Full Neurological Assessment — Framework
A complete neuro exam has six domains: consciousness, higher cortical function, cranial nerves, motor system, sensory system, and coordination/gait. In prehospital practice these are often abbreviated — but knowing the full framework lets you know what you're abbreviating and why.
STEP 1 Consciousness & Orientation
1
AVPU / GCS — establish baseline. Note trajectory.
2
Orientation — Person, Place, Time, Event (PPTE)
3
Attention — serial 7s, MOYB, or days of week backwards
4
Memory — immediate recall (3 words), recent events
GCS Components
E1–4
Eyes: none→spontaneous
V1–5
Verbal: none→orientated
M1–6
Motor: none→obeys
3/15
Minimum / coma
8/15
Intubation threshold
15/15
Normal
STEP 2 Higher Cortical Function
1
Speech — fluency, comprehension, repetition, naming. Note dysarthria vs dysphasia.
2
Praxis — follow complex commands ("wave goodbye")
3
Neglect — visual and sensory inattention (bilateral stimuli)
4
FAST-ED / NIHSS — structured stroke screening
Dysphasia vs Dysarthria
Dysarthria = words correct, articulation poor (motor). Dysphasia = language content wrong (cortical). Critical distinction — dysphasia = cortical lesion until proved otherwise.
STEP 3 Motor System
- Tone — spasticity (UMN), flaccidity (LMN), rigidity (extrapyramidal)
- Power — MRC scale 0–5, compare sides, proximal vs distal
- Pronator drift — arms out 10s, eyes closed. Drift = contralateral UMN lesion
- Coordination — finger-nose, heel-shin, rapid alternating (cerebellar)
- Gait — observe if able: hemiplegic scissor, ataxic, steppage, festinating
MRC Power Scale
0
No contraction
1
Flicker only
2
Movement, gravity eliminated
3
Against gravity
4
Against resistance (reduced)
5
Normal
STEP 4 Sensory System
- Light touch — cotton wool, ask patient to say "yes" when felt
- Pain/temperature — neuro tip or cold metal (same spinothalamic tract)
- Vibration — 128Hz tuning fork on bony prominences (dorsal column)
- Proprioception — toes up/down with eyes closed (dorsal column)
- Two-point discrimination — cortical sensation if needed
Key Patterns
- Glove/stocking = peripheral neuropathy
- Dermatome pattern = nerve root / cord lesion
- Hemibody = contralateral thalamus/cortex
- Dissociated loss = Brown-Séquard or syrinx
STEP 5 Reflexes
| Reflex | Root | Technique | ↑ (brisk) | ↓/absent |
|---|---|---|---|---|
| Biceps | C5–C6 | Finger on tendon, tap finger | UMN above C5 | LMN C5/6, peripheral neuropathy |
| Triceps | C6–C7 | Direct tap on tendon | UMN above C6 | LMN C7, radiculopathy |
| Supinator | C5–C6 | Tap radial styloid | UMN | C6 lesion |
| Knee (patellar) | L3–L4 | Leg relaxed, tap patellar tendon | UMN; anxiety | LMN, peripheral neuropathy, diabetes |
| Ankle (Achilles) | S1–S2 | Tap Achilles, foot in dorsiflexion | UMN | LMN S1, DM, hypothyroid |
| Plantar (Babinski) | L5–S1 | Stroke lateral sole | UPGOING = UMN pathology | Normal = downgoing (flexor) |
Cranial Nerves — Anatomy & Function
OH OH OH TO TOUCH AND FEEL VERY GREEN VEGETABLES AH HEAVEN
I · II · III · IV · V · VI · VII · VIII · IX · X · XI · XII
I · II · III · IV · V · VI · VII · VIII · IX · X · XI · XII
Type: SOME SAY MARRY MONEY BUT MY BROTHER SAYS BIG BRAINS MATTER MORE
S=Sensory M=Motor B=Both — I:S · II:S · III:M · IV:M · V:B · VI:M · VII:B · VIII:S · IX:B · X:B · XI:M · XII:M
S=Sensory M=Motor B=Both — I:S · II:S · III:M · IV:M · V:B · VI:M · VII:B · VIII:S · IX:B · X:B · XI:M · XII:M
| Nerve | Name | Type | Function | Lesion gives… | Causes |
|---|---|---|---|---|---|
| CN I | Olfactory | Sensory | Smell | Anosmia (unilateral or bilateral) | Head injury, anterior fossa meningioma, COVID-19, zinc deficiency |
| CN II | Optic | Sensory | Vision; afferent pupillary reflex | Visual field defects, RAPD, reduced acuity, colour vision loss | MS (optic neuritis), glaucoma, retinal detachment, ischaemic optic neuropathy, raised ICP |
| CN III | Oculomotor | Motor | Eye: SR, IR, MR, IO muscles; eyelid levator; pupil constriction (parasympathetic) | Ptosis, eye "down and out", mydriasis (fixed dilated pupil) if surgical; spared pupil if medical (DM) | Posterior communicating artery aneurysm, uncal herniation, DM, MS, cavernous sinus |
| CN IV | Trochlear | Motor | Superior oblique — intorts and depresses eye | Diplopia worse looking down (e.g. stairs); head tilt to opposite side | Head injury (most common), DM, MS, raised ICP, cavernous sinus |
| CN V | Trigeminal | Both | Sensation: face (V1 ophthalmic, V2 maxillary, V3 mandibular). Motor: jaw (masseter, temporalis, pterygoids) | Facial numbness in trigeminal distribution; jaw deviation to weak side; absent corneal reflex | Trigeminal neuralgia, MS, acoustic neuroma, skull base tumour, cavernous sinus, herpes zoster |
| CN VI | Abducens | Motor | Lateral rectus — abducts eye | Failure of lateral gaze ipsilateral; convergent squint; horizontal diplopia | Raised ICP (false localising), DM, MS, cavernous sinus thrombosis, Wernicke's, meningitis |
| CN VII | Facial | Both | Motor: facial expression. Sensory: taste anterior 2/3 tongue, external ear sensation. Parasympathetic: lacrimal/salivary glands | UMN: contralateral lower face spared (forehead). LMN: complete ipsilateral hemiface including forehead | Bell's palsy (LMN), stroke (UMN), Ramsay Hunt (HZV), parotid tumour, cholesteatoma, Lyme disease, sarcoid, acoustic neuroma |
| CN VIII | Vestibulocochlear | Sensory | Hearing (cochlear); balance (vestibular) | Sensorineural deafness, tinnitus, vertigo, nystagmus | Acoustic neuroma, Ménière's, ototoxic drugs (gentamicin, furosemide, cisplatin), noise damage, MS, meningitis |
| CN IX | Glossopharyngeal | Both | Sensory: posterior 1/3 tongue taste, pharynx, afferent gag. Motor: stylopharyngeus, parotid (para) | Loss of gag afferent, dysphagia, reduced taste posterior tongue; glossopharyngeal neuralgia | Posterior fossa tumour, skull base fracture, carotid aneurysm, MS, meningitis |
| CN X | Vagus | Both | Motor: pharynx/larynx (including vocal cords), efferent gag. Parasympathetic: heart/gut. Sensory: viscera, posterior pharynx | Hoarse voice, bovine cough, nasal regurgitation, uvula deviates away, absent gag efferent, dysphonia, tachycardia if bilateral | Posterior fossa/medullary lesion, lung apex tumour (recurrent laryngeal — L side), aortic aneurysm, thyroid surgery, PICA stroke |
| CN XI | Accessory | Motor | Sternocleidomastoid (head rotation), upper trapezius (shoulder shrug) | Weak shoulder shrug ipsilateral; weak head rotation away from lesion; winging of scapula if combined with CN XI | Posterior fossa tumour, jugular foramen syndrome (IX, X, XI together), cervical lymph node biopsy, penetrating neck injury |
| CN XII | Hypoglossal | Motor | Tongue movement (all intrinsic and most extrinsic muscles) | LMN: tongue deviates toward lesion, wasting, fasciculations. UMN: deviates away, no wasting | Motor neurone disease, skull base metastasis, neck dissection, posterior fossa tumour, vertebral artery aneurysm, stroke (medullary) |
Prehospital priority: CN III palsy with fixed dilated pupil = posterior communicating artery aneurysm or transtentorial herniation until proved otherwise. This is a neurosurgical emergency. CN VII: always distinguish UMN (forehead sparing = stroke) from LMN (complete face = Bell's or other LMN cause).
How to Test Each Cranial Nerve
I — Olfactory
1
Ask about smell changes. One nostril at a time.
2
Use familiar non-pungent smell (coffee, peppermint). Not ammonia — stimulates trigeminal.
II — Optic
1
Acuity: Snellen chart / newspaper / count fingers
2
Fields: Confrontation — each eye separately, compare to yours. Four quadrants.
3
Pupils: Direct + consensual reflex. Swinging flashlight test for RAPD.
4
Fundoscopy: Papilloedema, disc pallor, haemorrhages
III · IV · VI — Eye Movements
1
Cover each eye. Any ptosis? Pupil asymmetry?
2
"Follow my finger" — H-pattern in both eyes. Pause at extremes. Ask about diplopia.
3
Nystagmus: fast phase direction = direction of nystagmus. Peripheral = horizontal/rotatory. Central = vertical/direction-changing.
4
Convergence: finger towards bridge of nose.
V — Trigeminal
1
Sensory: Light touch and pin each division (forehead/V1, cheek/V2, chin/V3) bilaterally
2
Corneal reflex: Touch cornea (not sclera) with wisp of cotton from side. Both eyes should blink.
3
Motor: "Clench jaw" — palpate masseter. Open mouth — jaw deviates toward weakness.
VII — Facial
1
Raise eyebrows — check forehead wrinkling symmetrically
2
Close eyes tightly — can you force them open? (frontalis/orbicularis oculi)
3
Show teeth / smile — nasolabial fold flattening?
4
Puff out cheeks. Note: forehead sparing = UMN lesion (stroke). Full loss = LMN (Bell's).
VIII — Vestibulocochlear
1
Whisper test each ear; finger rubbing near ear
2
Rinne: 512Hz fork — mastoid then in air. Air > bone = normal or SNHL. Bone > air = conductive
3
Weber: Fork on forehead midline. Lateralises to conductive loss / away from SNHL side
4
Nystagmus + Dix-Hallpike for BPPV
IX · X — Glossopharyngeal · Vagus
1
Listen to voice — hoarse (X), nasal (X), normal
2
"Aah" — uvula should rise in midline. Deviation = away from CN X lesion
3
Gag reflex — afferent IX, efferent X. Check both sides. Note: absent gag ≠ always pathological in adults.
4
Swallow water — timing, drooling, cough after
XI · XII — Accessory · Hypoglossal
1
XI: Shoulder shrug against resistance (trapezius) — note asymmetry
2
XI: Turn head against resistance (SCM turns head to opposite side)
3
XII: Protrude tongue — deviates toward LMN lesion. Check for wasting, fasciculations.
Prehospital shortcut: In the acute setting prioritise II (pupils/acuity), III/IV/VI (eye movements, ptosis), V (corneal, sensation), VII (face), VIII (vertigo/nystagmus), IX/X (swallow/voice), XII (tongue). Full formal testing of I, IV, XI is rarely time-critical on scene.
Peripheral Nervous System Assessment
UPPER LIMB Key Nerve Roots & Nerves
| Nerve | Root | Motor | Sensory | Test |
|---|---|---|---|---|
| Axillary | C5–C6 | Deltoid | Regimental badge area | Arm abduction at shoulder |
| Musculocutaneous | C5–C6 | Biceps, brachialis | Lateral forearm | Elbow flexion (supinated) |
| Radial | C5–T1 | Triceps, extensors | Dorsum of hand (1st web) | Wrist/finger extension; "wrist drop" |
| Median | C6–T1 | Thenar eminence, FDS, FDP (lat.), pronators | Lateral 3½ fingers palm side | Thumb opposition (LOAF); "Papal blessing" |
| Ulnar | C8–T1 | Intrinsics, hypothenar, FDP (med.) | Medial 1½ fingers | Finger abduction; Froment's sign; "claw hand" |
Brachial Plexus Injuries
- Erb's palsy (C5–C6) — "waiter's tip" — arm adducted, medially rotated, wrist flexed. Mechanism: shoulder dystocia, motorcycle crash.
- Klumpke's (C8–T1) — claw hand + Horner's syndrome. Mechanism: upward arm traction.
- Total plexus — flail anaesthetic arm. High-velocity trauma.
LOWER LIMB Key Nerve Roots & Nerves
| Nerve | Root | Motor | Sensory | Test |
|---|---|---|---|---|
| Femoral | L2–L4 | Quadriceps | Anterior thigh, medial leg (saphenous) | Knee extension; knee jerk |
| Obturator | L2–L4 | Hip adductors | Medial thigh | Hip adduction against resistance |
| Sciatic | L4–S3 | Hamstrings + tibial + common peroneal | Posterior leg, foot | Knee flexion; tests below |
| Common peroneal | L4–S2 | Ankle/toe dorsiflexion, eversion | Dorsum of foot, lateral leg | "Foot drop"; Tinel's at fibular head |
| Tibial | L4–S3 | Calf, plantar flexion, toe flexion | Sole of foot | Ankle plantarflexion; ankle jerk |
Root Levels — Quick Reference
- L1–L2 — hip flexion (iliopsoas)
- L3–L4 — knee extension (quads); knee jerk L3/4
- L4–L5 — ankle dorsiflexion; foot drop if damaged
- L5–S1 — great toe extension (extensor hallucis longus — L5 sentinel)
- S1–S2 — ankle plantarflexion; ankle jerk S1
- S3–S5 — bladder/bowel/perineum
DERMATOMES Key Landmarks
Upper Limb
- C4 — cape of shoulders
- C5 — lateral shoulder/arm
- C6 — thumb and index finger
- C7 — middle finger
- C8 — little and ring finger
- T1 — medial forearm
- T4 — nipple line
- T10 — umbilicus
- T12/L1 — inguinal ligament
Lower Limb
- L1 — groin
- L2 — anterior thigh
- L3 — medial knee
- L4 — medial leg / medial foot
- L5 — dorsum of foot / big toe
- S1 — lateral foot / sole
- S2 — posterior thigh
- S3-5 — saddle area / perineum
Clinical Correlates
- T10 numbness → thoracic cord, T10 disc
- L4/L5 disc → L5 dermatomal pain (lateral calf, dorsum foot)
- L5/S1 disc → S1 dermatomal pain (posterior calf, sole, heel)
- Saddle anaesthesia → cauda equina. Emergency.
- Brown-Séquard → ipsilateral motor/proprioception loss, contralateral pain/temp loss
Cauda Equina — DO NOT MISS: Saddle anaesthesia (S3–S5) + bladder/bowel dysfunction + bilateral leg weakness/sensory loss = cauda equina syndrome until proven otherwise. URGENT MRI. Ask about urinary retention, incontinence, reduced perianal sensation in ALL patients with low back pain and any leg neurology.
Neurological Patterns — Localising the Lesion
UMN vs LMN Upper vs Lower Motor Neurone
| Feature | UMN (Central) | LMN (Peripheral) |
|---|---|---|
| Tone | Increased (spasticity / clasp-knife) | Decreased (flaccid) |
| Power | Reduced — pyramidal pattern (extensors UL, flexors LL weak) | Reduced — myotomal pattern |
| Reflexes | Brisk / hyperreflexic | Diminished / absent |
| Babinski | Extensor (upgoing) | Flexor (normal) |
| Wasting | Disuse only (late, mild) | Early, marked |
| Fasciculations | Absent | Present |
| Location | Brain, brainstem, spinal cord | Anterior horn, nerve root, plexus, peripheral nerve |
PATTERNS By Distribution
Hemiplegia
Ipsilateral CN + contralateral motor/sensory = brainstem. All contralateral = cortex/internal capsule/cord (C levels)
Paraplegia
Bilateral legs = spinal cord ≥T1. Check level with sensory testing. Ask about sphincters.
Quadriplegia
C1–C4: diaphragm involved (C3–C5 = phrenic). UMN below level; may have LMN signs at level.
Monoplegia
Single limb — cortex (small lesion), nerve root, or peripheral nerve. Distinguish by distribution.
Glove/stocking
Length-dependent peripheral neuropathy. Longest fibres affected first = feet before hands.
Proximal weakness
Myopathy or neuromuscular junction (MG). Difficulty rising from chair, climbing stairs.
Distal weakness
Peripheral neuropathy, MND, Charcot-Marie-Tooth
Crossed deficits
Ipsilateral face + contralateral body = BRAINSTEM lesion (Wallenberg, lateral medullary)
SENSORY PATTERNS Anatomical Localisation
Hemibody loss
Contralateral thalamus, internal capsule, parietal cortex. VPL nucleus thalamus = face + limbs same level.
Dissociated loss
Vibration/proprioception (dorsal column) vs pain/temp (spinothalamic) separated = cord lesion. Syrinx, Brown-Séquard.
Dermatomal
Single stripe or band = nerve root (disc prolapse, shingles, radiculopathy)
Peripheral nerve
Matches anatomical territory: carpal tunnel = median digits; ulnar = little/ring + medial palm
Stocking/glove
Peripheral neuropathy — symmetrical, distal, length-dependent
Cord level
Bilateral sensory loss below a level + motor signs. Urgently find level with pin prick — sacral segments last affected (sacral sparing = incomplete).
Saddle anaesthesia
S3–S5 loss. Cauda equina. Emergency MRI.
GAIT PATTERNS
- Hemiplegic (circumduction) — UMN stroke. Stiff extended leg swings out. Arm flexed/adducted.
- Scissor gait — bilateral UMN (cerebral palsy, cord). Hips adducted, cross midline.
- Steppage (high-stepping) — foot drop (L4/5, common peroneal). Lifts knee high to clear toe.
- Antalgic — pain minimisation. Short stance phase on affected side.
- Ataxic (cerebellar/sensory) — wide-based, unsteady. Cerebellar: worse with eyes open. Sensory: worse with eyes closed (Romberg +ve).
- Festinating (Parkinsonian) — small shuffling steps, stooped, accelerates forward, reduced arm swing, en-bloc turning.
- Waddling — proximal muscle weakness / hip girdle myopathy. Trendelenburg.
- Apraxic — "walking on ice", feet don't leave floor. Frontal lobe (NPH, vascular dementia).
Causes of Neurological Presentations
Sudden Onset
VASCULAR
- Ischaemic stroke (thrombotic/embolic)
- Haemorrhagic stroke (ICH, SAH)
- TIA (resolves <24h)
- Vertebral/carotid dissection
- Venous sinus thrombosis
- Hypertensive encephalopathy / PRES
- Vasculitis
TRAUMA
- Extradural haematoma (arterial — lucid interval)
- Subdural haematoma (acute/chronic)
- Diffuse axonal injury
- Contusion / intracerebral haemorrhage
- Spinal cord injury
- Peripheral nerve injury (traction, laceration)
SEIZURE
- Epilepsy (idiopathic, structural)
- Hypoglycaemia — always exclude
- Hyponatraemia
- Hypo/hypercalcaemia
- Drug/alcohol withdrawal
- Eclampsia
- Non-epileptic attack disorder (NEAD)
TOXIC/METABOLIC
- Hypoglycaemia / hyperglycaemia (HHS, DKA)
- Hyponatraemia / hypernatraemia
- Hepatic encephalopathy
- Uraemia
- CO poisoning
- Drug toxicity / overdose
- Wernicke's encephalopathy (B1 deficiency)
Subacute / Progressive
INFECTIVE
- Bacterial meningitis
- Viral encephalitis (HSV, EBV, CMV)
- Brain abscess
- Tuberculoma / TB meningitis
- Neurosyphilis
- Lyme neuroborreliosis
- HIV-related (toxoplasma, PML, crypto)
- COVID-19 neurological complications
INFLAMMATORY / IMMUNE
- Multiple sclerosis (relapsing-remitting, progressive)
- Neuromyelitis optica spectrum
- Guillain-Barré syndrome (ascending, post-infective)
- CIDP
- Vasculitis (SLE, PAN, giant cell)
- Myasthenia gravis
- Anti-NMDAR encephalitis
- Sarcoidosis
NEOPLASTIC
- Primary tumours (glioma, meningioma, lymphoma)
- Cerebral metastases (lung, breast, melanoma, renal, colon)
- Leptomeningeal carcinomatosis
- Spinal cord compression (metastatic)
- Paraneoplastic (SCLC, anti-Hu, anti-Yo)
- Acoustic neuroma (CN VIII)
- Pituitary tumour (bitemporal hemianopia)
DEGENERATIVE
- Motor neurone disease (ALS, PBP, PMA)
- Parkinson's disease and Parkinson-plus syndromes
- Alzheimer's / vascular dementia / DLB / FTD
- Huntington's disease
- Hereditary spastic paraplegia
- Friedreich's ataxia / spinocerebellar ataxias
- MSA / PSP / CBS
METABOLIC / NUTRITIONAL
- Subacute combined degeneration (B12 deficiency)
- Wernicke–Korsakoff (thiamine B1)
- Diabetic peripheral neuropathy
- Hypothyroidism (neuropathy, cerebellar, myopathy)
- Wilson's disease
- Porphyria
- Chronic renal/liver failure
STRUCTURAL / COMPRESSIVE
- Cervical myelopathy (spondylosis)
- Disc prolapse (radiculopathy)
- Spinal stenosis (neurogenic claudication)
- Chiari malformation
- Normal pressure hydrocephalus
- Syringomyelia
- Carpal tunnel / cubital tunnel
Peripheral Neuropathy — Causes by Type
POLYNEUROPATHY Symmetrical Glove/Stocking
- Metabolic: Diabetes (most common in UK), uraemia, hypothyroid, liver disease
- Nutritional: B12, B1 (thiamine), B6 excess, folate deficiency
- Toxic: Alcohol, chemotherapy (vincristine, cisplatin), metronidazole, INH, amiodarone, statins (myopathy)
- Inflammatory: GBS, CIDP, vasculitis
- Infective: HIV, leprosy, Lyme, CMV
- Paraneoplastic: Sensory > motor, anti-Hu
- Hereditary: Charcot-Marie-Tooth (CMT)
- Idiopathic: ~30% of cases
MONONEUROPATHY Single Nerve
- Median: Carpal tunnel (commonest), pronator teres entrapment
- Ulnar: Cubital tunnel (elbow), Guyon's canal (wrist)
- Radial: Saturday night palsy (axilla compression), posterior interosseous nerve
- Common peroneal: Fibular head compression (plaster, leg crossing, weight loss)
- Lateral cutaneous thigh: Meralgia paraesthetica (inguinal ligament, obesity/pregnancy)
- Diabetic mononeuropathy: Any nerve, vasa nervorum ischaemia
Red Flags — Do Not Miss
These presentations demand urgent action. Time-critical. Convey immediately.
THUNDERCLAP HEADACHE
- Sudden onset, maximal at onset ("worst ever")
- SAH until proved otherwise (CT then LP)
- Also: CVT, RCVS, pituitary apoplexy, vertebral dissection
- Even if normal neuro exam
MENINGISM
- Neck stiffness, photophobia, phonophobia
- Kernig's / Brudzinski's signs
- Non-blanching rash = meningococcal
- Do NOT delay abx for LP if bacterial meningitis suspected
CAUDA EQUINA
- Saddle anaesthesia (S3–S5)
- Bilateral leg weakness
- Urinary retention or incontinence
- Faecal incontinence
- Reduced anal tone on PR
- Urgent MRI same day
CORD COMPRESSION
- Known malignancy + back pain + neurology = cord compression until proved otherwise
- Bilateral weakness below a level
- Sensory level
- Bladder/bowel involvement
- High-dose dexamethasone + urgent MRI
STROKE / FAST
- F — facial droop
- A — arm drift/weakness
- S — speech: dysarthria, dysphasia, slurred
- T — time: call immediately, note last known well
- Eyes: gaze deviation, hemianopia, RAPD
- Posterior: vertigo + ataxia + crossed signs + dysphagia
CN III PALSY + HEADACHE
- Fixed dilated pupil + ptosis + eye down/out
- PComm aneurysm = neurosurgical emergency
- If associated with headache: treat as aneurysm
- Note: DM causes "pupil-sparing" CN III (medical, less urgent but still needs imaging)
GBS — ASCENDING PARALYSIS
- Post-infective (1–3 weeks after GI/URI)
- Ascending flaccid areflexic weakness
- Autonomic instability
- Respiratory compromise = ITU
- Sniff test / VC if available: if <20ml/kg = ventilatory support
TRANSTENTORIAL HERNIATION
- Rapidly declining GCS
- Unilateral/bilateral fixed dilated pupils
- Cushing's triad: hypertension, bradycardia, irregular breathing
- Decerebrate/decorticate posturing
- Pre-terminal — expedite transport
Prehospital Neuro Assessment Checklist
ON SCENE
1
GCS, BM, SpO2, temp, pupils (PERLA — size, reactivity, equality)
2
FAST screen — face/arms/speech. Time of onset / last known well.
3
Focal neurology — limb power, drift, sensation
4
Cranial nerve screen — eye movements, facial symmetry, swallow, tongue
5
Red flag check: headache character, meningism, saddle symptoms
6
Pre-alerts: stroke bypass / major trauma / neurosurgical
HANDOVER STRUCTURE
1
Onset: Sudden/gradual, time, activity at onset, progression
2
History: PMH, medications (anticoagulants), preceding illness/trauma
3
Findings: GCS (trend), pupils, FAST, focal deficits found
4
Working diagnosis / differential: Stroke? SAH? Metabolic? Trauma?
5
Last known well: Critical for thrombolysis / thrombectomy window