Physical examination. 17: neurological examination.
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Autonomic Nervous System↗
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Results for “Neurologic Examination”
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Evaluation of neurological examination of sheep.
One hundred clinically negative Merino sheep were examined neurologically in an attempt to establish normal responses. Dependable results were obtained regarding eye muscle integrity, corneal sensitivity, the optic papilla and righting reflexes and to some extent the knee jerk reflex. The elicitation of other reflexes was inconsistent and unreliable except the placing reflex as shown by raising and lowering the forequarters.
Animals↗
The construction of a scored neonatal neurological examination for assessment of neurological integrity in full-term neonates.
We describe the construction of a scored form for the neurological examination of the full-term neonate. Extensive data analyses were obtained from a large sample of neonatal neurological examinations performed by one examiner (MSP). Examinations were used from neonates with ages less than or equal to 48 hours (n = 727) and 72 hours to 1 week (n = 510) with gestational ages greater than or equal to 37 weeks. Forty-four items from several neonatal assessments were used in these neurological examinations. Further subdivision yielded a total of 65 items. Correlations were obtained for the 65 items. We factored the matrix of these correlations, using several solutions of factor analysis. Thirty-two items were thus grouped and pruned into seven dimensions (factors) to provide a scorable neonatal neurological examination (Neoneuro) with an internal consistency or reliability of 0.80. From the total scores, cut points are recommended for categories of normality/abnormality: normal, mildly abnormal, moderately abnormal, and severely abnormal. This scoring system is well-based both theoretically and psychometrically. The quantified computer-compatible scoring system permits evaluation of individual neonates, as well as comparison of samples of neonates on item scores, subscores (factor scores), and total scores. Such quantification will permit documentation of the natural history of specific abnormalities and the evaluation of various therapies.
Brain Damage, Chronic↗
[Developmental neurological examinations in preparatory school children (author's transl)].
302 primarily healthy preparatory school children aged from 4-6 years were examined neurologically, using a slightly modified Touwen-Prechtl examination scheme. It was possible to make statistically confirmed statements on the individual tests of neurological function for a German kindergarten population. To develop a short (screening) test representative of the entire nervous system would be very difficult indeed. We hope, however, by means of rational data reduction, to be able to find a compromise between the complexity of the nervous system and the necessities of practice.
Age Factors↗
Physical examination. Part 18. Neurological examination.
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Child, Preschool↗
[Developmental neurologic examination of premature infants. I. Nerve development and functional neurologic examination methods].
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Child Development↗
Influence of additional information on interrater reliability in the neurologic examination.
We performed a routine neurologic examination on 200 patients who were reexamined by a second physician under three different conditions: (1) reexamination of only one item, (2) complete reexamination without knowledge of the patient's history and complaints, and (3) complete reexamination with such knowledge. We used changes in reliability as an index of the effect of additional information on basic data collection. Additional information increased reliability, indicating that diagnostic hypotheses obtained mainly from the history improve the examiner's precision. When a complete reexamination was performed with knowledge of the patient's history, reliability was substantial (kappa > 0.6). More experienced examiners do not perform the examination more reliably, but do utilize the patient's history differently.
Humans↗
Training examiners to administer a quantitative neurological examination for a multicenter clinical trial.
A battery of quantitative neurological tests was used in a multicenter clinical trial to compare ACTH with placebo for the treatment of patients with multiple sclerosis in acute exacerbation. Since the battery of tests was administered in ten centers by physical therapists, it was critical that the examiners were well trained and remained so. Results of experiments showed that physical therapists could be successfully trained to administer the tests in a uniform fashion and remained trained for three years, the duration of the clinical trial. The fact that physical therapists are not taught tell-tale side effects of a treatment, and hence do not perceive these as do the physician examiners, introduces another level of objectivity into neurological clinical trials.
Activities of Daily Living↗
The clinical utility of computed tomographic scanning and neurologic examination in the management of patients with minor head injuries.
The evaluation and management of patients with minor head injury (MHI: history of loss of consciousness or posttraumatic amnesia and a GCS score greater than 12) remain controversial. Recommendations vary from routine admission without computed tomographic (CT) scanning to mandatory CT scanning and admission to CT scanning without admission for selected patients. Previous reports examining this issue have included patients with associated non-CNS injuries who confound the interpretation of the data and affect outcome. We hypothesized that patients with MHI and no other reason for admission with normal neurologic examinations and normal CT scans would have a negligible risk of neurologic deterioration requiring surgical intervention. To validate this hypothesis we studied 2766 patients with an isolated MHI admitted to seven trauma centers between January 1, 1988, and December 31, 1991. There were 1898 male patients and 868 female patients; injury was blunt in 99%. A neurologic examination and a CT scan were performed on 2166 patients; 933 patients had normal neurologic examinations and normal CT scans and none required craniotomy; 1170 patients had normal CT scans and none required craniotomy; 2112 patients had normal neurologic examinations and 59 required craniotomy. The sensitivity of the CT scan was 100%, with positive predictive value of 10%, negative predictive value of 100%, and specificity of 51%. The use of CT alone as a diagnostic modality would have saved 3924 hospital days, including 814 ICU days, and $1,509,012 in hospital charges. Based on these data, we believe that CT scanning is essential in the management of patients with MHI and that if the neurologic examination is normal and the scan is negative patients can be safely discharged from the emergency room.
Adolescent↗
[Continuing education on primary health care. (5). (9). The neurological examination].
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Humans↗
[School achievement and neurologic examination: a 7-years' correlation study].
Neurological examination and school performance were analyzed in 146 children from a longitudinal follow up on growth and development at northern metropolitan Santiago, Chile. Their reading and writing abilities and their performance on neuro-maturational tests at the third elementary grade, were compared with academic achievements seven years later and highly significant correspondence was found among these terms. Reading comprehension and simple arithmetic problem solving abilities were the most affected aspects in children that exhibited multiple subtle neurological abnormal signs. Writing and design abilities were also involved up to a certain degree. Intellectual endowment was a determinant factor in this relationship since children above average. I.Q. showed less neurological involvement and better academic qualifications and vice versa. Subjects with many subnormal neuro-maturational signs had relative under-ratings at school examinations, whichsoever their mental level was. Thirty percent of the initial 208 study case were missed in the 7 year time span: Most of them were unable to read and write properly at third elementary school grade, showed evidence of several minor neurological failures and abandoned school in the mean time. By contrast, 96% of the index group could be reexamined. This bias implies that between early learning plus neurological status, at age 9 years and the later academic performance should have been an extremely positive interrelationship for the whole series.
Achievement↗
Cranial sonography and neurological examination of extremely preterm infants.
Fifty-one extremely preterm infants were studied to ascertain whether there is an association between sonographic abnormalities and neurological examination at term, controlling for factors such as low birthweight and chronic lung-disease. Their mean birthweight was 956g and mean gestational age was 27.9 weeks. Sonography was performed at least once during the first week, twice within the first month, and once within a month of term-corrected age. Neurological assessment was used to classify the infants as normal, suspect or abnormal at term. Infants were divided into three groups, based on sonographic findings: group 1 (no hemorrhage), group 2 (grade 1 to 3 hemorrhage but normal sonogram or unilateral ventriculomegaly at term) and group 3 (periventricular leukomalacia, grade 4 hemorrhage or ventriculomegaly at term). On neurological examination, 23 infants were found to be normal, 15 suspect and 13 abnormal. On sonography, 27 infants were placed in group 1, 12 in group 2 and 12 in group 3. Sonographic findings and birthweight were the best predictors of the infant's performance on the neurological examination at term.
Apgar Score↗
The reliability and diagnostic validity of the physical and neurological examination for soft signs (PANESS).
Twenty-one children, mean age of 8 years, were each examined on separate occasions by two pediatric residents, blind to diagnosis, using the neurological examination (PANESS) included in the group of instruments recommended by the National Institute of Mental Health for psychotropic drug studies in children. Half the children were hyperactive/aggressive, one quarter were normal, and one quarter had histories or signs strongly presumptive of brain damage. Many of the signs, though reliable, did not occur in the majority of children. Examiners did achieve a high level of agreement about global neurological status. It was concluded that the neurological examination probably contains a substantial number of non-contributory items and should be regarded as experimental rather than definitive.
Brain Damage, Chronic↗
The neurologic examination and lesion localization.
As is true of animals with diseases of other organ systems, cats with neurologic disease should be approached in a systematic, problem-oriented manner (Table 1-1). The neurologic examination and process of lesion localization are the principal components of the evaluation. Lesions involving specific areas of the nervous system cause predictable neurologic deficits or problems ranging from monoparesis to seizures. By recognizing one of these problems and relating it to a particular anatomic region of the nervous system, a differential diagnosis of diseases that typically involve this area can be established. Although the neurologic examination and process of lesion localization are essential to developing the differential diagnosis, results of the history are equally important in predicting which disease or group of diseases is most likely present (Table 1-2). Identification of problems related to other organ systems on the physical examination, furthermore, should suggest that polysystemic diseases, such as infectious conditions, are potentially involved. After the differential diagnosis has been developed and the relative likelihood of each individual disease or group of diseases has been established, appropriate diagnostic procedures may be done. This should allow identification of the underlying cause and initiation of treatment, when indicated.
Animals↗
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↗
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↗
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↗
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↗