2. Neuorlogical assessment -_073811.pptx

Neurological assessment of child

1. Neurological asessment

2. Asessment HISTORY SYMPTOMS Common neuro related symptoms include Vertigo Syncope Dizziness Seizures( convulsions) Motor weakness Paralysis Paresis Monoplegia / monoplegia P araplegia/quadriplegia N europathy

3. Sensory symptom Paresthesiae/ dysesthesiae Hypoesthesia Headache Spinal nerves Dermatomes Myotomes

4. Examination Higher mental function GCS

5. Some terminologies Vertigo Dizziness Faintness Syncope

6. Higher mental function Appearance and behavior Delusions, illusions and hallucinations Orientation & cognition Conscious level Memory General intelligence Released reflexes Speech

7. 1. Appearance and behavior Appearance , posture and behavior Facial expression , speech , mood Patient alert and cooperative? Well groomed? Take interest in surrounding?

8. 2. Delusions, illusions and hallucinations Delusion Illusion Hallucination Thoughts and perception

9. Delusions – fixed, persisting,  false beliefs  that are not consistent with culture / education and cannot be corrected by logic Illusions – misperception of  real external stimulus ; most likely to occur when level of consciousness is declined Hallucinations – false sensory perception experienced  without real external stimulus ; usually experienced as originated in the outside world not as imagination from within the mind SPECIFIC EXAMPLES: Delusion – patient firmly believes that aliens are after him Illusion – an optical trick is used to make patient perceive an alien in front of him, even though there isn’t one there. Hallucination – with senses functioning normally patient sees an alien in front of him, even though there isn’t one there

10. 3. Orientation & Cognition Person Place (home or hospital) Time Orientation Day or night, morning or evening Cognition (knowing of awareness and judgment)

11. 4. Conscious level Level of consciousness Arousal Alert Lethargic Obtunded Stupor Coma

12. 5. Memory Immediate memory(recall) Recent memory Ask names of the public figures Day of the week Name of the month Long term memory Ask important events of the past Memory stored in whole brain 6.General intelligence Patient performance

13. 7. Released reflexes Grasp reflex avoiding response Palmo -mental reflex Snout reflex Glabellar tap reflex 8.Speech fluent/non fluent Content of speech Incomplete or pause

14. 2.Cranial nerves Cranial nerve tests 3. Sensory assessment Positive phenomena ( paresthesiae , dysesthesiae ) e.g. sensory system disease in sciatica Negative phenomena (hypoesthesia) E.g. peripheral neuropathy Primary sensation: Touch, pain, temperature . position, passive movement and vibration Cortical sensation: Two point discrimination, stereognosis, graphesthesia

15. Primary sensation Expose the area to be examined Explain to the patient procedure and response Apply the stimulus to normal site Compare two sides if the sensations are equal on both sides or not Don’t repeat the test leads to conflict and variable Sites to be tested should cover territories of both the peripheral nerves and posterior nerve roots

16. Results: Anesthesia Hypoesthesia dysesthesia

17. 4. Motor system Examine and compare two sides Note the any abnormality and location Bulk and nutrition of muscle Tone of muscle Power of muscle Reflexes Coordination of movements Involuntary movements Gait

18. Motor assessment Bulk and nutrition of muscle Atrophy/wasting Hypertrophy Fasciculation Tone of muscles Resistance felt when joint is moved passively Hypertonia (spasticity, rigidity) Hypotonia

19. Motor assessment Power of muscles. Manual muscle testing. 0-5 grades. Hemiplegia Monoplegia Paraplegia diplegia Quadriplegia

20. Deep tendon reflexes. Ankle jerk Knee jerk Biceps jerk Triceps jerk Brachioradialis jerk

21. Superficial reflexes. Planter reflex(S1) Abdominal reflex(T8,T12) Cremasteric reflex(L1,2) Anal reflex(S3,4) Corneal reflex

22. MOTOR ASSESSMENT Coordination. Smooth accurate and purposeful movement. Require intact sensory, motor, and cerebellar system. If gross motor weakness is present. coordination can not be tested. Loss of coordination is called ataxia.

23. Test for coordination Upper limb. Finger to nose test Finger nose test Lower limb Heel knee test Heel-toe test of gait(tandem walking)

24. Differential diagnosis of sensory and cerebellar ataxia Sensory ataxia Sensory ataxia is due to the loss of sense of position. Test for coordination become worse when the patient close his eyes, otherwise loss of sense and position is compensated with vision. Closure of eye has no affect on cerebellar ataxia. Romberg’s sign.

25. Cerebellar ataxia. Cerebellum is important to maintaining The body posture and equilibrium. Smoothing and synchronizing the timing of muscle contraction . Signs for cerebellar dysfunction. Nystagmus Scanning speech Intention tremors

26. 6.Gait Ask the patient to walk in a straight line and observe the gait Following are some abnormal gait Spastic gait. High stepping gait. Drunken gait. Waddling gait. Parkinsonian gait.

27. The face–hand test. The patient is being asked, “Where did I touch you?” If slightly confused (cortical level or demented), the patient reports, “On my face.”

28. Neuro Assessment Language & Speech : assessed together; located in the dominant hemisphere (left in most, including lefties) LEFT: written & spoken language, reasoning, number skills, scientific knowledge, right hand control RIGHT: insight, art, awareness, imagination, music awareness , left hand control

29. Neuro Assessment Aphasia: a disorder in processing language apraxia of speech : disorder in programming of speech (dominant hemisphere) Motor Sensory Dyslexia Dysgraphia

30. Neuro Assessment Broca’s Aphasia : (motor, expressive) unable to convert thoughts to words; speech limited to “yes/no”, name or 5 words or less; difficulty in finding correct word; difficulty repeating words & writing; understands; Wernicke’s Aphasia : (sensory, receptive) fluent speech; lacks content & meaning; does not understand spoken or written word; substitutes other words or uses non-words; not aware of speaking errors

31. Neuro Assessment Example: A patient with Broca’s might say “where is book”? and a patient with Wernicke’s might say “where is the paper of the cover”? Global Aphasia: both motor and receptive; non-fluent speech with poor comprehension and repetitive ability

32. Neuro Assessment Dysarthria… .. loss of articulation, phonation d/t muscle weakness or loss of breath control difficulty in articulation….. Scanning speech ……slow……separate words…..ass… ess ….me… nt Slurring speech ….imprecise …slurred….. azzezzmeeenntt Stammering …….abrupt…..repetition of last word..

33. Scale GCS Paeds GCS