Neurology clinical exam Flashcards
describe the fog test
ask the child to walk on the outer side of their heels and then on the inner portion
They will naturally posture their arms to assist balance
This will make any neurological deficits, particularly of the upper limbs, more obvious
what is the most likely aetiology for spastic diplegia
IVH –> PVL secondary to prematurity
what is the most likely cause for spastic hemiplegia?
Stroke
what are the most common causes of spastic quadriplegia?
Global insult
Hypoxic insult in the third trimester
Dyskinetic CP
Global hypoxic insult
Eg cord prolapse, antepartum haemorrhage, ruptured uterus
May also occur due to kernicterus
ataxic CP cause
most often genetic
Describe your approach to possible causes of CP
Prenatal: TORCH infections, malformations of cortical development, toxins, placental insufficiency, cerebrovascular accident, trauma, chromosomal abnormality
Perinatal: abruption, perinatal asphyxia, hypoglycaemia, kernicterus, HSV encephalitis and sepsis, prematurity with IVH
Post natal: trauma (accidental or NAI), hypoxia (choking, drowning), meningitis, toxin exposure
describe each stage of the GMFCS score
1 - can climb stairs without the railing. Can run and jump. Limited with speed and coordination
2 - walk in most settings, use a rail when climbing stairs. May use a handheld mobility device or wheelchair for long distances. May struggle in crowds or confined places. Ability to jump or run limited
3 - Walk using a handheld mobility device in indoor settings. May use a powered chair for long distances or self propel over short distances
4 - Uses mobility aids or powered mobility in most settings. May briefly stand or walk for transfers.
5 - Requires mobility aids/powered chair for all mobility. Limited abilities to maintain truncal tone and may need harness
explain the significance of the parachute reflex
If the baby’s head is turned towards the floor they should extend both arms towards the floor
Usually develops around 8-9 months
can look for asymmetry of this reflex ?hemiplegia
Describe the components of the 180 degree manoeuvre
Lie supine - what position is adopted?
Pull to sit by hands - grasp, neck tone
Allow to sit - can they maintain? Check lateral righting/propping
Axillary suspension - is there normal tone, scissoring, automatic walking?
Tilt sideways - is there head righting?
Ventral suspension - is there increased or decreased tone in this manoeuvre
Parachute reflex
Place prone
crossed adductor reflex
The adductor muscles of the opposite leg contract, may also cause leg extension
Signifies hyperreflexia of the side contralateral to the tendon hammer
how might one screen for complications of cerebral palsy
- Measure the head (for microcephaly, or macrocephaly due to hydrocephalus).
- Check the vision, visual fields and extraocular movements (for myopia, squint).
- Check the hearing (for sensorineural deafness).
- Check the ears (for chronic serous otitis media).
- Ask to check the gag reflex (bulbar dysfunction).
- Look at the teeth (for dental caries).
- Look at the back (for kyphoscoliosis).
- Inspect and auscultate the chest (for chest infection).
- Palpate the abdomen (for constipation).
- Examine the hips (for dislocation) and other joints for contractures
- Screen nutritional status (demonstrate fat and protein stores).
- Perform a functional assessment for activities of daily living (e.g. offer cup, spoon,
fork, knife, comb, toothbrush; ask the child to put on a piece of clothing).
glucose transporter 1 deficiency is a potential CP mimicker
what type of CP does it mimick?
Dyskinetic
Responds to ketogenic diet
describe the potential adverse effects of botulinum A tpxin use
BTX-A can
diffuse intra-axonally and across fascial planes, causing distant side effects. Side
effects can be gait-related, including deterioration in walking, local weakness,
unsteadiness, increased falls, and fatigue. Other side effects have included
aspiration pneumonia (impaired pharyngeal function from systemic spread of
small amounts of BTX-A), local pain, worsening of strabismus, dysphagia, muscle
atrophy, global weakness, and incontinence of urine and faeces. Drug interactions
include non-depolarising muscle relaxants and aminoglycosides, causing
potentiation of neuromuscular blockade.
describe the potential adverse effects of botulinum A tpxin use
BTX-A can
diffuse intra-axonally and across fascial planes, causing distant side effects. Side
effects can be gait-related, including deterioration in walking, local weakness,
unsteadiness, increased falls, and fatigue. Other side effects have included
aspiration pneumonia (impaired pharyngeal function from systemic spread of
small amounts of BTX-A), local pain, worsening of strabismus, dysphagia, muscle
atrophy, global weakness, and incontinence of urine and faeces. Drug interactions
include non-depolarising muscle relaxants and aminoglycosides, causing
potentiation of neuromuscular blockade.
describe the complications of intrathecal baclofen pump
include central side effects such as apnoea, respiratory
depression, bradycardia, hypotension and sedation, mechanical complications
including pump or side-port failure, catheter kinks, extrusions or dislodgement,
cerebrospinal fluid fistula, local infection and meningitis; also, rapidly progressive
scoliosis has been reported
