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)
ברוב הילדים המפותחים תקין בגיל ביה'ס הבדיקה אינה שונה מהמבוגר.* בילדים קטנים יותר חלק גדול מההסתכלות יכול להתבצע בזמן לקיחת האנמנזה כאשר הילד על ההורה או משחק בחפצים *
צורת הראש- ‘macrocephaly, microcephaly, crniosynostosisהשטחת הocciput- בילדים עם אחור התפתחותי, כלי דם בולטים ביל"ג התבלטות האוקסיפוט
תנוחה – המיפרטית, דיסטונית

7. Hpertelorism Low-set ears Crniosynostosis Macroglossia
Remind Low set Vs. Posterior rotation* Hypertelorism Vs. epicantal folds *Frontal bossing
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….
העדפת צד לפני גיל שנתיים חשודה *
7 mo
11 mo
4 mo.

11. הליכה TANDEMאחרי גיל 4 שנים

12. Cranial Nerves III, IV, VI,
Catch the otoscope light, follow light, face, toy.
Bilateral
3rd nerve palsy
6th nerve palsy
יש לציין ניסטגמוס*
יש לציין אפסוקלונוס*
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. Primitive reflexes 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