What is a neurological examination?

A neurological examination is also called a neuro examination. It's an evaluation of your child's nervous system. It can be done in the doctor's office. It may be done with instruments, such as lights and reflex hammers. It usually does not cause any pain to your child.

The nervous system consists of the brain, the spinal cord, and the nerves from these areas, as well as the muscles (the neuromuscular system). There are many aspects of this examination. It checks:

• Motor and sensory skills.
• Balance and coordination.
• Mental status (your child's level of awareness and interaction with the environment).
• Reflexes.
• Nerve function.

The extent of the examination depends on many factors. This includes the problem that your child is having, your child's age, and their condition.

Why is a neurological examination done?

A complete and thorough evaluation of your child's nervous system is important if there is any reason to think there may be an underlying problem.

Damage to the nervous system can cause delays in a child's development and functioning. Early identification may help find the cause and decrease long-term complications. A complete neurological examination may be done:

• During a routine physical.
• During a newborn physical.
• To follow the progression of a disease.
• Following any type of congenital anomaly (previously called birth defect) to the head or spine.
• If a child has any of these complaints:
  • Headaches.
  • Blurry vision.
  • Change in behaviour.
  • Severe tiredness (fatigue).
  • Change in balance or coordination.
  • Numbness or tingling in arms or legs.
  • Decrease in arm or leg movement.
  • Injury to the head, neck, or back.
  • Fever of unknown source (rare).
  • Seizures.
  • Slurred speech.
  • Weakness.
  • Tremor.

What is done during a neurological examination?

During a neurological examination, your child's doctor will test the functioning of the nervous system. The nervous system is very complex and controls many parts of the body. It consists of the brain, spinal cord, 12 nerves that come from the brain (cranial nerves), and the nerves that come from the spinal cord. The nervous system regulates the muscles. The blood circulation to the brain, from the arteries in the neck, is often examined. In infants and younger children, a neurological examination includes measuring the size of the head. Here are some of the areas that may be tested and evaluated during a neurological examination:

• Mental status. A child's level of awareness and interaction with the environment may be assessed by watching an infant interact with their parent, or by asking an older child to follow directions or answer questions. The older child will also be watched for clear speech and making sense while talking. This is usually done by your child's doctor just by observing your child during normal interactions.
• Motor function and balance. This may be tested by having an older child push and pull against the doctor's hands with their arms and legs. The child may be asked to squeeze fingers or hop, skip, or jump. Balance may be checked by assessing how the child stands and walks or having an older child stand with their eyes closed while being gently pushed to 1 side or the other. Your child's joints may also be checked either by passive (done by the doctor) or active (done by your child) movement.
• Sensory examination. Your child's doctor checks your child's ability to feel. This may be done by using dull needles, tuning forks, alcohol swabs, or other objects. The doctor may touch your child's legs, arms, or other parts of the body and have them identify the sensation (for instance, hot or cold, sharp or dull).
• Newborn and infant reflexes. In newborns and infants, reflexes called infant reflexes (or primitive reflexes) are evaluated. Each of these reflexes disappears at a certain age as the infant grows. They include:
  • Blinking. An infant will close their eyes in response to bright lights.
  • Plantar reflex (also known as Babinski reflex). Normally, as an infant's foot is stroked, the toes will extend upward. This response usually disappears after a year of age. It is considered abnormal for this reflex to remain present after 2 years.
  • Crawling. If an infant is placed on their stomach, they will make crawling motions.
  • Moro reflex (or startle reflex). A quick change in an infant's position will cause the infant to throw their arms outward, open their hands, and throw back their head. This reflex normally is gone after 6 months of age.
  • Tonic neck reflex. A newborn is tested lying down with face up. If their head is passively turned to 1 side, the arm on that side will extend, with the other arm flexing at the elbow and shoulder. This reflex normally goes away after 6 months of age.
  • Palmar and plantar grasp. An infant's fingers or toes will curl around a finger placed in the area.
• Muscle stretch reflexes in older children. These are sometimes called deep tendon reflexes. They are often checked using a reflex hammer. The reflex hammer is used at different points on the body, such as the knee or elbow. It tests the reflex arc between the nerves that cause the muscle contraction and those that send signals back to the brain. This checks both the peripheral nerves and the spinal cord. If the peripheral nerves are impaired, this test causes a reduced or absent response. If the spinal cord is injured, this test tends to cause a bigger response.
• Evaluation of the cranial nerves. There are 12 main nerves of the brain, called the cranial nerves (CN I-XII). During a complete neurological examination, most of these nerves are evaluated to help determine the functioning of the brain:
  • Cranial nerve I (olfactory nerve). This is the nerve of smell. Your child may be asked to identify different smells with their eyes closed.
  • Cranial nerve II (optic nerve). This nerve carries vision to the brain. A visual test may be given. Your child's eye may be examined with a special light.
  • Cranial nerve III (oculomotor). This nerve is responsible for pupil size and certain movements of the eye. Your child's doctor may examine the pupil (the black part of the eye) with a light and have your child follow their finger in various directions. Cranial nerves III, IV, and VI are tested together.
  • Cranial nerve IV (trochlear nerve). This nerve also helps with the movement of the eyes, in combination with CN VI.
  • Cranial nerve V (trigeminal nerve). This nerve allows the ability to feel the face, inside the mouth, and move the muscles involved with chewing. Your child's doctor may touch the face at different areas and watch your child as they bite down.
  • Cranial nerve VI (abducens nerve). This nerve helps with the movement of the eyes. Your child may be asked to follow a light or finger to move the eyes.
  • Cranial nerve VII (facial nerve). This nerve is responsible for the movement of the muscles of facial expression and taste from the front of the tongue. Your child may be asked to identify different tastes (sweet, sour, bitter), asked to smile, move their cheeks, forehead, or eyelids, or show their teeth.
  • Cranial nerve VIII (acoustic nerve). This is the nerve of hearing and vestibular function. A hearing test may be done on your child. Your child may undergo specialized testing for vestibular function.
  • Cranial nerve IX (glossopharyngeal nerve). This nerve is involved with taste and swallowing. Once again, your child may be asked to identify different tastes on the back of their tongue. The gag reflex may be tested. Cranial nerves IX and X are tested together.
  • Cranial nerve X (vagus nerve). This nerve is mainly responsible for the ability to swallow, the gag reflex, some taste, and part of speech. Your child may be asked to swallow. A tongue blade may be used to elicit the gag response.
  • Cranial nerve XI (accessory nerve). This nerve is involved in the movement of a muscle of the shoulders and neck. Your child may be asked to turn their head from side to side against mild resistance or to shrug their shoulders.
  • Cranial nerve XII (hypoglossal nerve). This nerve is responsible for movement of the tongue, along with CN IX and X. Your child may be asked to stick out their tongue and to speak.