Neurological Examination

Israel Matoth

Neurological Examination

Objective:

Determine the functional integrity of

central nervous system (CNS)

peripheral nervous system (PNS) Detecting and localizing sites of dysfunction

AnamnesisPresenting problem • timing and mode of onset • coursePast medical history I. • antenatal • perinatal • neonatal Possible insult: bleeding, infection, hypoxia, drugs, trauma - Warning signs: weight problems hypoglycemia, hypocalcaemia, severe jaundice, feeding difficulties, abnormal activity,

Anamnesis

II. •Development • Growth • Behavior

Milestones: delay, slowing, cessation, regression relation to prior illness? Trauma?

III. • Family history neuromuscular developmental

Neurological Examination (older children & adolescents)

Mental status & language function Cranial nerves Gross motor function Muscle strength Gait and station Balance and coordination Sensory system Deep tendon reflexes

Neurological Examination (the younger child)

I. Observation: Level of alertness Interest in people & environment Facies, head shape, body habitués

( dismorphic Features)

Crniosynostosis

Low-set earsHpertelorism

MicrognatiaCleft lip + palateMacroglossia

Neurological Examination (the younger child)

Spontaneous movements, position, posture

DystoniaFrog - positionRt. hemiparesis

Neurological Examination (the younger child)

Spontaneous vocalization, quality & pitch Walk, run, stoop, rise from floor

Gower’s Sign

Detailed assessment (playing & drawing):

Handedness Mental status + language

+ fine and gross motor skills

Denver Developmental Screening Test

- engaging the child in play: keys, toys, dolls….

4 mo.

7 mo 11 mo

Cranial Nerves

III, IV, VI,

Catch the otoscope light, follow light, face, toy.

Extra-ocular movement exam

Bilateral3rd nerve palsy

6th nerve palsy

Cranial Nerves

VIII

Looking ar direction of sound – 3m

Cranial Nerves

VII, IX , X, XII

Make face, stick out tongue, blow balloon, say aahh…

Peripheral VII n palsy

Central VII n palsy Tongue fasiculations

Cerebellar function

Pat-a cake games : rapid alternate movement Reach for a toy : dysmetria

Muscle tone

Resistance to passive motion Active motion + motion against resistance

( preschool and older: push- pull games )

Neonates and young infants

Ventral suspensionTraction

Shoulder girdle

Heel to ear

Scarf-sign

Deep tendon reflexes

(shoes off) brisk (+3) up to 6 months, then (+2).

tap on finger: Achilles, patellar

foot ball + ext. : Achilles

Openheim (tibia)

Primitive reflexesRooting 0-3m

Moro 0-4m

ATNR2w-6m

Hand grasp 0-3m Toe grasp 0-3m

Cross adductor 0-7m

Protective Equilibrium Responses

Parachute 8-9m persist voluntarily

Propping4-6m persist voluntarily

(Undress by Parent)

Fontanel's and sutures

Head circumference (infant +toddler)

Growth rate: 2,2,1,1,1,0.5,0.5,0.5,……1y

Microcephaly: 2SD below mean

Primary (<7m)

Secondary

Macrocephaly: >2SD above mean - meglencephly - hdrocephly:

•communicating • noncommunicating

Dismorphic features

Short V finger

Wasting of hand muscles

Clinodactily

Simian line

neck and back midline

Occult Spinal dysraphism

SkinNeurofibromatosis 1

fibromas

Café-au-let-spots

Axillary freckles

hyper pigmentation

Tuberous sclerosis Adenoma sebaceous

Shagreen patch

Ash-leaf-spot Sub-ependymal-lesions

Café-au-let-spots

Sturge Weber

Cutaneous hemangioma

Cranial Nerves II ( at the end of exam)

Reaction to light, follow objects

Cataract

Papilledema

Optic atrophy