Reference — Critical Care

Neuro Assessment Quick Reference

Bedside neuro check components, level of consciousness terminology, pupil findings, motor grading, deterioration warning signs, and documentation cues.

Educational use only. Always interpret findings in clinical context and escalate through appropriate channels per institutional protocol. This material supports nursing education and exam review. It is not medical advice and is not a substitute for clinical judgment, institutional policy, or medical direction. Always follow facility protocols and current provider orders.

Standard Neuro Check Components

Component	Assess	Document
Consciousness	Response to voice, touch, pain	Alert / lethargic / obtunded / stuporous / comatose; GCS E/V/M
Orientation	Person, place, time, situation	Oriented ×1–4; specify what is intact
Pupils	Size (mm), equality, reactivity	PERRL; mm size bilaterally; brisk/sluggish/fixed
Motor	Grip, plantar flexion/dorsiflexion bilaterally	MRC 0–5 per limb; drift; asymmetry
Sensory	Light touch or pinprick bilaterally	Intact / absent / diminished; symmetric vs. asymmetric
Speech	Clarity, word-finding, comprehension	Clear / dysarthric / expressive aphasia / receptive aphasia
Face	Smile, brow furrow, eyelid closure	Symmetric vs. asymmetric; CN VII involvement

Level of Consciousness

Term	Description
Alert	Awake, aware, responds to normal voice
Lethargic	Drowsy; arousable with verbal stimulation; returns to sleep
Obtunded	Requires vigorous verbal stimulation; slow, confused responses
Stuporous	Responds only to painful stimuli; limited purposeful response
Comatose	Unarousable; no meaningful response; eyes closed

Pupil Findings

Finding	Meaning
PERRL	Pupils Equal, Round, Reactive to Light — normal
Fixed + dilated (unilateral)	CN III compression — herniation suspected. STAT notification.
Fixed + dilated (bilateral)	Severe brainstem dysfunction / cardiac arrest. Critical.
Pinpoint	Opioid effect, pontine lesion, or sympathetic disruption
Anisocoria (unequal)	≤1 mm may be physiologic; new onset with neuro change = urgent
Sluggish	Less brisk than baseline — trend closely, may precede fixation

Motor Strength — MRC Scale

Grade	Description
5/5	Full strength against resistance
4/5	Moves against some resistance
3/5	Moves against gravity, not resistance
2/5	Moves only with gravity eliminated
1/5	Trace contraction only
0/5	No movement (plegia)

Acute Deterioration — Notify Provider

•GCS drop ≥2 points from baseline

•New pupil asymmetry, dilation, or loss of reactivity

•New focal deficit (weakness, facial droop, aphasia)

•Loss of previously intact orientation

•Sudden severe headache

•New seizure activity

•Cushing's triad: HTN + bradycardia + irregular respirations

Neuro Check Frequency

Setting	Frequency
Acute stroke / post-op craniotomy	Every 1–2 hours
Neuro ICU (stable)	Every 2 hours
Step-down unit	Every 4 hours
Medical-surgical floor	Every 8 hours or per order
Any acute change	Continuous / immediately; notify provider

Related Resources

Neuro Assessment and Neuro Checks GuideFull conceptual guide with clinical reasoning and deterioration patterns

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GCS Interpretation ChartGCS subscores, ranges, and clinical meaning

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Cranial Nerve Assessment ReferenceAll 12 cranial nerves with function and bedside testing

Open →

Standards & sources

Fact-checked Jun 20, 2026

This page is written to align with Society of Critical Care Medicine (SCCM) · Surviving Sepsis Campaign · American Association of Critical-Care Nurses (AACN). It is an educational summary, not a citation of any single document — always verify specific doses, values, and protocols against current guidelines and your facility policy. How we source content →