Neurological problems Flashcards
When taking a neurological history from a child what should be done?
Different from adult history taking.
From parent / carer (but don’t forget the child)
If it is for funny turns, need proper witness description (may not be present in clinic)
A thorough history helps us plan the examination.
Whats involved in the history taking?
Family history
Birth history (prenatal / perinatal and postnatal)
Developmental milestones
What are developmental milestones?
Normal for one age may be abnormal or other age.
Reflection of maturation of child’s nervous system.
Delay and abnormal pattern are indicators of underlying neurological diseases.
What are the key principles in neurodevelopment?
Motor development proceeds head to toe fashion.
Primitive reflexes (such as the Moro, grasp, and Galant) are normally present in the term infant and diminish over the next 4 to 6 months of life.
Postural reflexes (such as the positive support reflex, Landau, lateral propping and parachute) emerge at 3 to 8 months of age.
What is the hallmark of an upper motor neuron abnormality in an infant?
Persistence of primitive reflexes and the lack of development of the postural reflexes
What can head circumference show?
Accurate reflection of Brain size and development.
A small head (microcephaly) or a large head (macrocephaly or hydrocephalus) can be key findings in explaining the neurological abnormalities of a child.
What should be done in an examination
General physical examination:
- Somatic growth - measure height and weight and compare percentiles with head circumference.
- Skin search - a careful complete skin search is important. Look for the stigmata of the neurocutaneous syndromes such as café au lait or ash leaf lesions.
Neurology examination
Why should you check for dysmorphic features?
Carefully study the face especially the midface.
Face reflects the brain.
Anomalies of the midface are often associated with underlying brain malformations.
What can be seen in an eye examination?
Can be difficult due to poor cooperation.
“Retina is the window to the brain”.
Fundoscopy can provide valuable information.
How would you approach a neurology examination?
First : Stop, Look and Listen
Second : Make it a game
Third : Save the worst or the last
How do you “Stop, Look and Listen”?
Infants and children do not cooperate for the standard neurological examination.
Need to tailor or child’s age.
Learn more by “hands off” careful observation.
Mental status, cranial nerve examination, coordination by watching spontaneous activity
How can we “Make it a game”?
Make it into a game that engages the child’s curiosity and imagination.
Less threatening and the child is more cooperative when toys are used.
Not much gained by testing power and reflexes.
How do we “Save the worst for last”?
Last part of the examination are all those things that are the most threatening and unsettling to the child.
undressing the child for a complete examination
looking at the fundus
using the auroscope
testing the gag reflex (if at all essential)
measuring the head circumference.
What are some common scenarios in neurolog?
Seizures
Syncope
Movement disorders
Cerebral palsy
What is the definition of cerebral palsy?
An umbrella term covering a group of motor impairment syndromes secondary to non progressive lesions or anomalies in the brain arising in the early stages of development.
In most cases anomaly occurs pre or perinatally.
