this question.
long winded Addi, yet again (you guys are used to it by now, huh??)
Neuro Exams.
Most neuros I've seen, give the quick and dirty 5 minute exam as described by the OP and adding the foot tickle reflex where the toes should point down and not up.
Recently I saw an MS Specialist who gave me a full neuro exam. It included the generic exam plus running my foot down the opposite leg from shin to ankle, lying flat on the bed while the neuro asked me to let her control my leg while she jerked it a few times and moved it slowly across the bed. I couldn't let her control one leg, the muscles were too tight, so I was controlling it myself. She didn't do a memory test, but there were some other things she did that other neuros haven't - I just can't remember the details that great. She also explained every procedure to me and what it was supposed to look like in a 'normal' patient.
She also wrote every result down which I have never seen another neuro do.
Most neuros I've seen, give the quick and dirty 5 minute exam as described by the OP and adding the foot tickle reflex where the toes should point down and not up.
Recently I saw an MS Specialist who gave me a full neuro exam. It included the generic exam plus running my foot down the opposite leg from shin to ankle, lying flat on the bed while the neuro asked me to let her control my leg while she jerked it a few times and moved it slowly across the bed. I couldn't let her control one leg, the muscles were too tight, so I was controlling it myself. She didn't do a memory test, but there were some other things she did that other neuros haven't - I just can't remember the details that great. She also explained every procedure to me and what it was supposed to look like in a 'normal' patient.
She also wrote every result down which I have never seen another neuro do.
COMMUNITY LEADER
Hey Addi,
Not long after i had my one and only neuro exam, i was confused by what I experienced and what others described. I went in search of an explanation, i ended up finding numerous books and papers on the '5 minute neuro exam' which if i remember correctly, is not uncommon and seemingly accepted practice for busy neurologists.
It's been almost a year since but what i can remember (lol) i think my exam lasted a bit longer than 5 minutes but not by much.
* walk across the room (i was string puppet walking due to excessive bounce and not able to straighten my legs whilst walking) Still have excessive bounce when physically active or walking for more than about 5-10 minutes none stop.
Laying down:
* reflex? grabbed a leg in turn and shook the carp out of them, twisting and letting go (it felt weird, they were rubbery and all over the place)
* If he scraped my feet at all i didn't feel anything so i've asumed he didn't test
* Had me lift each leg (i had trouble controling the left cant remember the right)
* Had me run my heel down the opposite leg, (i was a little shocked and appologetic because it took 3 or 4 tries to control the left leg but the right leg got it first time)
Sitting up:
* Had me do the finger to nose touch, but only once each side ( i could do that but if i'd done if a few more i would of missed)
* Arms held up and out to my sides, he watched the tremor then asked me to look away whilst he pushed down on my arm (right went up and down a bit but cant remember the left) note due to this he stated i dont believe your anxious or depressed thats because the tremor was there even when i was distracted!
* I think i recall a rubber hammer on my elbows but really am not sure
* Asked me what happens when i close my eyes and i told him i fall backwards so did that part with me still sitting down (i fell backwards but i opened my eyes as he caught me)
* Checked my eyes, light was bright and he looked into both a few times ( I thought he might of seen the tremor in my eyeballs or that sometimes the pupils react differently)
He wrote it all down, didn't tell me if i'd passed or failed but i was pretty sure i'd failed some parts because if he didn't like a responce he repeated that part and only got the same effect out of me. He said he wasn't convinced yet it was MS but said he'd know more after the MRI (head and spine) and also ordered an EEG which i didnt end up having.
He didn't do another exam when i saw him again 2 months later, MRI 1.5T using his prefered method (no MS protocol or GAD) said he was 99% sure i didn't have MS and i hadn't had a stroke and he started walking out the room. The short story of the nightmare that ensured from that point on, was that i might have senile dementia (age 45) to account for my lexile losses, specifically loss of nouns but why i had trouble controlling my body was probably down to psycholgical.
He was completely ignoring his own exam assessment, his prior opinion that i was not anxious or depressed, the incorrect MRI for MS didn't find anything other than what he said were 'irrelevant bleeds' so he wasn't interested in me anymore, ta very much! I think he only said senile dementia because i questioned him on what could cause me to loose my nouns and only my nouns, his off the cuff response was S/D. He through out the psychological card when i questioned how senile dementia caused me to walk like a string puppet, so psychological explained that discrepancy in his opinion.
I think of him as the twit, his mini exam found evidence of neurological nature and his incorrectly ordered MRI of my brain even showed as he put it "irrelevant bleeds and something going on here and here" and even the MRI of the spine showed as he put it "something going on here" but nothing added up in his opinion to a problem. I've had a short phych-neurological assessment and mental health assessment, first prooves theres damage and the second prooves its got nothing to do with my mental health, so his opinion is worth nothing cause he's wrong, me blowing a rasberry!!!
I think there are mini exams and then there are 'full' exams, i'm still not sure which is better though i'm sure the 'full' neuro exam would find more than the mini.
Cheers.........JJ
Not long after i had my one and only neuro exam, i was confused by what I experienced and what others described. I went in search of an explanation, i ended up finding numerous books and papers on the '5 minute neuro exam' which if i remember correctly, is not uncommon and seemingly accepted practice for busy neurologists.
It's been almost a year since but what i can remember (lol) i think my exam lasted a bit longer than 5 minutes but not by much.
* walk across the room (i was string puppet walking due to excessive bounce and not able to straighten my legs whilst walking) Still have excessive bounce when physically active or walking for more than about 5-10 minutes none stop.
Laying down:
* reflex? grabbed a leg in turn and shook the carp out of them, twisting and letting go (it felt weird, they were rubbery and all over the place)
* If he scraped my feet at all i didn't feel anything so i've asumed he didn't test
* Had me lift each leg (i had trouble controling the left cant remember the right)
* Had me run my heel down the opposite leg, (i was a little shocked and appologetic because it took 3 or 4 tries to control the left leg but the right leg got it first time)
Sitting up:
* Had me do the finger to nose touch, but only once each side ( i could do that but if i'd done if a few more i would of missed)
* Arms held up and out to my sides, he watched the tremor then asked me to look away whilst he pushed down on my arm (right went up and down a bit but cant remember the left) note due to this he stated i dont believe your anxious or depressed thats because the tremor was there even when i was distracted!
* I think i recall a rubber hammer on my elbows but really am not sure
* Asked me what happens when i close my eyes and i told him i fall backwards so did that part with me still sitting down (i fell backwards but i opened my eyes as he caught me)
* Checked my eyes, light was bright and he looked into both a few times ( I thought he might of seen the tremor in my eyeballs or that sometimes the pupils react differently)
He wrote it all down, didn't tell me if i'd passed or failed but i was pretty sure i'd failed some parts because if he didn't like a responce he repeated that part and only got the same effect out of me. He said he wasn't convinced yet it was MS but said he'd know more after the MRI (head and spine) and also ordered an EEG which i didnt end up having.
He didn't do another exam when i saw him again 2 months later, MRI 1.5T using his prefered method (no MS protocol or GAD) said he was 99% sure i didn't have MS and i hadn't had a stroke and he started walking out the room. The short story of the nightmare that ensured from that point on, was that i might have senile dementia (age 45) to account for my lexile losses, specifically loss of nouns but why i had trouble controlling my body was probably down to psycholgical.
He was completely ignoring his own exam assessment, his prior opinion that i was not anxious or depressed, the incorrect MRI for MS didn't find anything other than what he said were 'irrelevant bleeds' so he wasn't interested in me anymore, ta very much! I think he only said senile dementia because i questioned him on what could cause me to loose my nouns and only my nouns, his off the cuff response was S/D. He through out the psychological card when i questioned how senile dementia caused me to walk like a string puppet, so psychological explained that discrepancy in his opinion.
I think of him as the twit, his mini exam found evidence of neurological nature and his incorrectly ordered MRI of my brain even showed as he put it "irrelevant bleeds and something going on here and here" and even the MRI of the spine showed as he put it "something going on here" but nothing added up in his opinion to a problem. I've had a short phych-neurological assessment and mental health assessment, first prooves theres damage and the second prooves its got nothing to do with my mental health, so his opinion is worth nothing cause he's wrong, me blowing a rasberry!!!
I think there are mini exams and then there are 'full' exams, i'm still not sure which is better though i'm sure the 'full' neuro exam would find more than the mini.
Cheers.........JJ
Mary, I was just thinking the same thing. A number of us chimed in; a neuro exam should be more thorough than the ones described above. Good luck in your search; I did a cursory check but didn't find it.
Thanks, Mary! I was sitting here waiting and hoping your memory held out. lol
Gonna go read it now. Thanks again...
Addi
Back already!!
I'm so quick because I remembered the people who posted but the topic was a little different than I remembered.
Here it is - What are your follow-up appointments like? (it includes some neuro exams)
http://www.medhelp.org/posts/Multiple-Sclerosis/The-Follow-up-Exam---Whats-yours-consist-of/show/1197459
Mary
I'm so quick because I remembered the people who posted but the topic was a little different than I remembered.
Here it is - What are your follow-up appointments like? (it includes some neuro exams)
http://www.medhelp.org/posts/Multiple-Sclerosis/The-Follow-up-Exam---Whats-yours-consist-of/show/1197459
Mary
I'm going to test my memory now and see if I can find a recent discussion we had about this very topic.
Be back soon (or not)
Mary
Be back soon (or not)
Mary
hi there
ha ha yes it did actually, the neuro tests how long it takes you to respomd i believe xx
jan xx
ha ha yes it did actually, the neuro tests how long it takes you to respomd i believe xx
jan xx
DIdn't the fast firing questions throw you for a loop?? Heck, when my daughter fast fires ONE question at me, it disorients me. lol
Addi
Hi addi
Dont know if mine different cause my brain scan showed abnormalities or not but i did google it the neuro exam i mean, and it said online the memory thing was normal practice during neuro exam. He fast fired questions at me and its summit called a fast response test apparently..
lot love jan x
Dont know if mine different cause my brain scan showed abnormalities or not but i did google it the neuro exam i mean, and it said online the memory thing was normal practice during neuro exam. He fast fired questions at me and its summit called a fast response test apparently..
lot love jan x
Thanks all! I am glad that I am not the only one who just had these things done. It looks like you had a bit more, jan.
Johnny - Wow...that web site is what prompted me to post this question! I don't know how I found it, but when I did it made me wonder if I was getting the short bus version of neuro exam.
Addi
Hi there
My neuro exam included a 3 minute memory test which my neuro has wrote to my Dr about i only remembered 2 outta 3 in 3 minutes.
Neuro mentioned 3 things Churchill shoes and Birmingham, then he goes onto other things for bout 10 minutes.. He then asked me to recall the 3 things he said - i couldnt think of shoes at all.. he also asked where i was what date and another i cant remember ha ha ha true xxx
He also did the touching bottom of your feet your toe should point down and not up on response xx
jan xx
My neuro exam included a 3 minute memory test which my neuro has wrote to my Dr about i only remembered 2 outta 3 in 3 minutes.
Neuro mentioned 3 things Churchill shoes and Birmingham, then he goes onto other things for bout 10 minutes.. He then asked me to recall the 3 things he said - i couldnt think of shoes at all.. he also asked where i was what date and another i cant remember ha ha ha true xxx
He also did the touching bottom of your feet your toe should point down and not up on response xx
jan xx
Hi Addi, What you describe is what I have had too. I have the reports from both neurologists here are just a few of their inconsistencies:
reporting a portion of the exam that wasn't tested such as "Knee toe Shin'
patient can walk unassisted (doctor was holding both hands)
patient has COPD (since when?)
just to name a few.
I thought that an exam was much more involved. I was once told that a good neurologist can pinpoint the location of a tumor or lesion through a thorough exam.
I guess they get paid regardless of how thorough an exam is.
reporting a portion of the exam that wasn't tested such as "Knee toe Shin'
patient can walk unassisted (doctor was holding both hands)
patient has COPD (since when?)
just to name a few.
I thought that an exam was much more involved. I was once told that a good neurologist can pinpoint the location of a tumor or lesion through a thorough exam.
I guess they get paid regardless of how thorough an exam is.
Here's a great site I found on Neuro exams a while back.
http://www.neuroexam.com/content.php?p=2
http://www.neuroexam.com/content.php?p=2
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