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PubMed2005

Neurologic examination abnormalities in children with bipolar disorder or attention-deficit/hyperactivity disorder.

BACKGROUND: Attention-deficit/hyperactivity disorder (ADHD) and bipolar disorder (BPD) are frequently comorbid and overlapping diagnoses. To move beyond diagnosis toward unique pathophysiology, we evaluated both ADHD and BPD children for neurologic examination abnormalities (NEAs) in comparison with normal control (NC) children. METHODS: We performed the Revised Physical and Neurological Examination for Soft Signs in three groups (ADHD, BPD, NC). Then, a rater blind to diagnosis evaluated their motor performance. Results were analyzed with a multiple analysis of covariance. RESULTS: Subjects with ADHD were impaired on repetitive task reaction time. In contrast, pediatric BPD subjects, both with and without comorbid ADHD, were impaired on sequential task reaction time. CONCLUSIONS: This differential pattern of NEAs by diagnosis suggests pathophysiologic differences between ADHD and BPD in children. Repetitive motor performance requires inhibition of nonrelevant movements; ADHD subjects' impairment in this domain supports the hypothesis that ADHD involves a core deficit of fronto-striato-basal ganglia neurocircuitry. In contrast, BPD subjects' impaired sequential motor performance is consistent with behavioral data showing impaired attentional set-shifting and reversal learning in BPD subjects. Further study, going beyond symptom description to determine pathophysiologic differences, is required to refine neuronal models of these often comorbid diagnoses.

Adolescent↗
PubMed2003

Neurological examination in the healthy term newborn.

We carried out a cross-sectional study with a sample of 106 normal full-term newborns examined within 24 to 72 hours of birth. The following findings were evaluated: head and chest measurements, muscle strength, tone, tendon reflexes, superficial reflexes, primitive reflexes, and cranial nerves. All 106 newborns were considered neurologically normal. We found no differences in the neurological examination findings for newborns with different gestational ages. Primitive reflexes and appendicular tone in newborns examined at earlier postnatal ages tended to be less intense. We were able to determine the prevalence of certain neurological examination findings for the normal newborn and to discuss some differences between our results and those of other studies. Prevalence estimations for the different findings in our study may be valid for different populations as long as the same methodology is adopted.

Anthropometry↗
PubMed1983

Neonatal neurologic examinations of very preterm infants: comparison of results with ultrasound diagnosis of periventricular hemorrhage.

Seventy infants born before 33-weeks gestation were studied by serial ultrasound brain scans from the first days of life; twenty had periventricular hemorrhage (PVH). Weekly neurologic examinations were performed from age 5 to 10 days. Only measures of passive tone could be elicited before an age equivalent to 34-weeks gestation because the infants were very sick, and many were receiving treatment with mechanical ventilation. Gestation was the most important determinant of this aspect of neurologic functioning, and no effect of time from birth was noted. Before ages equivalent to 34-weeks gestation, no significant relationship was found between measures of passive tone, including the size of the popliteal angle, and PVH diagnosed by ultrasound. At ages equivalent to 34 weeks or more, measures of active as well as passive tone and reflexes were consistently elicited. No single measure discriminated between infants with or without PVH, but serial observations indicated that persisting imbalance of active tone and clonus were only noted in infants with PVH, including 7 of the 8 infants who had PVH complicated by ventricular enlargement. It was concluded that neurologic examination does not reliably diagnose PVH during the neonatal period in sick, very preterm infants. At an age equivalent to term, it may help to distinguish infants who sustained permanent brain damage in association with neonatal PVH which may lead to adverse sequelae at follow-up.

Cerebral Hemorrhage↗
PubMed2005

Should the Babinski sign be part of the routine neurologic examination?

BACKGROUND: The Babinski sign is a well-known sign of upper motor neuron dysfunction that is widely considered an essential element of a complete neurologic examination. Little is known about reliability and validity of this sign. A less well-known sign of upper motor neuron dysfunction, decreased speed of foot tapping, also has not been carefully evaluated. Scientific evaluation of findings of the physical examination is crucial in directing busy clinicians. METHODS: Ten physicians (five neurologists and five non-specialists) examined each foot of 10 subjects, 8 of whom had known unilateral upper motor neuron weakness, 1 had bilateral leg weakness secondary to ALS, and 1 had no known neurologic deficits. Our main outcome measures were inter-rater reliability (kappa values) and accuracy (agreement with known upper motor neuron weakness). RESULTS: The reliability of the Babinski sign was fair (kappa 0.30) and was substantial for foot tapping (kappa 0.73). Agreement with known weakness was 56% for Babinski sign and 85% for foot tapping. Reliability and accuracy for both tests were similar for neurologists and non-specialists. CONCLUSIONS: The interobserver reliability and validity of the Babinski sign for identifying upper motor neuron weakness are limited. Slowness of foot tapping may be a more useful sign.

Adult↗
PubMed1992

The neurologic examination of the horse for purchase.

The veterinarian needs to be able to incorporate an accurate neurologic examination as a portion of the pre-purchase evaluation. Subtle neurologic deficits may be hidden by musculoskeletal disease or missed as a result of lack of knowledge or understanding of these disorders. It is important to known which musculoskeletal disorders are commonly associated with neurologic disease to better assist the buyer with the decision about whether to purchase the animal.

Animals↗
PubMed1990

The relationship between the pediatric neurological examination and neuropsychological assessment measures for young children.

Children with some degree of neurological dysfunction have traditionally been assessed by means of pediatric neurological examinations and/or neuropsychological test batteries. The present study investigated the relationship between these two different assessment methods in a normal population of 129 kindergarten and second grade students. Results indicated that of the 396 correlations conducted for each grade, 18% of the kindergarten and 15% of the second grade sample correlations were significant at the .01 level. Given the relatively few positive correlations, and the fact that there were few consistent patterns within and across grade levels, it was concluded that these two assessment procedures measure different areas of functioning and constitute two separate components of a broad evaluation of the relationship between behavior and the adequacy of brain functions.

Age Factors↗
PubMed1995

Historical aspects of the neonatal neurological examination: why child neurologists are not 'little' adult neurologists.

The origins of the neonatal neurological examination are described with their common basis attributable to evolutionary theory, the classical neurosciences, clinical neurology, and developmental psychology. It is shown that not only have the techniques of the bedside examination changed over the past half century but the purpose of the examination has also evolved; initially the examination was used to assess maturation of the developing infant, now it is used to determine whether cerebral pathology may be present and whether examination abnormalities are helpful in outcome assessment. The development of several of the current neonatal neuroogical examinations are reviewed and their cllinical and scientific basis examined.

History, 20th Century↗
PubMed1989

Neurological examination of elderly women under investigation for urinary incontinence.

A random sample of 6,000 women from the birth cohorts 1900-1920 were invited to participate in an investigation of urinary incontinence by completing and returning an enclosed questionnaire. Of the 4,206 women who returned the completed questionnaire, 677 (16.9%) complained of urinary incontinence and accepted an invitation to be examined and treated at our clinic. The first 150 consecutive patients recruited via this questionnaire who attended the clinic underwent a detailed neurological examination. The prevalence of neurological signs amongst this group of women was low, only 2% were considered to have a focal encephalopathy, 1% had an organic brain syndrome, 2% had a myelopathy and a further 1% were considered to have a polyneuropathy. There was no significant difference in the prevalence of neurological signs between the group of women with urinary incontinence and an age-matched control group from the total population. Thus, urinary incontinence in an unselected population of elderly women appears to be mainly dependent on other aetiological factors rather than neurological dysfunction.

Aged↗
PubMedDate not supplied

Neurological examination of the newborn.

Sophisticated technology for neurodiagnosis supplements, but does not replace, the neurological examination. Physical examination remains the standard for assessing the normal or abnormal function of the nervous system, the localization of neurological injury, and the severity of impairment. An experienced examiner can rapidly perform this assessment and then exercise the best judgement in selecting laboratory investigations.

Humans↗
PubMed2005

Toward a more efficient and effective neurologic examination for the 21st century.

Practice pressures and quality improvement require greater efficiency and effectiveness in the neurologic examination. I hypothesized that certain 'marginal' elements of the examination rarely add value and that 'core' elements, exemplified by the plantar response (Babinski), are too often poorly performed or interpreted. I analyzed 100 published, neurologic clinicopathologic conferences (CPCs) and 180 ambulatory neurologic consultations regarding 13 hypothetically 'marginal' examination components (including 'frontal' reflexes, olfaction, jaw strength, corneal reflex, etc.); also, 120 exams on medical inpatients with neurologic problems, recording definitive errors. I surveyed the recalled practices of 24 non-neurologists and reviewed the literature for relevant data or guidance. In the CPCs the 'marginal' elements of the examination were rarely provided, requested, or used diagnostically, nor did they contribute in the 180 ambulatory consultations. In the chart review errors and omissions dominated testing of plantar responses, with missed Babinski signs in 14% of all cases and 77% of patients with Babinski signs. House officers harbored unrealistic expectations for performance of 'marginal' examination elements. Most textbooks omit detailed guidance (and none cite evidence) on achieving greater efficiency. Exams should be streamlined, while improving 'core' skills. Neurologists should apply evidence to update the exam taught to students and non-neurologists.

Humans↗
PubMedDate not supplied

Age-related changes in the neurologic examination of healthy sexagenarians, octogenarians, and centenarians.

Although numerous studies have focused on age-related changes in the nervous system, few have systematically assessed global neurologic examination changes, and even fewer have included the most elderly population, ie, the centenarians. To perform such a study, we developed a quantitative assessment that includes the major components of a standard bedside neurologic evaluation, with special emphasis on cognitive function. First, we demonstrated that the quantitated examination could correctly classify healthy controls and patients with stroke or dementia based on discriminant analysis. This examination was then applied to healthy community-dwelling elderly ranging from 60 to 108 years of age. Significant age-related neurobehavioral changes were apparent across even these most "successfully" aged groups. Analysis of the full pattern of cognitive and neurologic findings provided the most accurate assessment. Pathologic reflexes, reportedly associated with normal aging, occurred infrequently in this healthy geriatric population, suggesting that age-related changes in the neurologic examination may be more accurately interpreted when assessed in conjunction with cognitive status. This quantitative examination may be useful in future population-based studies of neurologic function in the aged.

Aged↗
PubMed1992

Infarcts with a cardiac source of embolism in the NINDS Stroke Data Bank: neurologic examination.

To gain insight into neurologic signs relevant to the diagnosis of cardiogenic embolism, we analyzed data from 1,290 patients with cerebral infarcts in the NINDS Stroke Data Bank. Based solely on the presence of potential cardiac sources of embolism, we divided patients into groups of high (N = 250), medium (N = 167), and low (N = 873) risk of a cardiogenic mechanism for their stroke. Diminished level of consciousness was highly associated with the presence of a cardiac source of embolism. Of the four primarily cortical deficits assessed, three (visual field abnormalities, neglect, and aphasia) showed a highly significant graded relationship to the cardiac risk groups. For the fourth cortical deficit (other nonlanguage cognitive functions), this relationship did not attain statistical significance. Conversely, hemiparesis without sensory or cortical deficits had a strong inverse association to the presence of a cardiac source of embolism. This inverse association was weaker for sensorimotor strokes and nonexistent for pure sensory strokes. Although some neurologic findings had highly significant associations with the presence of a cardiac source of embolism, their predictive value for an embolic source was low.

Cerebral Infarction↗