 General physical exam was unremarkable.  HEENT:  Pupils were equal and respond to light and accommodation bilaterally.  Extraocular movements were intact.  Visual fields were intact to confrontation.  Funduscopic exam revealed no disc pallor or edema.  Retinal vasculature appeared normal.  Face is symmetric.  Facial sensation and strength are intact.  Auditory acuities were grossly normal.  Palate and uvula elevated symmetrically.  Sternocleidomastoid and trapezius muscles are full strength bilaterally.  Tongue protrudes in midline.  Mental status exam: revealed the patient alert and oriented x 4.  Speech was clear and language is normal.  Fund of knowledge, memory, and attention are grossly intact.  Neurologic exam:  Vasomotor system revealed full power throughout.  Normal muscle tone and bulk.  No pronator drift was appreciated.  Coordination was intact to finger-to-nose, heel-to-shin and rapid alternating movement.  No tremor or dysmetria.  Excellent sensory.  Sensation is intact in all modalities throughout. The patient does have notable trigger points diffusely including the occiput, trapezius bilaterally, lumbar, back, and sacrum.  Gait was assessed, the patient's routine and tandem gait were normal.  The patient is able to balance on heels and toes.  Romberg is negative.  Reflexes are 2+ and symmetric throughout.  Babinski reflexes are plantar.