Pediatric Neuro Assessment

Question 1

Signs of severe neurologic disease in infants

Answer 1

• extreme irritability
• persistent asymmetry of posture
• persistent extension of extremities
• constant turning of head to one side
• marked extension of the head, neck, or extremities (opisthotonus)
• severe flaccidity
• limited response to pain
• sometimes seizures

Question 2

How would the FNP assess CN I in an infant?

Answer 2

very difficulty to test

Question 3

How would the FNP assess CN II in an infant?

Answer 3

Visual acuity - have infant regard your face and look for facial response and tracking

Question 4

How would the FNP assess CN II and III (response to light) in an infant?

Answer 4

Darken room, raise infant to sitting position to open eyes - use light and test for optic blink reflex (blink in response to light) - use the otoscope light (without speculum) to assess pupillary responses

Question 5

How would the FNP assess CN III, IV, and VI (extraocular movements) in an infant?

Answer 5

Observe how well the infant tracts your smiling face (or a bright light) and whether the eyes move together

Question 6

How would the FNP assess CN V in an infant?

Answer 6

(Motor) test rooting reflex - test sucking reflex (watch infant suck breast, bottle, or pacifier) and strength of suck

Question 7

How would the FNP assess CN VII (facial) in an infant?

Answer 7

Observe infant crying and smiling; note symmetry of face

Question 8

How would the FNP assess CN VIII (acoustic) in an infant?

Answer 8

test acoustic blink reflex (blinking of both eyes in response to a loud noise)

Question 9

How would the FNP assess CN IX, X (swallow) in an infant?

Answer 9

observe coordination during swallowing

Question 10

How would the FNP assess CN XI in an infant?

Answer 10

Observe symmetry of shoulders

Question 11

How would the FNP assess CN XII in an infant?

Answer 11

Observe coordination of sucking swallowing, and tongue thrusting - pinch nostrils; observe reflex opening of mouth with tip of tongue to midline

Question 12

When assessing the sensory function in an infant, flicking the infant’s sole with your finger causes a change in facial expression and crying but no withdrawal. You know this response is:

Answer 12

abnormal - weakness or paralysis may be present

Question 13

An infant demonstrates a strong grasp of the examiner’s finger when it is placed in the infant’s palm, what reflex is being demonstrated and at what age does this reflex occur?

Answer 13

palmar grasp reflex - age birth to 3-4 months

Question 14

When held in an upright position with soles of the feet touching the surface of the table, the infant flexes the hip and knee and the other foot will step forward -alternating stepping will occur. What reflex is this?

Answer 14

Placing and stepping reflex - age birth (best after 4 days) variable age to disappear
Absence may indicate paralysis (breech delivery babies may not have a placing reflex)

Question 15

With the child lying supine, turn the head to one side, the arm and leg on the side the head is turned toward will extend while the opposite arm/leg will flex. What reflex is this?

Answer 15

Asymmetric Tonic Neck Reflex - age birth to 2 months
Persistence beyond 2 months suggests asymmetric central nervous system development and sometimes predicts the development of cerebral palsy

Question 16

When the infant’s held body is lowered abruptly about 2 feet, the arm will abduct and extend, hands will open, and legs will flex - the infant may cry. What reflex is this?

Answer 16

Moro Reflex (startle reflex) -age birth to 4 months
Persistence beyond 4 months suggests neurologic disease (e.g. cerebral palsy) - beyond 6 months strongly suggests it

Question 17

When an infant is held in the prone position with one hand and stroking one side of the back 1cm from midline with the other from the shoulder to buttocks - the spine will curve toward the stimulated side. What reflex is this?

Answer 17

Trunk Incurvation (Galant) reflex test - age birth to 2 months
Absence suggests a transverse spinal cord lesion or injury - persistence may indicate delayed development

Question 18

When assessing for this reflex, the infant is suspending in the prone position and the head is slowly lowered toward a surface- the arms and legs will extend in a protective fashion.

Answer 18

Parachute Reflex - age 8mo and does not disappear

Delay in appearance may predict future delays in voluntary motor development

Question 19

To assess for this reflex, the perioral skin at the corners of the infant’s mouth is stroked - the mouth will open and the infant will turn the head toward the stimulated side and suck

Answer 19

Rooting reflex - age birth to 3-4 months

Absence of rooting indicates severe generalized or central nervous system disease

Question 20

When assessing for this infant reflex, you suspend the infant prone with one hand. The head will lift up and the spine will straighten

Answer 20

Landau reflex - age birth to 6 months

Persistence may indicate delayed development

Question 21

To assess for this infant reflex, hold the infant around the trunk and lower until the feet touch a flat surface. The hips, knees, and ankles will extend, the infant will stand up, partially bearing weight, sagging after 20-30 seconds

Answer 21

Positive Support Reflex - age birth or 2mo until 6mo
Lack of reflex suggests hypotonia or flaccidity - fixed extension and adduction of legs (scissoring) suggests spasticity from neurologic disease, such as cerebral palsy

Question 22

In newborns, this symptom may be a sign of neurologic insult or may reflect a variety of metabolic, infectious or other constitutional abnormalities, or environmental conditions such as drug withdrawal

Answer 22

persistent irritability

Question 23

You see facial grimacing in your 8-mo-old patient. You understand that this/these CN(s) is/are intact:

a) V and VII
b) VIII
c) IX and X
d) III, IV, and VI

Answer 23

a) V (Trigeminal) and VII (Facial)