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1. History

Even with increasingly sophisticated neurodiagnostic testing, the assessment and diagnosis of a child with a possible neurologic disorder begins with detailed neurologic history and examination, including several aspects of the general physical examination. The standard pediatric history and physical examination are presented in Chapter 9. A careful history will allow the clinician to establish the nature and course of the illness. Determining the progression of the illness (acute vs chronic, progressive vs static, episodic vs continuous) will help to determine an approach to the evaluation. When the developmental history is vague, other resources such as extended family members and baby scrapbooks may provide clarification of prior development. Episodic events such as headaches or seizures warrant emphasis on precise details preceding, during, and succeeding the events in question. Often, in age of readily accessible digital media, spells can be videotaped, providing important details that can assist in diagnosis.

2. Neurologic Examination

A general physical examination is an essential aspect of any neurologic assessment. Growth parameters and head circumference should be charted (see Chapter 3). A developmental assessment using an appropriate screening tool is part of every neurologic evaluation of an infant or young child and can be used to document the child’s developmental status. Chapter 3 delineates age-appropriate developmental landmarks (see Tables 3–1 and 3–2) and discusses the multiple screening tools available to the practitioner. The specifics of the neurologic examination are determined by the age of the child and the ability to cooperate with the examination. Expected newborn-infant reflexes and other age-related examination findings are included in Chapter 2. The hallmark of neurologic diagnosis is localization, defining where within the nervous system the “lesion” is located. While not all childhood neurologic disorders are easily localized, the part of the nervous system involved—for example, central versus neuromuscular—can often be defined and will act as a guide for evaluation and diagnosis.

Table 25–1 outlines components of the neurologic examination. Much of the examination of the frightened infant or toddler is, by necessity, observational. An organized approach to the examination is thus imperative. Playing games will engage a toddler or preschooler; activities such as throwing and catching a ball, stacking blocks, hopping, jogging, counting, and drawing (circles, lines) can reduce anxiety and allow assessment of fine and gross motor coordination, balance, and handedness. In the older child, “casual” conversation can reveal both language and cognitive competence in the form of drawing, writing, calculating, and spelling.

Table 25–1.Neurologic examination: toddler age and up.

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