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PubMed1996

Clinical neurologic indices of toxicity in animals.

The fundamental structures and functions of the nervous systems of animals and humans are conserved in many ways across species. These similarities provide a basis for developing common neurologic examinations for a number of species of animals and also provide a basis for developing risk assessments across species for neurologic end points. The neurologic examination requires no expensive equipment and can be conducted in the field or wherever impaired animals are identified. The proper conduct of neurologic examinations in animals assumes that the examiner has a fundamental understanding of the normal structure and function of the nervous system as well as knowledge about the spontaneous disease background of the species being studied.

Animals↗

PubMedDate not supplied

Evaluation of an algorithmic approach to pediatric back pain.

Pediatric patients require a systematic approach to treating back pain that minimizes the number of diagnostic studies without missing specific diagnoses. This study reviews an algorithm for the evaluation of pediatric back pain and assesses critical factors in the history and physical examination that are predictive of specific diagnoses. Eighty-seven pediatric patients with thoracic and/or lumbar back pain were treated utilizing after this algorithm. If initial plain radiographs were positive, patients were considered to have a specific diagnosis. If negative, patients with constant pain, night pain, radicular pain, and/or an abnormal neurological examination obtained a follow-up magnetic resonance imaging. Patients with negative radiographs and intermittent pain were diagnosed with nonspecific back pain. Twenty-one (24%) of 87 patients had positive radiographs and were treated for their specific diagnoses. Nineteen (29%) of 66 patients with negative radiographs had constant pain, night pain, radicular pain, and/or an abnormal neurological examination. Ten of these 19 patients had a specific diagnosis determined by magnetic resonance imaging. Therefore, 31 (36%) of 87 patients had a specific diagnosis. Back pain of other 56 patients was of a nonspecific nature. No specific diagnoses were missed at latest follow-up. Specificity for determining a specific diagnosis was very high for radicular pain (100%), abnormal neurological examination (100%), and night pain (95%). Radicular pain and an abnormal neurological examination also had high positive predictive value (100%). Lumbar pain was the most sensitive (67%) and had the highest negative predictive value (75%). This algorithm seems to be an effective tool for diagnosing pediatric back pain, and this should help to reduce costs and patient/family anxiety and to avoid unnecessary radiation exposure.

Algorithms↗

PubMedDate not supplied

[Polyneuropathy deficiency among Xavante indians].

UNLABELLED: The authors present two cases of polyneuropathy deficiency among Xavante indians where the sole food was rice in case 1 and almost so in case 2. The rice consumed by these indians was processed or hulled. Intoxication by cyanide from maniot or other vegetable was excluded. CASE REPORT: Two indians aged 18 and 25 years with a progressive history of weaness, decrease in muscular force and thinning were observed in their villages. On removal to the Hospital São Paulo, atrophy of the distal musculature of the upper and lower limbs, motor deficit distally with zero degree in the flexor musculature, abolished deep reflexes, plantar cutaneous reflex without response bilaterally, decreased tactile, painful and pallesthetic sensitivity distally in the lower limbs were noted on neurological examination of case 1. On neurological examination of case 2 proximal hyporeflexia in the upper limbs, areflexia in the distal portions of the upper and lower limbs, tactile and painful hypoesthesia in the feet, right hypoacousis were noted. Electromyography showed abnormalities compatible with symmetric sensorimotor polyneuropathy with an axonal demyelination pattern in case 1 and predominantly demyelinizing in case 2. Cerebrospinal fluid tests were normal. DISCUSSION: Polyneuropathy was characterized by the clinical history and by neurological, electromyographic and cerebrospinal fluid tests. The diagnosis of polyneuropathy deficiency was established by the clinical history and by electromyography suggesting peripheral polyneuropathy of nutritional origin. This neuropathy deficiency does not fit myeloneuropathies such as ataxic tropical neuropathy, spastic paraparesis and Cuba neuropathy. CONCLUSION: The Xavante polyneuropathy deficiency is caused by thiamine (vitamin B1) deficiency, that is dry beriberi, owing to consumption of industrially processed rice as sole or almost sole food. The Xavante polyneuropathy is different from the neuropathy observed among Kreen-Akrore indians and from that of adolescent indians in the Xingu Park.

Adolescent↗

PubMed1996

Headache of recent onset in adults: a prospective population-based study.

One hundred consecutive adult patients with headache of recent onset were prospectively studied. Every patient was examined by craneal CT scan. Their mean age was 46 years (range 17-82). Neurological examination was normal in 80 patients. Organic headache represented 39% of the entire group, and 26% of them had a normal neurological examination. The yield of CT scan in patients with headaches and a normal neurological examination was 22.5% (95% IC: 14%-33%); of which we encountered the following pathologies: intracranial tumors (13), hydrocephalus (2), arachnoid cyst (1), toxoplasmic abscess (1) and parenchymal hemorrhage (1). The clinical characteristics of the headache on their own was insufficient to rule out the possibility of an intracranial tumor. Neuroimaging studies should be performed in all adult patients with non-vascular headache of recent onset, and previously headache-free individuals.

Adolescent↗

PubMed1982

Prognostic value of the electroencephalogram in neonatal asphyxia.

In order to determine whether an EEG early in the course of asphyxia neonatorum is of any more value than the neurological examination in predicting outcome we reviewed case histories of 38 infants with asphyxia neonatorum. The EEG background activity was valuable in predicting outcome. Normal and maturationally delayed EEGs were associated with normal outcomes while low voltage, electrocerebral inactivity and burst suppression EEGs were highly correlated with severe neurological sequelae. Epileptiform activity was not as predictive of outcome as background activity. Although initial normal neurological examinations were associated with normal developmental and neurological outcomes, moderately and severely abnormal infants had more variable courses. A single EEG done early in the course of asphyxia neonatorum is a more sensitive predictor of outcome than the neurological examination.

Asphyxia Neonatorum↗

PubMed2006

The current etiologic profile and neurodevelopmental outcome of seizures in term newborn infants.

OBJECTIVES: The objectives of this study were to delineate the etiologic profile and neurodevelopmental outcome of neonatal seizures in the current era of neonatal intensive care and to identify predictors of neurodevelopmental outcome in survivors. METHODS: Eighty-nine term infants with clinical neonatal seizures underwent neurologic examination, electroencephalography (EEG), neuroimaging, and extensive diagnostic tests in the newborn period. After discharge, all infants underwent regular neurologic evaluations and, at 12 to 18 months, formal neurodevelopmental testing. We tested the prognostic value of seizure etiology, neurologic examination, EEG, and neuroimaging. RESULTS: Etiology was found in 77 infants. Global cerebral hypoxia-ischemia, focal cerebral hypoxia-ischemia, and intracranial hemorrhage were most common. Neonatal mortality was 7%; 28% of the survivors had poor long-term outcome. Association between seizure etiology and outcome was strong, with cerebral dysgenesis and global hypoxia-ischemia associated with poor outcome. Normal neonatal period/early infancy neurologic examination was associated with uniformly favorable outcome at 12 to 18 months; abnormal examination lacked specificity. Normal/mildly abnormal neonatal EEG had favorable outcome, particularly if neonatal neuroimaging was normal. Moderate/severely abnormal EEG, and multifocal/diffuse cortical or primarily deep gray matter lesions, had a worse outcome. CONCLUSIONS: Mortality associated with neonatal seizures has declined although long-term neurodevelopmental morbidity remains unchanged. Seizure etiology and background EEG patterns remain powerful prognostic factors. Diagnostic advances have changed the etiologic distribution for neonatal seizures and improved accuracy of outcome prediction. Global cerebral hypoxia-ischemia, the most common etiology, is responsible for the large majority of infants with poor long-term outcome.

Brain↗

PubMedDate not supplied

[Value of a developmental diagnostic procedure with infants at the age of 12 months with prior perinatal disorders].

68 children after "perinatal distress" and 34 healthy children without perinatal risk factors were examined at 12 months corrected age. The developmental status was determined by "Bayley-Mental-Scale", "Bayley-Infant-Behaviour-Record" and a standardized neurological examination, quantified according to Prechtls optimality concept. Reliability and predication of these instruments has been analysed by variation of clinical criteria in the "high-risk" group and comparison with control children: After excluding children with mental and motor retardation the correlation between "Bayley-Mental-Scale" and the results of the neurological examination decreases, but increases within the control group. Considering rating-scores of the "Infant-Behaviour-Record" it could be shown that this correlation is due to a higher impact of social and interactive patterns in healthy control children. The neurological examination differentiated between children with obvious neurological impairment; in the range of more than 85% optimal conditions it is impossible to detect discrete lesions with the help of optimality-scores. Items of the "Bayley-Mental-Scale" can be related to Piagets stages of development; yet their placement according to stages of difficulty is different from that of the standardization sample.

Developmental Disabilities↗

PubMed2000

Tone abnormalities are associated with maternal cigarette smoking during pregnancy in in utero cocaine-exposed infants.

OBJECTIVE: Maternal cigarette smoking, alcohol use, and other factors confound studies of in utero cocaine exposure. Our goal was to determine whether in utero cocaine exposure is associated with an abnormal neurologic examination in infants, while controlling for concomitant cigarette smoke exposure and other confounding variables. DESIGN: Healthy newborns with birth weights > or =2000 g were prospectively enrolled into a race-matched study of cocaine-exposed and cocaine-unexposed infants. Urine and meconium samples were analyzed for illicit drugs, the cocaine metabolite, benzoylecgonine, and the nicotine metabolite, cotinine. A detailed neurological examination was performed at approximately 6 weeks of age by an examiner blinded to history. RESULTS: At 6 weeks of age, 40 cocaine-exposed infants and 56 cocaine-unexposed infants were examined. Tone abnormalities were the only neurologic abnormalities discovered, predominantly generalized hypertonia. Logistic models found that maternal urine cotinine levels were predictive of an abnormal neurologic examination, whereas cocaine exposure or benzoylecgonine levels were not. No interaction was found between maternal cigarette smoking and cocaine exposure. Race, ethanol exposure, prenatal care, homelessness, and head circumference were not predictive of an abnormal tone examination. The odds ratio for an abnormal examination was 2.9 (95% confidence interval: 1.04-8.25), if the maternal urine cotinine level was >200 ng/mL. CONCLUSION: Our findings suggest that maternal cigarette smoking may be the major predictor of tone abnormalities reported in cocaine-exposed infants.

Cocaine↗

PubMed1990

[A case of hereditary motor and sensory neuropathy of neuronal type with retardation of motor development].

An atypical case of hereditary motor and sensory neuropathy of neuronal type with retardation of motor development was described. The patient was a 15-year-old boy who had suffered from distal muscle weakness with atrophy of four limbs and deformities of hands and feet since age 6 months. These symptoms were slowly progressive. He had never walked. His parents were not consanguinous. His parents and two siblings were unremarkable on neurological examination and on nerve conduction studies. On neurological examination, he showed severe degree of muscle weakness and atrophy in the distal upper and lower limbs, moderate degree of muscle weakness and atrophy in the proximal upper limbs and slight degree of made weakness and atrophy in the proximal upper limbs. Deep tendon reflexes in four limbs were decreased or absent. Vibration sensation was moderately decreased in the distal parts of four limbs. On the nerve conduction studies, no sensory nerve potential was recorded in the median, ulnar and sural nerves bilaterally. Motor nerve conduction velocity of the right tibial nerve was 21 m/sec and the amplitude of the compound muscle action potential (M-wave) was 0.15 mV, and no M-wave was elicited with the electrical stimulation of the median, ulnar and peroneal nerves. Neelde EMG showed fibrillation potentials and giant spikes with a reduction of the number of motor units. On sural nerve biopsy, the densities of both myelinated and unmyelinated fibers were severely decreased.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗

PubMed1992

Follow-up study of macrocephalic children with enlargement of the subarachnoid space.

Eighteen macrocephalic children with enlargement of the subarachnoid space (ESAS), with or without mild ventricular dilatation, were followed prospectively to a mean age of 56 months. All were born at term, with uneventful neonatal period and negative tests for congenital infections. There were 17 boys and 1 girl and the mean follow-up period was 46 months (8-58 months). The initial neurologic evaluation, between ages of 2 to 33 months, disclosed abnormalities in 2 cases. At the follow-up one was still abnormal and the other had a normal neurological examination. Another child, who had a normal neurological examination at the age of 5 months, at the age of 7 years and 7 months had an IQ of 77. Thus the abnormality rate at follow-up was 11%. The OFC returned to the normal range in 45% of the children at the follow-up period. There were no cases of intracranial hypertension. One infant had subdural taps performed at the age of 13 months that disclosed a fluid with the same characteristics as the CSF. All the children had a CT-scan performed at the beginning of the study that revealed a large subarachnoid space; in 77% it was associated with mild ventricular dilatation. Eleven had CT-scans repeated, during the study period, which showed resolution of the process in 3 cases, improvement in 2, and unchanged in 6. We conclude that enlargement of the subarachnoid space in macrocephalic children is often a benign entity. ESAS and macrocephaly will still be present in the majority of children in the long-term follow-up.

Child↗

PubMed1997

Late effects of early surgery on lipoma and lipomeningocele in children less than 1 year old.

PURPOSE: We attempted to assess the usefulness of urodynamic testing for diagnosing lipoma and lipomeningocele, and the late effects of early neurosurgical intervention in children less than 1 year old. MATERIALS AND METHODS: A total of 28 patients in whom spinal surgery was performed before age 1 year for correcting lipoma and lipomeningocele underwent neurological and urodynamic evaluation preoperatively, and within 3 months and up to 14.5 years postoperatively. RESULTS: Preoperatively 15 patients (54%) had an abnormal neurological examination and 7 had an abnormal urodynamic study. Of the 13 patients with a normal neurological examination 3 had an abnormal urodynamic study. Overall 10 patients (37%) had an abnormal urodynamic examination preoperatively. Immediately after surgery 8 patients (29%) had improvement (2 of 15 with an abnormal neurological examination and 6 of 10 with an abnormal urodynamic study), whereas the condition of 9 (32%) worsened, including 4 of the 13 who were neurologically and 6 of the 18 who were urodynamically normal (1 in both categories). With time an additional 7 patients (25%) had progressive deterioration, including 6 urodynamically and 5 neurologically (4 in both categories), 2 (7%) had improvement (1 each urodynamically and neurologically) and the condition of 19 (68%) remained stable. Six patients (21%) underwent secondary spinal surgery for recurrent tethering. CONCLUSIONS: Early surgical repair seems to provide a degree of protection against later spinal cord tethering, and subsequent neurological and/or urodynamic deterioration (25% of our patients versus a reported 80% of those followed expectantly).

Female↗

PubMedDate not supplied

Neurological assessment of the hemiplegic patient.

There are more and more situations where nursing is responsible for ongoing assessment of the functioning of the hemiplegic patient who has been discharged from an acute care setting. The goal of the neurological assessment in the primary care setting is to determine the ability of the hemiplegic patient to perform activities of daily living. The objectives of this paper are to: 1) suggest a guideline for neurological examination of the hemiplegic patient in seven functional areas. The purpose is not to describe the total neurological examination, but rather to focus on the examination of pertinent neurological areas that provide data about the functioning of the patient; 2) outline potential problems derived from pertinent neurological findings in these seven areas; 3) discuss general implications these problems have for the nurse to assist the hemiplegic patient and his family, optimizing his potential. No attempt will be made to discuss details of nursing intervention.

Hemiplegia↗

PubMed1989

[The Apgar score as a predictor of neurologic sequellae].

65 newborns with Apgar score less than 7 were studied. Initially 2 groups were formed. Group 1 with severe asphyxia Apgar 0-3 and group 2 with moderate asphyxia Apgar 4-7. Each group was divided according to Apgar score at 5 minutes; with good recuperation Apgar greater than or equal to 6 and bad recuperation Apgar less than 6. So four subgroups were formed. All patients were evaluated with Amiel Tison neurological examination at 12 months old. Of the 65 newborns, 52 (80%) had a normal neurologic examination, and only 12 (20%) were not normal. There were not significant statistic differences neither between the moderate and severely asphyxiated groups nor between the four subgroups at 5 minutes and their neurological examination. We conclude that the Apgar score at 5 minutes is not a good predictive of neurological sequelae, because there is a myriad of factors difficult to investigate in relation to the etiology of neurologic sequelae. We stress the importance of reviewing the original idea about the Apgar score as a useful method (instrument) to evaluate the hemodynamic and homeostatic conditions of the newborns.

Apgar Score↗

PubMed1998

Neurocognitive effects of chronic lead intoxication in Andean children.

Lead (Pb) intoxication in children has been associated with neurodevelopmental disabilities which may result in motor and cognitive impairment. We conducted blood lead (PbB) measurements, neurological examinations and cognitive tests on children living in Ecuadorian villages where Pb is used extensively in the glazing of ceramics. Group I consisted of 55 children with a mean PbB level of 48.0 microg/dl (SD: 26.4, range: 9.2-119.1 microg/dl) who received PbB tests and complete neurological examinations. An appreciable number of the children with elevated PbB levels were normal on specific components of the neurological examination. Among the children who showed neurological deficits, higher PbB levels were associated with abnormal tendon reflexes, finger tapping, visual pursuit, size discrimination, draw-a-person, and math calculation skills. Group II consisted of 41 children with a mean PbB level of 47.4 microg/dl (SD: 22.0, range: 6.6-84.7 microg/dl) who were administered Raven's Coloured Progressive Matrices (RCPM) non-verbal reasoning test. Performance on RCPM was abnormal in 22 (53.7%) of 41 children. Children with abnormal RCPM scores had higher PbB levels (t-test: P=0.030). There was a significant inverse correlation between RCPM scores and PbB levels for children ages 9 years and older (r=-0.618, P=0.011). Males had higher mean PbB levels as a function of age than females (t-test: P=0.037), and more males showed neurocognitive deficits. The results demonstrate a range of neurological responses in children with chronically elevated PbB levels from apparent exceptional neuro-physiological tolerance of PbB intoxication, to some fine motor and cognitive deficits.

Ceramics↗

PubMed2006

Medical outcome of 8-year-old singleton ICSI children (born >or=32 weeks' gestation) and a spontaneously conceived comparison group.

BACKGROUND: There is little information about the long-term outcome of children born after ICSI. In this study, the eldest cohort of ICSI children worldwide, reaching the age of 8 years, was investigated at the prepubertal stage to monitor subsequent puberty and future fertility. To investigate possible health problems, a thorough medical and neurological examination was performed. METHODS: Medical outcome of 8-year-old singletons (n=150) born through ICSI (>or=32 weeks) was compared with that of 147 singletons of the same age born after spontaneous conception (SC). Information about their general health was obtained from the parents by means of a questionnaire. RESULTS: Fifteen of 150 ICSI children experienced a major congenital malformation compared with 5/147 SC children (P < 0.05). Pubertal staging was similar in both groups. Neurological examination did not show important differences between ICSI and SC children. ICSI children did not require more remedial therapy or surgery or hospitalization than SC children. CONCLUSION: Physical examination including a thorough neurological examination did not reveal important differences between the two groups. Major congenital malformations were significantly more frequent in the ICSI group. However, most of them were corrected by minor surgery. Further monitoring of these children at an older age is recommended.

Belgium↗

PubMedDate not supplied

[Clinical techniques for use in neurological physical examinations. I. General organisation, cranial and peripheral spinal nerves].

AIMS: The purpose of this work is to focus on the main practical aspects of the techniques used for the physical examination of the nervous system and to present an approach for the practice of this study in adult patients. DEVELOPMENT: We recommend clinicians to carry out a brief but consistent and effective exploration in a systematic, flexible and orderly manner to check for alterations in the functioning of the nervous system. Should any anomalies be detected, then a more detailed and thorough neurological exploration must be performed selectively. The techniques and data from this examination are organised into five broad categories: mental status, cranial nerves, motor function, reflex function and sensory function. The practical aspects of the main techniques used in the physical exploration are reviewed and we also describe the technique to be employed for palpating the main peripheral nerves. CONCLUSIONS: The study offers a detailed description of the chief clinical techniques used in the physical exploration of the cranial nerves and for the palpation of the peripheral nerves; we also present an approach to performing the neurological examination. Furthermore, we highlight the importance of physically examining the nervous system in contemporary medicine and the need to continually perfect the way these techniques are performed in order to achieve an efficient clinical practice.

Cranial Nerves↗

PubMed1987

Cry analysis in infants with Rh haemolytic disease.

The influence of hyperbilirubinaemia on the infants' cries and the feasibility of the use of cry analysis for the early identification of developing kernicterus were studied by analyzing the cries of 100 healthy one-day-old infants and 31 infants with Rh haemolytic disease of the newborn (Rh-HDN) by using sound spectrographic methods. The newborn infants with Rh-HDN were divided into three subgroups according to the findings in a neurological examination: an evident group (10 infants), a transient group (13 infants) and an asymptomatic group (8 infants) and followed up until one year of age. Cry recording and a neurological examination were carried out once for each of the healthy one-day-old infants and twice a day during the first week of life for the infants with Rh-HDN, and thereafter once a day until discharged and at the ages of 1 and 3 months. Additional neurological examinations were performed on the Rh-HDN infants at the ages of 6 and 12 months. Bilirubin determination was carried out in connection with the cry recordings during the first week of life. The effect of blood exchange transfusion on the cry sound was investigated in infants with a bilirubin level above 250 mumol/l (n = 12) and below this level (n = 15) before the procedure. An electroencephalography (EEG) was recorded once during the neonatal period and once during the follow-up. The cries of the healthy infants were used to develop a cry score comprising 16 characteristics (latency, duration of phonation, maximum and minimum pitch of fundamental frequency, occurrence and maximum pitch of shift, glide, melody form, biphonation, furcation, noise concentration, voice quality, double harmonic break, glottal plosives, vibrato and glottal roll), which was then applied to the analysis of the cries of the 31 infants with Rh-HDN. In addition, maximum pitch of fundamental frequency, furcation and combination of biphonation and/or furcation were studied. The cry score and maximum pitch of fundamental frequency increased most obviously in the infants in the evident group as compared with the values after birth in the various subgroups and with the values of the healthy one-day-old infants or the infants in the asymptomatic group day by day. Both parameters also increased in the asymptomatic group between days 2 and 3 as compared with the initial value after birth and with the healthy infants.(ABSTRACT TRUNCATED AT 400 WORDS)

Crying↗

PubMed1992

Neuropsychological and neurological manifestations of HIV-1 dementia in drug users.

The cognitive and motor deficits associated with human immunodeficiency virus-1 (HIV-1) infection have been studied using neurological examination and neuropsychological tests. However, drug users with HIV-1 infection generally have been excluded from such studies. Forty-four well-characterized drug users stratified by Centers for Disease Control staging were administered a standardized neurological examination and a battery of neuropsychological tests under single-blind conditions designed to minimize the acute effects of psychoactive substances. The results of the blind neurological examination were consistent with the previously ascertained clinical staging of HIV-1 infection. The pattern of neuropsychological deficits across HIV-1 states was similar to those found in cohorts of homosexual men.

AIDS Dementia Complex↗