1. The Neuro Exam
Yes, you really do have to wake them up and do
this
Last Updated by Lindsay Pagano
Summer 2013
2. What are the components and how do I
document them?
Neuro:
• Mental Status
• Language, Speech
• Cranial Nerves
• Motor
• Reflexes
• Sensory
• Cerebellar
• Gait
3. What are we checking and how?
Mental Status
• What?
– Level of alertness, awareness
– Degree of interaction
– Orientation
– Following commands
– Older children: naming objects, simple calculations, extinction, neglect,
fund of knowledge
– Difference from baseline
• How?
4. Language, Speech
• Language
– comprehension
– spontaneous, fluent
– appropriate content
– other things you can check: repetition, naming objects, reading, writing
• Speech
– prosody
– volume
– rate
– dysarthria
7. Motor
• Tone
• Muscle bulk
• Strength: check agonist/antagonist pairs
– Grading system
• 0: no movement
• 1: can see muscle contraction but no movement
• 2: can move with gravity eliminated
• 3: can move against gravity
• 4: can resist opposition to some extent, but not full (+, - also)
• 5: full strength
– Pronator drift: correct position!
– Orbiting
• Abnormal movements
8. Reflexes
• Grading system
– 0: absent
– 1+: hyporeflexic
– 2+: normal
– 3+: brisk, without clonus
– 4+: brisk, with clonus
• More pathologic descriptors: crossed, spreading
• Where to check
• Clonus
– Sustained
– Unsustained
• Other reflexes: pectoral, grasp, suck, moro, jaw jerk
• Plantar response
9. Sensory
• How and what part of the nervous system are we checking?
– Light touch
– Pinprick
– Temperature
– Vibration
– Joint position sense
• Checking a level
• Romberg- correct positioning!
11. • Casual
• Toe
• Heel
• Tandem
• What are those last 3 testing?
Gait
12. Other Neuro Rotation Tips
• Neuro exam on all patients
• Report all AEDs in per dose and mg/kg/day
• Know the patients primary neurologist
• When applicable know the last head imaging and EEG done and
the results
• Make sure after their inpatient stay they have follow up and a
breakthrough seizures plan/medication
• In clinic, be sure to ask birth history, developmental history (gross
motor, fine motor, language, social), about school performance,
therapies