Neurological examination

What is a neurological examination?

A neurological examination, also called a neuro exam, is an evaluation of your child's nervous system that can be performed in the physician's office. It may be performed with instruments, such as lights and reflex hammers, and usually does not cause any pain to the child. The nervous system consists of the brain, the spinal cord, and the nerves from these areas. There are many aspects of this examination, including an assessment of motor and sensory skills, balance and coordination, mental status (the child's level of awareness and interaction with the environment), reflexes, and functioning of the nerves. The extent of the examination depends on many factors, including the initial problem that the child is experiencing, the age of the child, and the condition of the child.

Why is a neurological examination performed?

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, or during a complete physical. Damage to the nervous system can cause delays in the child's normal development and functioning and early identification may help to identify the cause and decrease long-term complications. A complete neurological examination may be performed: 

• During a routine physical. 
• During a newborn physical. 
• Following any type of birth defect to the head or spine. 
• If the child has any of the following complaints:
  • Headaches.
  • Blurry vision.
  • Change in behavior.
  • Fatigue.
  • Change in balance or coordination.
  • Numbness or tingling in the arms or legs.
  • Decrease in movement of the arms or legs.
  • Injury to the head, neck, or back.
  • Temperature of unknown source.

What is done during a neurological examination?

During a neurological examination, your child's physician will "test" the functioning of the nervous system. The nervous system is very complex and controls many parts of the body. The nervous system consists of the brain, spinal cord, 12 nerves that come from the brain, and the nerves that come from the spinal cord. In infants and younger children, a neurological examination includes the measurement of the head circumference. The following is an overview of some of the areas that may be tested and evaluated during a neurological examination:

• Mental status
  Mental status (the child's level of awareness and interaction with the environment) may be assessed by watching the infant interact with the parent, or by asking the older child to follow directions or answer questions appropriately. The older child will also be observed for clear speech and making sense while talking. This is usually done by your child's physician just by being in the room with the child during normal interactions.
• Motor function and balance
  This may be tested by having the older child push and pull against the physician's hands with his/her arms and legs. The child may be asked to squeeze fingers or hop, skip, or jump. Balance may be checked by having the older child stand with his/her eyes closed while being gently pushed to one side or the other. Your child's joints may also be checked simply by passive (performed by the physician) and active (performed by the child) movement.
• Sensory examination
  Your child's physician may also perform a sensory test which tests your child's ability to feel. This may be done by using different instruments: dull needles, tuning forks, alcohol swabs, or other objects. The physician may touch the child's legs, arms, or other parts of the body and have him/her identify the sensation (i.e., hot/cold, sharp/dull).
• Newborn and infant reflexes
  There are different types of reflexes that may be tested. In newborns and infants, reflexes called infant reflexes (or automatisms) are evaluated. Each of these reflexes disappears at a certain age as the infant grows. These reflexes include, but are not limited to, the following:
  • Blinking - an infant will close his/her eyes in response to bright lights.
  • Babinski reflex - as the infant's foot is stroked, the toes will extend upward.
  • Crawling - if the infant is placed on his/her abdomen, crawling motions will be made.
  • Moro's reflex - a quick change in the infant's position will cause the infant to throw the arms outward, open the hands, and throw back the head.
  • Palmar and plantar grasp - the infant's fingers or toes will curl around a finger placed in the area.
  • Startle - a loud noise will cause the infant to extend and flex the arms while the hands remain in a fist.
• Reflexes in the older child
  These are usually examined with the use of a reflex hammer. The reflex hammer is used at different points on the body to test numerous reflexes, which are noted by the movement that the hammer causes.
• Evaluation of the nerves of the brain
  There are 12 main nerves of the brain, called the cranial nerves. 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 his/her eyes closed.
  • Cranial nerve II (optic nerve)
    This is one of the nerves of the eye that helps control vision. A visual test may be given and your child's eye may be examined with a special light.
  • Cranial nerve III (oculomotor)
    This is another nerve that controls part of the eye. This nerve is responsible for the pupil size and the movement of the eye. Your child's physician may examine the pupil (the black part of the eye) with a light and have your child follow the light in various directions.
  • Cranial nerve IV (trochlear nerve)
    This nerve also helps with the movement of the eyes.
  • Cranial nerve V (trigeminal nerve)
    This nerve allows for many functions, including the ability to feel the face, inside the mouth, and move the muscles involved with chewing. Your child's physician may touch the face at different areas and watch your child as he/she bites 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 various functions, including the movement of the face muscle and taste. Your child may be asked to identify different tastes (sweet, sour, bitter), asked to smile, move the cheeks, or show the teeth.
  • Cranial nerve VIII (acoustic nerve)
    This nerve is involved with hearing. A hearing test may be performed on your child.
  • Cranial nerve IX (glossopharyngeal nerve)
    This nerve is involved with taste. Once again, your child may be asked to identify different tastes on the back of the tongue.
  • 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 and a tongue blade may be used to elicit the gag response.
  • Cranial nerve XI (accessory nerve)
    This nerve is involved in the movement of the shoulders and neck. Your child may be asked to turn his/her head from side to side against mild resistance, or to shrug the shoulders.
  • Cranial nerve XII (hypoglossal nerve)
    The final cranial nerve is mainly responsible for movement of the tongue. Your child may be instructed to stick out his/her tongue and speak.