Neurological History
Headache
Perinatal asphyxia (unlikely if discharge <5d)
Cortical
Cranial: Brain stem (except I/II) v neuropathy
Trunk/Extremity
Fasciculations
Anterior horn disease or neuropathies (LMN)
Tone
spastic (pyramidal UMN): unidirectional, speed depended
rigid (extrapyramidal UMN): bidirectional, speed independent
Myotonia: difficulty relaxing after contraction: Myotonic dystrophy
hypotonic (LMN, but can be UMN in infant)
Power
impaired by hypertonia > UMN
weak > LMN
Reflexes
up (pyramidal UMN)
Sensation
Intact (UMN)
dermatomal level (spine injury)
nerve distribution (nerve injury)
Coordination
(cerebellar IPSILATERAL UMN)Dysdiadochokinesia: to finger tap
Finger-nose
?LMN/NMJ weakness impeding
Gait (examine shoes)
Hemiparesis: arm flexed adducted, leg circumducted (UMN)
Waddle: proximal weakness
Head Circ
micro
macro: hydrocephalus
Back
Meningomyelocele
Upper (cerebellar/Basal nuclei don't have UMN signs?)
V Lower MN
V Mixed (leukodystrophy)
Encephalopathy (Brain)
Myelopathy (Spine)
Radiculopathy (nerve root)
Neuropathy (nerve)
NMJ
Myopathy (muscle)
Diffuse or localised lesion
Static or progressing
Deterioration in grades
Worsening headache
Regression of milestones
- Worsening (tumour)
Perinatal asphyxia (unlikely if discharge <5d)
Cortical
- Intellect def > global cortical path
- Normal intellect > Isolated upper motor neuro
- MMSE
Development
Attention, fine motor, visual-spacial abilities
Cranial: Brain stem (except I/II) v neuropathy
Trunk/Extremity
Fasciculations
Anterior horn disease or neuropathies (LMN)
Tone
spastic (pyramidal UMN): unidirectional, speed depended
rigid (extrapyramidal UMN): bidirectional, speed independent
- lead pipe: smooth
- cogwheel: superimposed tremor
Myotonia: difficulty relaxing after contraction: Myotonic dystrophy
hypotonic (LMN, but can be UMN in infant)
Power
impaired by hypertonia > UMN
weak > LMN
- Proximal (myopathy e.g. muscular dystrophy)
- Trendelenberg - stand on one leg (glut hip abd lift pelvis)
- Gower's sign - Stand from floor
- Distal / wasting (LMN EXCEPT MYOTONIC DYSTROPHY a myopathy = distal weakness and inability to relax after contraction)
Reflexes
up (pyramidal UMN)
- positive Babinski's sign = extended big, fanned others (normal <12mo)
Sensation
Intact (UMN)
dermatomal level (spine injury)
nerve distribution (nerve injury)
Coordination
(cerebellar IPSILATERAL UMN)Dysdiadochokinesia: to finger tap
Finger-nose
?LMN/NMJ weakness impeding
Gait (examine shoes)
Hemiparesis: arm flexed adducted, leg circumducted (UMN)
Waddle: proximal weakness
Head Circ
micro
macro: hydrocephalus
Back
Meningomyelocele
Upper (cerebellar/Basal nuclei don't have UMN signs?)
V Lower MN
V Mixed (leukodystrophy)
Encephalopathy (Brain)
Myelopathy (Spine)
Radiculopathy (nerve root)
Neuropathy (nerve)
NMJ
Myopathy (muscle)
Diffuse or localised lesion
Static or progressing
Deterioration in grades
Worsening headache
Regression of milestones