NEUROLOGICAL ASSESSMENT

1. Assessment of Pediatric Nerves System

2. INTRODUCTION
• The nervous system consists of the
• Central Nervous System (CNS),
• Peripheral Nervous System(PNS),
• Autonomic Nervous System(ANS).
• Together these three components integrate all
Physical, Emotional, and Intellectual Activities.

3. INTRODUCTION
• The CNS includes the
• Brain .
• Spinal Cord.
• These two structures collect
and interpret Voluntary and
Involuntary sensory and
motor signals.

4. Assessment :-
• The Assessment of nerves System consist of
• History
• Examination
• Investigation

5. PRESENTING COMPLAINT
Brief Statement Of Primary Problem (Including Duration) That
ThatCausedFamilyToSeekMedicalAttention
• Ask about the symptoms:
• What are they?
• Which part of the body do they affect? Are they localised or
more widespread?
• When did they start?
• How long do they last for?
• Were they sudden, rapid or gradual in onset?
• Is there a history of trauma?
History

6. Ask About Any Associated Symptoms
•Fever
•Headache
•Numbness, cold or warmth
•Weakness, unsteadiness, stiffness
•Nausea or vomiting
•Visual disturbance
•Altered consciousness
•Photophobia

7. • Past Medical History
• Some neurological problems can present years
years after a causative event.
• Major medical illnesses
• Previous hospital admissions with dates and
diagnoses
• Current medications
• Known allergies (not just drugs)
• Immunization status - be specific, not just up to
date

8. • Past Surgical History
• Major surgical illnesses-list operations and dates
• Trauma-fractures, lacerations

9. Con, History
• Post Natal History
• Delivery & Post Delivery Are Important In The
History Its Give Clue In The Diagnosis In Some
Diseases

10. • Pregnancy and Birth History
• Maternal health during pregnancy: bleeding,
trauma, hypertension, fevers, infectious illnesses,
medications, drugs, alcohol, smoking, rupture of
membranes
• Gestational age at delivery
• Labor and delivery - length of labor, fetal distress,
type of delivery (vaginal, cesarean section), use of
forceps, anesthesia, breech delivery
• Neonatal period - Apgar scores, breathing
problems, use of oxygen, need for intensive care,
hyperbilirubinemia, birth injuries, feeding

11. • Developmental History
• Ages at which milestones were achieved and current
developmental abilities - smiling, rolling, sitting alone,
crawling, walking, running, 1st word, toilet training,
riding tricycle, etc
• School-present grade, specific problems.
• Behavior - enuresis, thumb sucking, pica, nightmares
etc.
• Feeding History
• Breast or bottle fed, types of formula, frequency and
amount, reasons for any changes in formula
• Solids - when introduced, problems created by specific
types

12. • Family History
• Illnesses - cardiac disease, hypertension, stroke, diabetes,
cancer, abnormal bleeding, allergy and asthma, epilepsy
• Mental retardation, congenital anomalies, chromosomal
problems, growth problems, consanguinity.
• Social
•Living situation and conditions - daycare, safety issues
•Composition of family
•Occupation of parents

13. Examination
• General Examination
• Weigh
• Height
• Head Circumference
• Systemic Examination

14. meningeal signs
•Kernig's sign.
•Brudzinski's sign.

15. • A Complete Neurologic Assessment Consists Of :
• MentalStatus(Memory, Orientation, Calculations )
• CranialNerveAssessment
• ReflexTesting
• MotorSystemAssessment
• SensorySystemAssessment
• Coordination
• Gait

16. Cranial Nerves
I. Olfactory
II. Optic
III.Oculomotor
IV.Trochlear
V. Trigeminal
VI.Abducens
VII.Facial

17. VIII.Vestibulocochlear
IX.Glosopharyngeal
X. Vagus
XI.spinal Accessory
XII. Hypoglossal
Cranial Nerves

18. Motor System
• Observing the child's posture and simple
maneuvers such as retrieving a ball or
running outside the examination room
can check motor integrity. The following
grading system can be used for assessing
muscle strength:
• 0 - No muscle contraction
• 1 - Flicker or trace of contraction
• 2 - Active movement without gravity
• 3 - Active movement against gravity
• 4 - Active movement against gravity and
resistance

19. Sensory
• The sensory exam includes testing for: pain
sensation (pin prick), light touch sensation
(brush), position sense
• Object Discrimination, Which Tests For
Higher Cortical Functions, Can Be Done
Using Coins, Paper Clips, Or Rubber Bands.
• Stereognosis: The ability to recognize an object
by feel.
• Graphesthesis: “Draw” a number in the palm
of the person’s hand and ask them to identify
the number.

20. Reflexes.
• Jaw Jerk (CN V)
• Biceps (C5-6)
• Triceps (C6-8)
• Brachioradialis (C5-6),
• Patellar (L2-4)
• Ankle (S1-2).
• + Babinski's sign = dorsiflexion of the great toe and fanning of
the toes. Can be normal up to 1 year of age
• Clonus =abnormal movement marked by alternating contraction
and relaxation of a muscle occurring in rapid succession.
Grade Description
0 Absent
1+ Hypoactive
2+ "Normal"
3+
Hyperactive without
clonus
4+ Hyperactive with Clonus

21. Coordination
• Rapid Alternating Movements
• Point-to-Point Movements
• Balance Test
• Romberg's Sign
• patient's inability to remain immobile with
his feet together and eyes closed.

22. Gait
Ask the patient to:
•Walk across the room, turn and come
back
•Walk heel-to-toe in a straight line
•Walk on their toes in a straight line
S1
•Walk on their heels in a straight line
L5
•Rise from a sitting position

23. Neurological examination of the infant.
• 1) Posture and muscle
tone
• 2) Primitive reflexes

24. Posture and muscle tone.
• 1) Resting Posture -
observing the infant
undressed. The infant
should have flexion of the
elbows, hips, and knees .
• 2) Passive Tone -
determining resistance of
passive movements of the
joints while the infant is
awake and not crying.
• 3) Active Tone - traction
response up to 3 months of

25. Primitive reflexes.
• -Present From The Time Of
Birth
• -Represents Spinal Reflexes
Until The Infant Becomes
Older And Higher Cortical
Functions Suppress Them.

26. • Sucking Reflex
• Rooting Reflex
• Moro Reflex
• Tonic Neck Response
• Palmar And Plantar Grasp Reflexes
• Parachute Response
• Reflex Placing And Stepping Responses
• Horizontal (Ventral) Suspension (Landau
(Landau Reflex)
Primitive reflexes.

27. Thank you