CNS examination in children
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This document provides an overview of how to examine the central nervous system. It describes how patients may present with neurological issues and lists the areas to examine, including higher functions, cranial nerves, motor system, reflexes, and sensory systems. The examination involves assessing consciousness, orientation, memory, attention, intelligence, speech, and gait. It also details how to test individual cranial nerves and provides examples of involuntary movements, signs of meningeal irritation, and cerebellar signs. The goal of the examination is to thoroughly evaluate neurological function.
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CNS examination in children
- 1. CNS EXAMINATION by Dr. Gobinda Prasad Pradhan
- 2. How they present • Altered sensorium • Loss of consciousness • Loss of attained milestones • Seizure • Abnormal movements • Dev. Delay • Aspiration of feeds • Weakness • Ataxia, nystagmus • Disturbance of speech, vision, hearing • Loss of bladder & bowel movement………& many more ©Dr. Gobinda Pr. Pradhan
- 3. EXAMINATION • Higher function • Cranial nerve • Motor • Involuntary movements • Reflex • Sensory system • Autonomic function • Cerebellar signs • Signs of meningeal irritation • Skull & spine • PNS • Locomotor system ©Dr. Gobinda Pr. Pradhan
- 4. ©Dr. Gobinda Pr. Pradhan
- 5. HIGHER FUNCTION COMA IS G C : Consciousness O : Orientation M : Memory A : Attention I : Intelligence S : Speech G : Gait ©Dr. Gobinda Pr. Pradhan
- 6. Consciousness : ability to relate to both self & surroundings Level of Consciousness • Drowsy • Obtundation • Stupor • Delirium • Light coma • Deep coma • Falccid coma ©Dr. Gobinda Pr. Pradhan
- 7. Consciousness ©Dr. Gobinda Pr. Pradhan
- 8. Orientation • Time • Place • Person ©Dr. Gobinda Pr. Pradhan
- 9. MEMORY • Immediate • Short term • Long term ©Dr. Gobinda Pr. Pradhan
- 10. Attention Digit repetition test • The digit span test consists of telling the person that you are going to give him a short test. The person is then told to listen carefully because you will say a series of numbers and ask him to repeat them back to you in the same order you say them. • The first series is three numbers, such as "3, 9, 2." Each number is said in a monotone voice, one second apart. The person repeats those numbers back to you. • The next step is to speak a series of four numbers, such as, "4, 7, 3, 1." Again, the individual repeats those back to you. • Continue in the same manner by increasing the series of numbers to five and ask the person to repeat the numbers back to you. Some test versions stop after a series of five numbers, while other versions continue increasing the series of numbers by one each time until the answers are incorrect. ©Dr. Gobinda Pr. Pradhan
- 11. Intelligence • Calculation & abstract thinking ©Dr. Gobinda Pr. Pradhan
- 12. Speech • Is a function of dominant hemisphere • Involves Higher cortical function, muscle articulation, voice production • Delayed speech • no word up to 18 m. • Or no sentence up to 3yrs. • Slurred speech……………………(pyramidal lesion). • Monotonus speech …………….(extrapyramidal lesion). • Staccato speech…………………(cerebeller lesion) ©Dr. Gobinda Pr. Pradhan
- 13. GAIT • Stance : is the way a person stands • Gait : is the way a person walks  Hemiparetic gait  Ataxic gait  Shuffling gait  High stepping gait  Spastic or scissoring gait  Waddling gait ©Dr. Gobinda Pr. Pradhan
- 14. Can u recognise ? ©Dr. Gobinda Pr. Pradhan
- 15. Can u recognise ? ©Dr. Gobinda Pr. Pradhan
- 16. Can u recognise ? ©Dr. Gobinda Pr. Pradhan
- 17. Can u recognise ? ©Dr. Gobinda Pr. Pradhan
- 18. Can u recognise ? ©Dr. Gobinda Pr. Pradhan
- 19. CRANIAL NERVE • I • II • III • IV • V • VI • VII • VIII • IX • X • XI • XII ©Dr. Gobinda Pr. Pradhan  Olfactory  Optic  Occulomotor  Trochlear  Trigeminal  Abducens  Facial  Vestibulocochlear  Glossopharyngeal  Vagus  Spinal accessory  hypoglossal
- 20. OLFACTORY • Difficult to examine in children • m/c/c for poor smell perception in children ? • Tested from 5 yr onwards ©Dr. Gobinda Pr. Pradhan
- 22. OPTIC NERVE • Visual aquity (snellens, Jaegers,Menace) • FOV (perimetry, confrontation method, menace) • Colour vision (Isihara) • Fundus ©Dr. Gobinda Pr. Pradhan
- 23. 346 • Ptosis • Pupil(Pupil size,LR) • Squint • Nystagmus • Diplopia ©Dr. Gobinda Pr. Pradhan
- 24. Which manoeuvre is this ? DOLL’S EYE / OCCULO-CEPHALIOC REFLEX ©Dr. Gobinda Pr. Pradhan
- 25. LIGHT REFLEX • Afferent….. Optic nerve. • Center……..midbrain.(3rd nerve nuclei ) • Efferent……3rd cr. N. to both eyes • Direct/Consensual ©Dr. Gobinda Pr. Pradhan
- 26. TRIGEMINAL Sensory : • Ophthalmic • Maxillary • Mandibular Motor: • Masseter • Temporalis • Pterygoid Reflexes: • Corneal reflex • Conjunctival reflex • Jaw reflex Clench the teeth Side to side movement against resistance ©Dr. Gobinda Pr. Pradhan
- 27. FACIAL • Sensory : Ant 2/3rd of tongue • Motor : • Asymm. of forehead m/s • NL fold obliteration • Deviation of mouth with drooling • Able to close his eyes • Prominence of platysma ©Dr. Gobinda Pr. Pradhan
- 28. SCARY?? ©Dr. Gobinda Pr. Pradhan Bell’s phenomenon
- 29. VESTIBULOCOCHLEAR • Difficult to examine • Cochlear • Watch test/Rinne/Weber • Vestibular • Calorie test • Unterberger’s test • Tandem walking ©Dr. Gobinda Pr. Pradhan
- 30. IX & X tested together Gag reflex…absent in bulber palsy UMN exaggarated in pseudo bulber palsy LMN Uvula ….normally central & mobile. • In unilateral lesion….uvula deviate to healthy side • In bilateral lesion…uvula is central but immobile ©Dr. Gobinda Pr. Pradhan
- 31. ©Dr. Gobinda Pr. Pradhan
- 32. GLOSSOPHARYNGEAL • Sensory : post 1/3rd of tongue(can’t be done) • Motor : Stylopharyngeus • Reflex : • Gag reflex • Palatal reflex ©Dr. Gobinda Pr. Pradhan
- 33. VAGUS • Sensory : touch the palate & pharynx • Motor : Uvula position(say aaahh) • Reflex : • Gag reflex • Palatal reflex ©Dr. Gobinda Pr. Pradhan
- 34. SPINAL ACCESSORY • SCM • Trapezius : shoulder shrugging ©Dr. Gobinda Pr. Pradhan
- 35. HYPOGLOSSAL • Bulk : wasting/Atrophy • Power : Spastic/ Flaccid ©Dr. Gobinda Pr. Pradhan
- 36. MOTOR SYSTEM • Bulk (Size, Shape, Symmetry) • Tone • Power ©Dr. Gobinda Pr. Pradhan
- 37. Tone (resistance offered by m/s to passive stretch) • Inspection • Position at rest : frog-leg posture • Hold them in axilla : slips/scissoring • Palpation • Firm • Loose • Hard • Rubbery • Limbs are moved passively at each joint to assess the tone ©Dr. Gobinda Pr. Pradhan
- 38. Power (Force that can be voluntarily generated) • Fix the proximal joint ©Dr. Gobinda Pr. Pradhan
- 39. Involuntary movements • Tremor • Chorea • Athetosis • Ballismus • Dystonia • Myoclonus • Fasciculation • Tics ©Dr. Gobinda Pr. Pradhan
- 40. REFLEXES • Superficial • Corneal/conjunctiva • Palatal • Abdominal • Cremasteric • Anal • Plantar • Deep • Jaw • Biceps • Supinator • Triceps • Knee • Ankle ©Dr. Gobinda Pr. Pradhan
- 41. Sensory system • Lateral column sensation (Light touch, Pain, temp.) • Posterior column sensation (Vibration, Propriosensation, Romberg’s test, Pressure) • Cortical sensation • Position sense • Tactile localization • 2 point discrimation • Sensory inattention • Stereognosis • Agraphasthesia ©Dr. Gobinda Pr. Pradhan
- 42. Autonomic system • BP • Sweating • Bladder • Bowel ©Dr. Gobinda Pr. Pradhan
- 43. Signs of meningeal irritation • Neck rigidity • Tripod sign • Head drop • Kernig’s sign • Brudzinski sign ©Dr. Gobinda Pr. Pradhan
- 44. ©Dr. Gobinda Pr. Pradhan
- 45. ©Dr. Gobinda Pr. Pradhan
- 46. Cerebellar signs • Upper limb • Finger-nose test • Dysdiadochokinesia • Rebound phenomenon • Lower limb • Tandem walking • Heel knee test ©Dr. Gobinda Pr. Pradhan
- 47. Skull & spine • Macewan/Cracked pot sign • Transillumination ©Dr. Gobinda Pr. Pradhan
- 48. ©Dr. Gobinda Pr. Pradhan
- 49. STILL CONFUSED !! ©Dr. Gobinda Pr. Pradhan