Neurological examination methods
Infant nervous system is at the stage of growth and development, and infant emotional instability, sometimes difficult to cooperate, so the examination should also be flexible response.
1, consciousness and mental state: according to children’s reaction to the outside world to determine whether it has conscious disturbance. The degree of consciousness disorder can be divided into drowsiness, confusion and coma. Mental state should pay attention to irritability, irritability, delirium, dullness, depression, hallucinations and directional disorders.
2. Skin: Many congenital nervous system diseases often associated with skin abnormalities, such as cerebral hemangiomatosis, trigeminal nerve distribution in the side of the red hemangioma can be seen; nodular sclerosis can be seen in the face of hemangiofibroma, trunk or extremities skin depigmentation spots and so on.
3, head: first, observe the shape and size of the skull. The head circumference of newborns is about 34 cm at birth, 1.5 cm in the first half of life, 0.5 cm in the second half of life, 46 cm at the age of 1, 48 cm at the age of 2, 50 cm at the age of 5, and 54-58 cm at the age of 15. We should also pay attention to whether the scalp vein is angry or not. Palpation should pay attention to the size and tensity of the front fontanelle and the condition of cranial sutures.
Too small or early closure of the fontanel is seen in microcephaly; tardive or too large in rickets, hydrocephalus, etc. Full or elevated anterior fontanel suggests increased intracranial pressure, anterior fontanel depression in dehydration and so on.
4. Five senses: Many nervous system diseases can be combined with the development of five senses malformation, such as small eyeball, cataract seen in congenital rubella or toxoplasmosis infection, eye spacing can be seen in 21-trisomy syndrome, cretinism, ear can be seen in fragile X chromosome syndrome, tongue is large and thick in cretinism, mucopolysaccharide disease and so on.
5. Spine: Should pay attention to whether there are deformities, abnormal bending, rigidity, whether there is tapping pain, spina bifida, meningocele, dermal sinus and so on.
Neurological auxiliary examination
First, cerebrospinal fluid examination.
For infants with suspected neurological disorders, CSF can be sampled for laboratory examination. The CSF pressure measured after puncture was 0.39-0.98 kPa (40-100 mm water column) in children and 0.098-0.14 kPa (10-14 mm water column) in newborns.
Two. EEG and main electrophysiological examination.
1. Electroencephalogram (EEG): the examination of the electrophysiological functions of neurons in the cerebral cortex. Include:
(1) Conventional EEG: the presence or absence of spike waves, sharp waves, spike-slow complex waves and their distribution in different brain regions are the main laboratory basis for correct diagnosis, typing and rational drug selection, and whether the background EEG activities recorded during wakefulness and sleep are normal.
(2) dynamic EEG (AEEG): continuous EEG records for 24 hours, or even days.
(3) video EEG (VEEG).
2. Evoked Potentials: Response Potentials of the Corresponding Conduction Pathways are evoked by stimulating the central nervous system through auditory, visual and somatosensory pathways, respectively. Include:
(1) brainstem auditory evoked potential (BAEP): evoked by headphone sound stimulation. It can be used for hearing screening in any uncooperative children, including newborns, and for evaluating brainstem function in comatose children.
(2) Visual evoked potential (VEP): PVEP, evoked by pattemed stimuli, can detect the damage of each segment of visual pathway in monocular retina, optic nerve, optic chiasma, posterior optic chiasma and occipital visual cortex respectively. Infants and young children can not concentrate their attention on the image, can be changed by flash stimulation induced, called FVEP, but the specificity is poor.
(3) somatosensory evoked potential (SEP): stimulate limb mixed nerve with pulsed electric current, record sensory afferent pathway response potential along the body surface. Abnormal spinal nerve roots, spinal cord and brain lesions can be abnormal.
3. Peripheral nerve conduction function: learning is called nerve conduction velocity (NCV). Helps to determine whether the peripheral nerve is damaged, the nature of the damage (myelin or axonal damage) and the severity of the damage. It is believed that the test results may be normal when more than 10% of the fibers in the lesion remain normal.
4. Electromyography (EMG): To help clarify the nature (neurogenic or myogenic) of the muscles under test.
Three. Neuroimaging examination
1. Computerized tomography (CT).
2. Magnetic resonance imaging (MRI).
3. Magnetic resonance angiography (MRA) and digital subtraction angiography (DSA) are used in the diagnosis of cerebrovascular diseases.
Points for attention in neurological examination
Because the nervous system of children is in the stage of growth and development, the normal standards of different ages are different, and the examination methods have their own characteristics.
1. When examining children, try to get the cooperation of the children. Some examinations can be done on the examiner himself first. For example, when examining the tendon reflex, the examiner can tap his forearm with a hammer to reduce the baby’s fear.
2, sometimes, in order to avoid boredom or fatigue, it can be checked separately.
3. Neurological examination of infants is easy to be affected by external environment. When the baby falls asleep, the muscle tone relaxes, the original reflex weakens or disappears. Before feeding and hunger, he often appears restless and hyperactive, and after eating milk, he often falls asleep. Therefore, the best way to check is about an hour before eating.
4. Indoor light should be sufficient and soft, but do not let the light directly shine on the baby’s face, keep the environment quiet, check from the baby to disturb the smallest examination, do not have to proceed in sequence.