Neurological Examination

1. Neurological Examination Israel Matoth

2. Neurological Examination Objective: • Determine the functional integrity of central nervous system (CNS) peripheral nervous system (PNS) • Detecting and localizing sites of dysfunction

3. Anamnesis Presenting problem •timing and mode of onset • course Past 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,

4. Anamnesis II. •Development • Growth • Behavior Milestones:  delay,  slowing,  cessation,  regression relation to prior illness? Trauma? III.• Family history neuromuscular developmental

5. 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

6. Neurological Examination (the younger child) I. Observation: • Level of alertness • Interest in people & environment • Facies, head shape, body habitués ( dismorphic Features)

7. Hpertelorism Low-set ears Crniosynostosis Macroglossia Cleft lip + palate Micrognatia

8. Neurological Examination (the younger child) • Spontaneous movements, position, posture Frog - position Rt. hemiparesis Dystonia

9. Neurological Examination (the younger child) • Spontaneous vocalization, quality & pitch • Walk, run, stoop, rise from floor Gower’s Sign

10. 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…. 7 mo 11 mo 4 mo.

12. Cranial Nerves • III, IV, VI, Catch the otoscope light, follow light, face, toy. Bilateral 3rd nerve palsy 6th nerve palsy Extra-ocular movement exam

13. Cranial Nerves • VIII Looking ar direction of sound – 3m

14. 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

15. Cerebellar function • Pat-a cake games : rapid alternate movement • Reach for a toy : dysmetria

16. Muscle tone • Resistance to passive motion • Active motion + motion against resistance ( preschool and older: push- pull games )

17. Neonates and young infants Shoulder girdle Traction Ventral suspension Heel to ear Scarf-sign

18. Deep tendon reflexes (shoes off) • brisk (+3) up to 6 months, then (+2).  tap on finger: Achilles, patellar  foot ball + ext. : Achilles Openheim (tibia)

19. Primitivereflexes Moro 0-4m Rooting 0-3m Cross adductor 0-7m Hand grasp 0-3m Toe grasp 0-3m ATNR 2w-6m

20. Protective Equilibrium Responses Propping 4-6m  persist voluntarily Parachute 8-9m persist voluntarily

21. (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

22. Macrocephaly: >2SD above mean - meglencephly - hdrocephly: •communicating • noncommunicating

23. Dismorphic features Clinodactily Wasting of hand muscles Short V finger Simian line

24. neck and back midline Occult Spinal dysraphism

25. Skin Neurofibromatosis 1 fibromas Café-au-let-spots Axillary freckles hyper pigmentation

26. Tuberous sclerosis Adenoma sebaceous Café-au-let-spots Shagreen patch Ash-leaf-spot Sub-ependymal-lesions

27. Sturge Weber Cutaneous hemangioma

28. Cranial Nerves • II ( at the end of exam) Reaction to light, follow objects Cataract Papilledema Optic atrophy