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PubMed1996

The utility of head computed tomographic scanning in pediatric patients with normal neurologic examination in the emergency department.

Head injury is a frequent cause of morbidity and mortality in pediatric trauma. Guidelines for obtaining computed tomographic (CT) scans in the child with mild head injury are poorly defined. This study investigated the utility of head CT scanning in the pediatric patient presenting with normal neurologic examination. All patients undergoing head CT scanning for trauma in the emergency department (ED) at a tertiary care pediatric trauma center during 1992 were identified (508). Charts were reviewed for historical and physical examination findings, CT results, and need for neurosurgical intervention. Patients were excluded if they had an abnormal neurologic examination (179), known depressed skull fracture (11), bleeding diathesis (3), age older than 18 years (1), or developmental delay (1). Included were 313 patients (median 5.5 years) who presented with clinical variables including sleepiness (38%), vomiting (34%), headache (30%), loss of consciousness (LOC) (25%), irritability (22%), amnesia (20%), and seizures (8%). An abnormal head CT was noted in 88 cases (28%); 79 (25%) were traumatic abnormalities involving the skull and/or contents. Thirteen patients (4%) had intracranial injuries (ICI); all had either a linear (10), basilar (2), or depressed (1) skull fracture noted on CT. Four patients required neurosurgery, three for epidural hematoma, and one for a complicated orbital fracture (without ICI). No clinical variables (seizure, LOC, vomiting, headache, confusion, irritability, sleepiness, amnesia) were associated with ICI (P > 0.05). In pediatric head trauma patients, with normal neurologic examinations in the ED, ICI occurs < 5% of the time and neurosurgery is needed in 1% of the cases. Commonly used clinical variables are not associated with ICI in these children.

Acute Disease↗

PubMed2004

Techniques for the neurological examination of taxane-induced neuropathy.

Taxanes are considered to be the key drugs in the treatment of breast cancer. Although physicians who treat patients with breast cancer have rarely seen patients with neuropathy as an adverse effect of treatment before the advent of taxanes, patients with breast cancer who are treated with taxanes frequently exhibit peripheral neuropathy. As peripheral neuropathy often causes deterioration of the quality of life of patients, it is very important to precisely assess the extent of peripheral neuropathy at an early stage. Clinical oncologists should be familiar with the techniques of neurological examination. In this article we describe the basic techniques for the neurological examination of patients with taxane-induced peripheral neuropathy. In the hope of facilitating the precise evaluation of taxane-induced peripheral neuropathy, the items of neurological examinations in this article are described with reference to the physician neuroexamination form (PNEF) designed by BioNumerik Pharmaceuticals Inc.

Antineoplastic Agents, Phytogenic↗

PubMed2000

Efficacy of neuroradiological imaging, neurological examination, and symptom status in follow-up assessment of patients with high-grade gliomas.

OBJECT: It is standard practice for the oncological follow-up of patients with brain tumors (especially in the setting of clinical trials) to include neurological examination and neuroradiological studies such as computerized tomography (CT) or magnetic resonance (MR) imaging in addition to evaluation of the patients' symptomatology and performance score. The validity of this practice and its impact on the welfare of patients with high-grade gliomas has not been adequately assessed. The purpose of this study is to provide such an assessment. METHODS: The authors studied 231 similarly treated patients who were participating in three prospective North Central Cancer Treatment Group or Mayo Clinic trials who developed progressive disease during follow up. According to the protocol, the symptom status, performance score, results of neurological examination, and CT or MR status were recorded prospectively in each patient at each evaluation (every 6-8 weeks). At progression, 177 (77%) of 231 patients experienced worsening of their baseline symptoms or they developed new ones. In the remaining 54 asymptomatic patients (23%), neuroradiological imaging revealed the progression. Asymptomatic progression was more likely to be detected on MR imaging compared with CT studies (p < 0.01). In no asymptomatic patient was progression detected on neurological examination alone. The median survival time after tumor recurrence was 13.3 weeks in symptomatic patients compared with 41.7 weeks in the asymptomatic group (p < 0.0001). Asymptomatic patients were more aggressively treated, with surgery (p < 0.0001) and second-line chemotherapy (p < 0.0002). Multivariate analysis of survival time following first progression by using both classification and regression trees and Cox models showed that treatment at recurrence was the most important prognostic variable. CONCLUSIONS: Symptoms are the most frequent indicators of progression in patients with high-grade gliomas (77%). All asymptomatic progressions were detected on neuroradiological studies; MR imaging was more likely than CT scanning to reveal asymptomatic recurrences. Survival after disease progression was significantly longer in asymptomatic patients and could be related both to treatment following progression and to other favorable prognostic factors such as performance score.

Brain Neoplasms↗

PubMed2000

The role of quantitative neurological examination in clinical neurotoxicology.

The use of the clinical neurological examination to document abnormal signs in suspected neurotoxic disorders is described, recognizing that identifying an abnormal examination does not establish the cause of the problem. Several forms of quantitative tests of neurological function are discussed, and their application to the evaluation of neurotoxic disorders is reviewed. Although results of such testing are rarely specific for toxic exposure, these measures have important application in sequential evaluations to document small changes in neurologic function over time.

Humans↗

PubMed1992

The history of the neurological examination. Part 1: ancient and pre-modern history--3000 BC to AD 1850.

Every time a physician conducts a neurological examination the process continues a biomedical search for understanding the nervous system which is as ancient as the earliest civilizations in human history. Most of the modern neurological examination evolved in a short time span, between 1850 and 1914, but the origins of neurology as a medical quest for knowledge date to the first evolution of urban life, in the valleys of the Euphrates and the Nile. This paper reviews this history in two chronological segments: part 1 up to 1850 and part 2 the subsequent period.

History, Ancient↗

PubMed1996

Abnormalities on neurological examination among sheep farmers exposed to organophosphorous pesticides.

OBJECTIVES: Organophosphates are effective pesticides which are frequently used in several agricultural settings. Although their acute effects are well characterised, it remains unclear whether long term exposure can damage the human nervous system. This study sought to investigate their long term effects by comparing abnormalities on neurological examination between groups of workers exposed to organophosphates and an unexposed group. METHODS: 146 exposed sheep farmers and 143 unexposed quarry workers were recruited into a cross sectional study of symptoms and neuropsychological effects of long term exposure to organophosphates in sheep dip. From a symptom questionnaire given immediately after dipping the 10 most symptomatic and 10 least symptomatic farmers were selected. Several months later each of these, along with 10 of the unexposed quarry workers, underwent a standardised neurological examination similar to that which might be used in clinical practice, at at time as remote as possible from recent exposure to organophosphates so as to exclude any acute effects. RESULTS: All 30 selected subjects agreed to participate. The components of the examination which showed a significant difference were two point discrimination on the dorsum of the hand (symptomatic farmers 22 mm; asymptomatic farmers 13 mm; quarry workers 8 mm) and the dorsum of the foot (symptomatic farmers 34 mm; asymptomatic farmers 10 mm; quarry workers 11 mm), and mean calf circumference (symptomatic farmers 35.0 cm; asymptomatic farmers 36.3 cm; quarry workers 38.6 cm). Overall the prevalence of neurological abnormalities was low. CONCLUSIONS: The differences in neurological examination detected between groups were subtle and their clinical significance was unclear. However, they do suggest evidence of an adverse neurological effect from exposure to organophosphates. Further, larger scale studies will be required before it is possible to confirm or refute the differences detected.

Adult↗

PubMed1985

Neurologic examination in stroke rehabilitation: adequacy of its description in clinical textbooks.

Medical textbooks were reviewed to establish how well they presented those aspects of examination of the nervous system which are important in stroke rehabilitation. In addition, information was sought concerning such factors as the presence of instructions for the examiner and patient, grading and interpretation of results, and the importance of observer variation which can influence results of periodic neurologic examination of stroke patients. Study results demonstrated that the description of the neurologic examination which should be used in stroke rehabilitation was often incomplete and poorly defined. Material provided little interpretation for the physical signs which might be found. Factors which might influence results of periodic examination of the nervous system in stroke patients received little attention. There is an urgent need to develop a standardized form of clinical examination to meet the needs of practitioners who assess neurologic status in stroke rehabilitation.

Books↗

PubMed1996

Quantified neurological examination with emphasis on motor and sensory functions in patients with rheumatoid arthritis and controls.

A controlled study of quantified clinical neurological examination, including psychophysical assessment of sensory thresholds, in patients with rheumatoid arthritis (RA) was carried out. Fifty-five women with seropositive RA living in North Norway and 83 healthy controls underwent clinical neurological examination quantified by neurological symptom score (NSS) and neurological deficit score (NDS). Vibration threshold (VT), warm-cold detection threshold (limen) as well as heat pain detection threshold (HPDT) were performed to evaluate afferent myelinated and unmyelinated fibre functions. Higher scores on NSS and NDS were seen in RA patients compared with the controls. Higher index finger and big toe VT was demonstrated in the patients, while results from warm-cold limen and HPDT were not significantly different in the two groups. Among the disease-related variables, the most prominent finding was a positive association of index finger VT with disease duration in the patients (P = 0.01). Maximum walking time (15 m) was a significant predictor of big toe VT in the patient group (P = 0.0001). This study suggests impaired peripheral nerve function in afferent myelinated fibres. However, involvement of dorsal column fibres cannot be excluded, although patients with radiological atlantoaxial subluxation were not included in this study.

Adolescent↗

PubMed1984

The neurological examination in child psychiatry: a review of its uses.

This review is an attempt to evaluate critically some of the recent literature on the clinical utility of the neurological examination in child psychiatric practice. Three separate but related issues are discussed; the accuracy of the examination in assessing cerebral dysfunction, the strength of the association between neurological signs and behaviour disorders and finally the clinical significance of this association. It is pointed out that not all neurological signs are of equal significance, but that developmental neurological signs which indicate cerebral immaturity are weakly associated not only with hyperactivity, but possibly with other behaviour disorders as well. Some of the methodological weaknesses in this literature are pointed out. Recent studies of children with motor impairment (clumsiness) are briefly mentioned as a potentially more fruitful avenue of research. It is concluded that the neurological examination may be useful in identifying sub-groups of behaviourally disturbed children who differ from other children with behaviour disorders in terms of etiology, prognosis or treatment needs. Unfortunately, little work has been done in this specific area and further research is needed.

Attention Deficit Disorder with Hyperactivity↗

PubMed1979

The neurologic examination in patients with central nervous system trauma.

The neurological assessment of the head injured patient must be integrated into the emergency management and daily care of the patient. Neurosurgical nurses are in the best position to perform serial neurologic examinations and assess changes in the patient's clinical picture. If this added responsibility is assumed, neurosurgical nurses must take an active role in improving assessment skills. The improved assessment of the head injured patient will result in early intervention in the patient's course to avert potential problems, thus resulting in improved morbidity and eventual outcome. As neurosurgical nurses expand their roles in nursing, improved patient assessments are mandatory to deliver optimal patient care.

Humans↗

PubMed2004

Preterm neonatal neurological examination.

This chapter covers the purposes for which a neurological examination of a neonate may be performed. A brief description is given, of assessments currently in use. More extensive information is provided on the elements of the Neurobehavioral Assessment of the Preterm Infant (NAPI), an assessment which has been used extensively by this author and others (see references at www-med.stanford.edu/school/pediatrics/NAPI/index). Medical and environmental factors that impact on the neurobehavioral performance of an infant are outlined. Two detailed case studies give insight to the complexity of the initial hospital stay of extremely low birth weight infants of short gestational age. The results of NAPIs for each of these cases are explained and the relation to long term outcome at 18 months is presented.

Awareness↗

PubMed2002

Diagnosing Parkinson's disease using videotaped neurological examinations: validity and factors that contribute to incorrect diagnoses.

Field work is commonly required in movement disorders research. Sending neurologists into the field can be logistically challenging and costly. Alternatively, neurological examinations may be videotaped and reviewed later. There is little knowledge of the validity of the videotaped neurological examination in the diagnosis of Parkinson's disease (PD). We examined the validity of the videotaped Unified Parkinson's Disease Rating Scale (UPDRS) motor examination in the diagnosis of PD, and sought to determine which factors are associated with incorrect diagnoses. PD patients and controls were enrolled in a familial aggregation study between August of 1998 and June of 2000, and as part of that study each was examined by a physician who performed an in-person UPDRS motor examination. Each also underwent a second, videotaped UPDRS motor examination. Based on the review of this videotape, a neurologist, who was blinded to the previous clinical diagnosis, assigned a diagnosis of PD or normal. A total of 211 of 231 PD patients (sensitivity = 91.3%), and 170 of 172 controls (specificity = 98.8%) were correctly identified based on the videotape. True positives had a higher mean rest tremor score (1.7 vs. 0.3; P < 0.001), action tremor score (0.9 vs. 0.3; P < 0.001), bradykinesia score (11.2 vs. 7.4; P = 0.02), and disease of longer mean duration (8.9 vs. 5.8 years; P = 0.001) than false negatives. False negatives did not differ from true positives in terms of age, total dose of levodopa, Hoehn and Yahr score, or rigidity, gait and posture, or facial masking scores (each assessed during the in-person examination). The videotaped UPDRS motor examination is a useful means of diagnosing PD and provides an alternative approach for the diagnosis of PD in field studies. A limitation is that patients with milder PD of shorter duration may not be recognized as PD.

Adult↗

PubMed1985

Correlation between the findings of a clinical neurological examination and the urodynamic dysfunction in children with myelodysplasia.

Clinical neurological findings in 47 children with lumbosacral myelodysplasia did not correlate well with the existing dysfunction of the lower urinary tract as diagnosed by urodynamic studies. The level of intact skin sensation, and the presence or absence of bulbocavernosus and anal reflexes could not significantly predict the function of the detrusor muscle, proximal urethra and striated urethral sphincter. Therefore, one should not rely on a clinical neurological examination to outline the urological management in such patients.

Adolescent↗

PubMedDate not supplied

[The unreliability of neurologic examination in the diagnosis of neonatal periventricular-intraventricular hemorrhage]

OBJECTIVE: To evaluate the efficacy of the clinical neurologic examination, hematocrit and glycemia in the diagnosis of periventricular-intraventricular hemorrhage in the newborn weighing less than 2000g considering the neurosonography as the gold standard.METHODS: This is a cohort prospective study from May 18th, 1994 to May 17th, 1995 carried out at the Hospital das Clinicas da UFMG. The study group comprised 38 newborns with the ultrasound diagnosis of periventricular-intraventricular hemorrhage; the control group comprised 81 newborns who although submitted to the same evaluation protocol did not show any echographic signs of hemorrhage. The ultrasound examinations were all done by the same researcher who was not aware of the clinical history or the neurologic and laboratory examinations.RESULTS: Clinical neurologic alterations, mainly generalized hypotonia, were found to be associated with hemorrhage (p = 0.009), but there was a confounding effect due to the gestational age of the newborn. The predictive values of a positive or negative test were only 45% and 79%, respectively, which is clearly unreliable for the diagnosis of the hemorrhage. Hematocrit and glycemia were not clinically relevant either.CONCLUSIONS: The clinical neurologic examination is not reliable to indicate periventricular-intraventricular hemorrhage in the newborn. Newborns at risk should be routinely screened by neurosonography.

Journal Article↗

PubMed1994

Serial neurologic examinations after near drowning and outcome.

OBJECTIVE: We evaluated serial neurologic examinations after warm water near drowning to determine how rapidly survivors with poor neurologic outcome could be identified. RESEARCH DESIGN: Retrospective chart review. SETTING: University-affiliated pediatric hospital. PATIENTS: Forty-four children admitted to the pediatric intensive care unit with an abnormal mental status after near drowning during a 5-year period. Follow-up was a minimum of 6 months. INTERVENTIONS: None. MEASUREMENTS: A 14-point coma scale was used to evaluate both cortical and brain-stem function at the time of hospital admission and then daily afterward. The Mann-Whitney U Test was used to compare patients grouped as having satisfactory outcomes (those who returned to their presubmersion baseline or had very mild deficits) and unsatisfactory outcomes (total custodial care or death). Significance was defined as P < .05. CONCLUSION: All satisfactory survivors were sufficiently awake to have spontaneous, purposeful movements 24 hours after near drowning and had normal brain-stem function. All children without spontaneous, purposeful movements and normal brain-stem function 24 hours after near drowning suffered severe neurologic deficits or death. In this retrospective investigation of 44 children, the cortical examination 24 hours after warm water near drowning distinguished satisfactory survivors from children who required total custodial care or died.

Adolescent↗

PubMed1999

Electromyographic findings in shoulder dislocations and fractures of the proximal humerus: comparison with clinical neurological examination.

There is no consensus of opinion about the frequency of associated nerve lesions in anterior shoulder dislocations and fractures of the proximal humerus. We undertook a prospective study to assess the incidence, the severity of the nerve injury and the diagnostic value of electromyographic examination; 215 patients were included. We performed neurological examination and needle electromyography (EMG). Nerve injury was graded according to a denervation score at the EMG. EMG disorders were seen in 133 patients (62%). Testing of sensibility and clinical reflexes proved not to be a reliable indicator for EMG abnormalities. Detection of axonal lesions by grading muscle strength based on the MRC score after these shoulder traumas is difficult. The findings of this study imply that by clinical examination alone a large number of axonal lesions remain undetected.

Adolescent↗

PubMed1978

Comparison of the averaged evoked cisterna cerebellomedullaris potential, cortical potential, and neurologic examination in the diagnosis of spinal cord injury of the dog.

Average cerebrocortical potentials (ECP) and cisterna cerebellomedullaris potentials (ECMP), evoked by ulnar and sciatic nerve stimulation, were compared with neurologic examination to evaluate their accuracy in the diagnosis of the degree of experimental spinal injury in 24 Beagles. The dogs were divided into 2 equal groups. Various impact forces were applied to the spinal cord at L1 of 1 group of dogs and various degrees of compression forces were applied to the spinal cord at L1 of the other group of dogs. The degrees of functional loss in both groups of dogs extended from mild to complete. The dogs were untreated and monitored for 30 days after injury. A short-acting barbiturate was compared with a long-acting barbiturate as the means of anesthesia; both were found to permit similar production of ECP and ECMP. The ECMP was found to be a more sensitive, more easily interpreted, and more consistent means of evaluating the degree of spinal injury than the ECP or the neurologic examination.

Anesthesia↗

PubMed2004

Neurological examination in healthy term infants aged 3-10 weeks.

OBJECTIVES: The neurodevelopmental progress of newborn term infants is checked routinely at around 6 weeks of postnatal age. The maturation of neurological signs in this age range however has not been systematically studied and normative data are not available. The aim of this study was to document any changes in posture, tone, reflexes, behaviour and movements in low-risk full-term infants between 3 and 10 weeks of postnatal age. STUDY DESIGN: We performed a structured neurological examination previously standardised in full-term newborns in the first 48 h after birth. In the current study, a total of 76 examinations were performed between 3 and 10 weeks of age in low-risk full-term infants. RESULTS: The results of the examinations were divided according to postnatal age. In most items, the scores changed with time, with a definite shift in their distribution occurring around 6 weeks. At this age, a reduction in flexor tone of the limbs was observed, together with an increase in active neck tone. Visual orientation in contrast had already improved by 3 weeks when all infants were able to follow a target in a full circle compared to newborns that are often only able to follow a target in an arc. CONCLUSIONS: Our results suggest that 6 weeks post-term birth is an important milestone for changes in neurological signs, particularly those related to muscle tone and posture, probably reflecting maturation of the nervous system. These findings provide important guidelines for the interpretation of the neurological examination performed at this age.

Child Development↗