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Neurological Examination Israel Matoth. Neurological Examination Objective:  Determine the functional integrity of central nervous system (CNS) peripheral.

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Presentation on theme: "Neurological Examination Israel Matoth. Neurological Examination Objective:  Determine the functional integrity of central nervous system (CNS) peripheral."— Presentation transcript:

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 Crniosynostosis Low-set earsHpertelorism MicrognatiaCleft lip + palateMacroglossia

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

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…. 4 mo. 7 mo 11 mo

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

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 Ventral suspension Traction Shoulder girdle 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 Primitive reflexes Rooting 0-3m Moro 0-4m ATNR 2w-6m Hand grasp 0-3mToe grasp 0-3m Cross adductor 0-7m

20 Protective Equilibrium Responses Parachute 8-9m  persist voluntarily Propping 4-6m  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 Short V finger Wasting of hand muscles Clinodactily 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 Shagreen patch Ash-leaf-spotSub-ependymal-lesions Café-au-let-spots

27 Sturge Weber Cutaneous hemangioma

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


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