Table 3. Key points during the neurological examination.

Key points during neurological examinations
1) Check that nostrils are unobstructed and that the airflow is normal.
2) Present different odors to the patient, while closing one nostril at a time with your finger on the ipsilateral upper lateral cartilage. Ask for a quick and deep inhalation and then for identification of the odors.
3) Preferably, formally validated psychophysical tests should be performed (for example: UPSIT test).
4) Avoid using irritating substances like alcohol and ammonia.
5) Do not forget to examine all cranial nerves, with particular attention to the facial nerve (especially the gustatory portion), trigeminal nerve and optic nerve (fundoscopy should always be performed).
6) During the examination, search for signs of neurological or systemic diseases that may be commonly associated with olfactory loss (e.g. cleft lip in Kallmann syndrome, nystagmus due to phenytoin use, rigidity and tremor from Parkinson’s disease, muscular atrophy from amyotrophic lateral sclerosis or motor impersistence from Huntington’s disease).

UPSIT: University of Pennsylvania Smell Identification Test.