4. 1-Lethargy=sleepy but fully arousable.
2-Drowsiness=light coma+arousable only to severe stimuli.
3-Stupor=moderate coma+unarousable+localize the pain.
4-Coma=deep coma.. unarousable..not localize the pain.
8. Delayed speech
=no word up to 18 m.
Or no sentence up to 3yrs.
Causes
-MR
-Deafness
-articulation defect
-bilingolism-physiological .
Slurred speech……………………(pyramidal lesion).
Monotonus speech …………….(extrapyramidal lesion).
Staccato speech…………………(cerebeller lesion)
9.
10. 3rd & 4th cranial nerves are
located in the mid brain
5th , 6th , 7th & 8th cranial nerves
are located in the pons
9th , 10th , 11th & 12th cranial
nerves are located in the medulla
oblongata
11. Common non irritant odours +to each
nostril+eye closed .
Difficult in children.
Anosmia =loss of smell.
18. 3-reflexes:
jaw reflex.ال ينفتح حتى ألسفل الضرب اتجاه يكون ان يجبفك
Normally this reflex is absent or very slight.
However in individuals with UMNL the jaw
jerk reflex can be quite pronounced.
24. Cochlear part(hearing)
*At birth ---moro reflex.
*younger deviate to sound.
*Later Renne s test+ Weber test.
Vestibular part
nystagmus +vertigo
25.
26.
27.
28.
29. Sensory ……loss of post 2/3 of tongue.
Motor……pharyngeal O/E….
1-gag reflex…absent in bulber palsy UMNL
……exaggarated in pseudo bulber palsy LMNL.
2-Uvula ….normally central & mobile.
In unilateral lesion….uvula deviate to healthy side.
In bilateral lesion…uvula is central but immobile.
37. Bulber palsy Pseudo –bulber palsy
It is LMNL of the bulber
cranial nerve 8-9.
Lead to loss of gag reflex
+ flaccid paralysis of
pharynx & larynx.
It is UMNL of the bulber
cranial nerve nuclei
Lead to exaggerated gag
reflex.
Spastic paralysis of the
pharynx & larynx.
38. Late singes
Neck stiffness.
Back stiffness.
+ve kernig’s sing.
+veBrudziniski’ neck
sign.
+veBrudziniski’ leg
sign.
Early singe
chin-chest test.
Chin-knee kissing
test.
Tripod singe
39. Rapid flexion of the head is
accompanied by brisk flexion of both
knee
48. 1-Young child…….painful stimulation on the
opposite side of the tested muscle.
2-Older child….ask to move against resistance.
3-Test every joint for its muscle group.
4-Grading of muscle power
54. Neck….pulling the child from both UL.
Intercostal m. ……short breath
حتى العد اليستطيع10......بعد على شمعه اطفاء اليستطيع30سم.
m. Of abdomen…….localize bulge of the
abd.(e.g. poliomylitis).
Diaphragm…..paradoxical respiration.
57. UMNL =Pyramidal lesion…..
spasticity(clasp knife) resistance on the
start of movement.
Extrapyramidal lesion…..
rigidity(resistance is all over movement ).
Rigidity may be (cog-weal or lead
pipe)
58. =usually with extrapyramidal lesion.
*Chorea….sudden irregular purposeless dancing
movement affect big proximal joint.
*Athetosis…slow twisting movement affect distal joint.
*Dystonia….slow twisting movement in trunk.
*Tremors….rapid alternating movement around small
joint.
60. -1st year ……grasp reflex & object transfer.
-2nd year……button & unbutton.
->3years……U.L.
1- Finger to nose test
2-Finger to finger test
3-Dysdiadochokinesis…inability toperform rapidly
alternating movement(e.g. rapid pronation and supination)
4-Rebound test
L.L.
Heal to shin test
Toe finger test
Foot Tapping test
Inco-ordination = ataxia.
61. Isolated fibers contraction not all the muscle .
Difficult to see in any muscle
Easily to seen in the tongue?
purly muscle organ coverd by mucosa ,,,,no
submucosa or fat like other muscle.
=LMN
63. Special standpoints:
Requires good cooperation on the patient`s side.
Most often we compare different parts of the body.
The patient should not see the examined part of the
body !
64. Pain: pin prick, tooth picks
Light touch: use a wisp of cotton wool.
Temperature: use cold (5-10 0C)/or hot (40-45 0C)
test tubes.
65. Joint position / motion:
-Hold the sides of the patient’s
finger ! Move it up and down at
random ! Ask to specify the
direction of movement !
Vibration:
-Place a vibrating tuning fork
on a bony prominence ( ankle,
knee,processus styloideus
radii and ulnae, elbow,
clavicula)
66. Two point discrimination:
-The ability to discriminate two blunt points when
applied simultaneously. (3-5 mm on the finger, 4-7
cm on the trunk).
69. sudden passive stretchsudden massive
activation of AHCssudden massive
contraction of all muscle fibers
Superficial reflexes-deep –visceral-others
70. *Scratch the lateral part of the sole….
…..planter flexion of the toes.
+ve Babiniski s.=dorsiflexion of the big toe &
fanning of the other toes=UMNL
Normal up to 2yr…….why?
71. Scratch abdominal wall by a pin from outward
inward ….contraction of a segment of
abdominal muscles.
T7
T8
T9
T10
T11
T12
72. Light scratch along the inner aspect of the
upper part of the thigh lead to
elevation of the testicles.
73. Scratch the peri anal region
lead to contraction of external anal sphincter.
74. Biceps jerk (c5-6)
Blow upon the thumb on the biceps tendon while
the elbow is slightly extended
75. Blow upon the triceps tendon while the elbow
is flexed.
76. Blow upon styloid process of radius….flexion &
supination of elbow… (brachioradialis)
77. Blow on the qudriceps tendon..
(pateller tendon)
79. Only done if jerk is exaggerated (UMNL).
ايه؟؟؟؟؟؟؟؟ شروطها
*Ensure that the pt is relaxed.
*Apply sudden and sustained flexion to the ankle……
*normally few oscillatory beats may occur…..
*if persist = +ve clonus.
Knee clonus.. Ankle clonus..
80. 1-physiological < 18m.
2- pathological:
=lesion in the arc
1-afferrent ………...neuritis.
2-posterior horn…..disc protrusion.
3-AHC……………….Poliomylitis.
4-Efferrent………...neuritis.
5-muscle…………...myopathy.