Paediatric neuro conditions/exam

Question 1

what is a classic sign indicating increased spasticity in the upper and lower limbs in a child?

Answer 1

scissoring of legs

fisting of hands

Question 2

tell me some things you’d look for/test in a neurological exam of a child

Answer 2

Gait- hemiparesis, proximal myopathy, foot drop, abnormal posturing
Appearance- dysmorphic features, abnormal posturing, skin lesions (NF etc), strabismus, chronic illness, muscle wasting, scoliosis
Behaviour- developmental delay, dysarthria, tics, stereotypy

Power- Gower’s sign, trendelenberg sign
Tone- look for spasticity (scissoring, fisting etc), floppiness, head lag etc; clonus
Reflexes- look for hypothyroidism etc
Coordination- heel toe walking, maze games with hands

Cranial nerves/other:
• Ophthalmoscopy looking for papilloedema
• Pupillary reaction
• EOM
• Red reflex
Doll’s eye reflex in infants; follow face with eyes
• Gross developmental exam–> learning/language delay? (think CN8)

Extra things you might do in an exam
• Duck walk- proximal myopathy
• Ball catch games- coordination
• Pen and paper drawing- visuospatial, handedness
• Walking up and down stairs
• Walking on heels/Walking on toes
Walking around a chair/piroette- looking for cerebellar lesions