Babies!
What is the normal tone of a newborn?
For a term newborn the resting posture is flexion of the extremities with the extremities closely adducted to the trunk.
When do you expect an infant to be sitting independently?
6 mo of age!
What is night time awakening a red flag for?
Increased ICP. Differential includes malignancy, hydrocephalus, IIH
What do you see on EEG in infantile spasms?
Hypsarrythmia!
List 4 primitive reflexes
Suck, rooting
Moro
Plantar/palmar grasp
Moro
Galant
Stepping
Describe a normal toddler's gait
He has a wide base, is unsteady, and toddles. His arms are held at near shoulder level in a high guard position. This is a protective position and probably aids in his balance.
Are migraines unilateral or bilateral in children?
Can be either, but the most common pre-pubertal location is bifrontal rather than unilateral in our adult friends.
Child with progressive weakness and high pitched, soft, nasal voice. She has ptosis and difficulty raising her eyebrows or looking up. What it your definitive diagnostic test?
EMG to look for myasthenia gravis
What is a normal hand position in babies?
A newborn baby’s hand is held in a fisted position with the fingers flexed over the thumb. The hand should open intermittently and should not always be held in a tight fisted position. Rubbing the ulnar aspect of the hand or touching the dorsum of the hand will often cause extension of the fingers. Over the first 1 to 2 months of life, the baby’s hand becomes more open. Persistence of a fisted hand is a sign of an upper motor neuron lesion in an infant.
What is a reflex you can test to see if a child is developmentally ready to start walking?
The parachute reflex! The parachute is the last of the postural reflexes to develop. It usually appears at 8 to 9 months and certainly is present by 12 months of age.
What headache could present as a daily morning headache on first awakening, 2/10, only lasting 15 minutes in a tight band around the head?
Hypertension headache! Especially in individuals with or predisposed to hypertension. But make sure you're not missing any other red flags
What do you need to screen for in a patient with opsoclonus myoclonus?
Neuroblastoma
List 3 cranial nerves that you can evaluate while a baby is sucking
Sucking and swallowing assesses Cranial Nerves 5, 7, 9, 10, and 12 because all of these cranial nerves are involved in this complex act.
Crying: 7, 9, 10
Eye movements: 3, 4, 6
When does handedness develop?
AFTER 12 months. There should be equal handedness and development of fine motor skills until then. Be concerned about hemiparesis if a hand preference develops in infancy.
How can you evaluate for headache severity in a school age child?
How many days is the child being sent home from school or staying home from school? Are they participating in class and extracurricular activities as normal?
PedMIDAS is a clinical tool that can help to quantify severity of a headache, especially migraine, disorder.
A school age child shows up with a history of recent URI and dizziness not responding to zofran/Epply maneuvers and her motor exam looks like this. What is the diagnosis?
Acute cerebellar ataxia
This is similar to vestibular neuritis in that it is demyelination following an illness, but due to the cerebellar location you will see ataxia (or truncal titubation in this video). These children can be sent home with supportive care and PT and as long as there are no red flag signs, tyipcally do not need imaging or admission.
How do you test arm and leg recoil? (Part of the Ballard exam)
Arm recoil tests tone and action of the biceps. The arms are held in flexion against the chest for a few seconds, then are quickly extended and released. The arms should spring back to the flexed position. The hyotonic infant will have slow incomplete recoil. Asymmetry to this response with lack of recoil would be seen with Erb’s or brachial plexus palsy.
To test leg recoil, the legs are fully flexed on the abdomen for a few seconds, then the legs are quickly extended and released. The legs should spring back to the flexed position. Legs that remain extended could be due to either hypotonia or abnormal extensor tone.
What is the most important task in a pediatric neuro exam?
Observe!! There is so much you can learn about developmental milestones, mental status, and motor functioning simply by watching.
What can you observe about this child?
What is the landmark pediatric migraine study and its major conclusion on management?
The CHAMPS trial. Found that 3 months of daily riboflavin (B2) their control was as effective as 3 months of daily propranolol or amitriptyline.
What is a CNS autoimmune complication of the flu?
Acute Necrotizing Encephalopathy
This is a rare and rapidly progressive condition that it thought to be auto-immune mediated destruction of the CNS