What does a neurological examination check after a head injury concussion? 

What We’ll Discuss in This Article 

• The primary purpose of neurological assessments in identifying brain trauma. 

• Checking levels of consciousness using the Glasgow Coma Scale (GCS). 

• How pupil reactions and vision indicate the health of the brainstem. 

• Assessing motor skills, including muscle strength and physical coordination. 

• Testing cognitive functions such as orientation, memory, and concentration. 

• The difference between functional bedside exams and structural brain imaging. 

• When a neurological check signals a medical emergency requiring urgent care. 

A neurological examination is a series of physical and cognitive tests used by healthcare professionals to evaluate how the brain and nervous system are functioning following a head impact. When a person sustains a concussion, the brain often looks normal on structural scans, but its ability to process information and coordinate the body may be temporarily impaired. By performing these structured checks, clinicians can determine the severity of the injury, identify specific areas of dysfunction, and monitor for any signs that the condition is worsening. Understanding what happens during this exam can help patients and families feel more informed during a clinical assessment in a UK hospital or minor injury unit. 

Assessing consciousness and the Glasgow Coma Scale 

A neurological examination always begins by evaluating a person’s level of awareness and responsiveness, typically using the Glasgow Coma Scale. A neurological examination is used to check the brain and nervous system for signs of damage or dysfunction after an injury. This scale provides a numerical score based on three specific categories: how well a person can open their eyes, their ability to speak coherently, and how they move in response to instructions. 

In a clinical setting, a “perfect” score is 15, which indicates the person is fully awake, orientated, and able to follow commands. A lower score suggests that the brain is under significant stress or that consciousness is impaired. UK clinicians perform this check repeatedly during the first 24 to 48 hours. This allows them to see a “trend” in the patient’s condition. If the score remains stable or improves, it is a positive indicator of recovery. If the score drops, it is an immediate red flag that requires further investigation, such as a brain scan, to rule out internal bleeding or swelling. 

Checking pupil reactions and visual function 

One of the most vital physical checks in a neurological exam involves the eyes, specifically the reactions of the pupils. A clinician will use a small penlight to observe how quickly the pupils constrict when exposed to light. Because the nerves controlling the pupils are located deep within the brainstem, this test provides a non-invasive way to check the health of the most critical parts of the brain. Under normal circumstances, both pupils should be equal in size and react symmetrically to the light. 

In addition to pupil checks, the exam may involve “tracking” tests, where the patient follows a moving finger or object with their eyes. This helps identify issues with the vestibular system or the coordination of eye movements, which are frequently disrupted during a concussion. If one pupil is larger than the other or fails to react to light, it can indicate a serious increase in pressure within the skull. Clinicians also check for “double vision” or blurriness, as these sensory changes are key markers for assessing the functional impact of the head injury. 

Testing motor function and physical coordination 

The neurological exam includes a thorough assessment of the motor system to ensure that the brain is sending clear and effective signals to the muscles. This usually involves checking muscle strength in the arms and legs. A doctor or nurse will ask the patient to squeeze their hands, push and pull with their arms, and lift their legs against resistance. They are looking for “symmetry,” meaning the strength is the same on both sides of the body. One-sided weakness is a major clinical indicator of a more serious brain injury beyond a simple concussion. 

Coordination and balance are also tested through specific bedside movements. Common checks include the “finger to nose” test, where the patient must touch their own nose and then the clinician’s finger repeatedly, or asking the patient to walk a short distance to assess their “gait.” Because the cerebellum, located at the back of the brain, manages balance, any staggering or lack of coordination can indicate that this region was affected by the impact. The National Institute for Health and Care Excellence provides guidelines for performing neurological observations to ensure patient safety after head trauma. 

Screening for cognitive clarity and orientation 

A concussion is often described as a “functional” injury because it affects how the brain processes information rather than its physical structure. To evaluate this, clinicians perform cognitive screening or orientation checks. This involves asking simple questions to see if the patient knows who they are, where they are, and what the current date is. These are often referred to as questions of “Person, Place, and Time.” 

Beyond basic orientation, the exam may test short-term memory and concentration. A clinician might ask the patient to repeat a short list of words or count backwards from 20. Confusion, a slow response time, or “gaps” in memory regarding the accident are standard signs of a concussion. These cognitive hurdles occur because the brain is experiencing a metabolic energy crisis and is struggling to manage complex tasks. While the patient may look physically fine, these cognitive tests reveal the underlying neurological strain. 

Evaluating sensory responses and reflexes 

Clinicians also check how the body responds to touch and other sensory inputs. This involves testing whether the patient can feel a light touch on their skin in various locations and checking for any numbness or “pins and needles.” These tests ensure that the sensory pathways between the brain, spinal cord, and peripheral nerves are functioning correctly. Any persistent loss of sensation or unusual tingling can indicate that the injury has affected specific neural tracks. 

Reflex checks, such as the well-known “knee-jerk” test, are also used to assess the integrity of the nervous system. While these are less commonly the primary focus in a standard minor concussion, they provide a broader picture of neurological health. In more significant head injuries, abnormal reflexes can signal that the brain’s inhibitory signals are not reaching the spinal cord properly. Together with the motor and sensory checks, these evaluations help the clinical team determine if the injury is limited to a concussion or if there is a risk of more widespread neurological involvement. 

Comparing clinical exams and structural imaging 

It is a common misconception that a brain scan is the only way to “see” a head injury. In fact, a neurological examination is often more useful for managing a concussion than a CT or MRI scan. The clinical exam focuses on how the brain is “working,” whereas a scan only shows how the brain “looks.” In the vast majority of concussions, the brain’s physical structure appears normal on a scan, even when the patient has clear neurological symptoms. 

The following table compares the role of the physical neurological exam versus structural brain imaging: 

Feature	Neurological Bedside Exam	Structural Brain Imaging (CT/MRI)
Primary Focus	Brain function and electrical signals.	Physical structure and bone.
Detects Concussion?	Yes, by identifying functional deficits.	No, usually appears completely normal.
Detects Bleeding?	Identifies the symptoms of a bleed.	Provides a visual picture of blood.
Assessment Tool	GCS, pupils, motor, and cognitive tests.	X-rays or magnetic fields.
Clinical Timing	Performed repeatedly over 48 hours.	Usually a one-off emergency check.
Key Indicators	Changes in awareness or coordination.	Visible blood, swelling, or fractures.

Conclusion 

A neurological examination is a comprehensive check of the brain’s ability to communicate with and control the body following a head injury. By assessing consciousness, pupil reactions, coordination, and cognitive clarity, UK healthcare professionals can safely monitor a patient’s recovery and identify any “red flags” early. Stability in these tests during the first 48 hours is the most reliable indicator that the brain is beginning to heal from a concussion. 

If you experience severe, sudden, or worsening symptoms, call 999 immediately. 

Authority Snapshot (E-E-A-T Block) 

This guide was produced by the Medical Content Team and reviewed by Dr. Stefan Petrov to provide safe, evidence-based information on head injury assessments. The content is strictly aligned with the clinical standards of the NHS and the National Institute for Health and Care Excellence (NICE) regarding neurological observations. Our goal is to help the public understand the medical protocols used to ensure safety and identify serious complications following a concussion.