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CNS Examination in children I Cranial Nerve Examination (I to VI) in children | Pediatrics — Transcript

by Learning Pediatrics · 2,271 words · 392 segments · language en · Watch on YouTube

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0:00[Music]
0:00hello everyone today in this video i
0:03will perform the third part of the cns
0:05examination crania no examination so
0:08first crania now is olfactory now its
0:11function is
0:13to sense the smell
0:15and as we know sense of ismail is
0:18present since birth
0:20but it's not possible to test the
0:22function of olfactory now in less than
0:24five years age group so whenever the age
0:27of the child is more than five year then
0:29we can perform the examination of first
0:31cranial nerve
0:32first we have to explain the child
0:35that we are going to
0:37check the both the nostrils
0:39tell the child to close the eyes
0:41and then
0:43bring the known irritating substance
0:45example in this video i brought the
0:48chocolate eliji
0:50and the hing
0:52and
0:53bring the substance near to the
0:56one nostril and
0:58occlude the another nostril then ask the
1:01child to
1:02tell about the smell
1:04if the child is able to recognize the
1:06correct smell that means child is having
1:08normal olfactory now function
1:11if child is having loss of sense of
1:13smell
1:14we label as a anosmia it can be due to
1:17some upper respiratory tract infection
1:19some allergic disorder or if the child
1:21is having any mass in the nasal cavity
1:23or due to trauma
1:25we label as a hyposmia and hyperusement
1:28whenever child is having the decrease or
1:31increase sense of smell respectively
1:34we label as a perisma whenever there is
1:36a distorted sense of smell and always
1:40remember
1:41don't bring the irritating substance for
1:43the olfaction because it will stimulate
1:46the triseminal now
1:48so always bring the known irritating
1:50substance for the first cranial now
1:52examination then we have to assess the
1:55second cranial nerve optic now for the
1:57assessment of the optic nerve function
2:00we have to assess the visual acuity
2:02then color vision then field of vision
2:04then fundus examination
2:07for the visual acuity for far reason
2:10in examination whole we can tell the
2:12child to read the letter which is
2:14mentioned in the notice board
2:16but ideally in more than three years age
2:19group
2:20far reason should be assessed by the
2:22sunillas chart or e chart
2:25we have to mention the visual equity of
2:27the child by the formula small d by
2:30capital d where small d is the distance
2:33between child and the chart
2:35which we keep
2:376 meter
2:38it is numerator and capital d is the
2:41smallest line of the letter in snail and
2:43chart that child can read
2:46it is denominator and the size of the
2:48later in snail and chart
2:51is
2:52basically a distance at which later are
2:55readable by the normal reason person so
2:58the largest later in snellen's chart
3:01normal person can read at the distance
3:04of 60 meter and the smallest later
3:08normal person can read at the
3:10distance of 6 meter
3:12that's why this 6 meter distance we keep
3:15between the chart and the
3:17child
3:18normal visual equity at the time of
3:20birth is
3:226 by 45
3:24it improves as the age increase and it
3:26becomes 6 by 6 by the age of 6 years
3:31and if child is not able to read
3:34the largest letter
3:36of the sunilla's chart at the distance
3:38of 6 meter then we will decrease the
3:41distance between the child and the chart
3:44and
3:45if the child is able to read the
3:48largest letter at the distance of three
3:50meter we will mention three by sixty
3:53if child is not able to read even at the
3:56distance of one meter between the chart
3:59and the child
4:01then we will tell the child to count the
4:03finger at 1 meter distance
4:06and visual equity
4:08is less than 1 by 60 if child even not
4:12able to count the finger
4:14then
4:15we will just move our hand
4:17then we will check child is able to
4:19perceive or not
4:21if child is not able to perceive even
4:23the hand movements
4:26then check the perception of light is
4:28there or not and we have to mention the
4:30visual acuity of the both the eyes
4:33separately
4:34after that we have to assess the near
4:36vision in more than three years age
4:38group by keeping any book at the
4:40distance of 30 to 35 centimeter if child
4:43is able to read according to the age we
4:45will label as a normal near reason then
4:48we have to assess the color reason by
4:51ishihara chart if child is able to
4:54identify able to differentiate between
4:57the various color it is again possible
4:59in more than three years age group
5:02after that we have to assess the field
5:04of vision by the confrontation test it
5:06is again possible in more than three
5:07years age group and distance between the
5:10child and the examiner should be half
5:12meter an examiner should sit at the same
5:15eye level of the child and
5:19both should occlude the same side of the
5:22eyes so example in this video i am
5:24testing the child's right eye field of
5:27vision so for this i have occluded my
5:29right eye and i have tell the child to
5:32occlude his left eye and then we have to
5:35give the instruction to the child that
5:38fix the gaze
5:40of
5:41his right eye
5:42into the examiner's left eye and then i
5:45have placed my finger at the lateral
5:48limit of the my own visual field midway
5:51between
5:53myself and the child and
5:56then i'm moving my finger toward the
5:58child and
5:59then we have to ask the child to say
6:02yes whenever child is able to see the
6:04finger so we have to compare the hour
6:08field of vision with the child's field
6:10of vision and we have to check all the
6:13four quadrants of each eye separately
6:16and after field of vision we have to
6:18assess the fundus
6:20and fundus examination should be done by
6:22the ophthalmoscope
6:24in this video you can see how to perform
6:26the fundus examination by ophthalmoscope
6:29and we have to mention the details of
6:31optic disk
6:33macula retina retinal vessels
6:36if you find any abnormality is there
6:38then we have to clearly mention
6:41after second cranial nerve examination
6:43we have to perform the examination of
6:45third cranial nerve oculomotor now in
6:48this first we have to examine for the
6:50ocular moments then pupil size shape and
6:53bilaterally equal or not then pupillary
6:56light reflects then echo mutation reflex
6:58for the assessment of ocular movements
7:01we have to simultaneously assess the
7:03fourth and sixth cranial nerve also all
7:06extraocular muscles are supplied by the
7:09third cranial now except
7:12lateral rectus which is supplied by the
7:14sixth abducent now
7:16and superior oblique which is supplied
7:18by the fourth trochlear nerve
7:21for the assessment of ocular movements
7:24first we have to explain to the child
7:26and then we have to sit at the distance
7:28of 30 to 40 centimeter from the child
7:31and then we have to move our finger in
7:33the shape of invisible edge
7:36for the assessment of
7:38all the eye movements abduction
7:40adduction
7:42and extortion induction
7:44up and down
7:46and then we have to explain to the child
7:48to follow our finger without moving the
7:50head
7:52child will have the double reason or
7:55disconjugate gauge
7:56when third or fourth or sixth grain and
7:59now palsy will be there and this double
8:01vision occur when child looks toward
8:03which paralyzed muscle normally moves
8:06the eyeball
8:07and according to the
8:09position of eyeball also we can
8:11differentiate is it the third or fourth
8:14or the
8:15sixth cranial nerve parsy example in
8:17third gradient now policy child will
8:19have the squint and i will be displaced
8:22outward and down
8:24and in fourth grade and now policy i
8:27will be displaced up and out in sixth
8:29grade and now policy it will be
8:32displaced inward
8:34so by the position of eyeball we can
8:36differentiate which cranial nerve pulse
8:38is there third cranial now also supply
8:41the levator pulpery superioris so
8:43whenever there is a third cranial nerve
8:45palsy child will have the unilateral
8:47ptosis then check the pupil size shape
8:50and bilaterally equal or not whenever
8:53there is a third karinen now parsi pupil
8:55will be dilated we have to examine for
8:57the pupillary light reflex by directly
9:00shining the
9:01light into the eye in response to the
9:04light pupil of both eyes will be
9:05constricted so pupil constriction in the
9:08ipsilateral eye which is stimulated with
9:11light label as a direct pupillary light
9:13reflex while pupil constriction of the
9:15opposite eye will be labeled as a
9:18indirect pupillary light reflex so in
9:20this video i have assist the left direct
9:22pupillary light reflex and right
9:25indirect pupillary light reflex
9:27for this we have to tell the patient to
9:29keep the hand between both the eyes
9:31so
9:33we can avoid the direct stimulation of
9:35the
9:36opposite side of the eye claim for
9:38pupillary light reflex is optic now and
9:40the efferent limb is oculomotor now
9:43so if the child is having the optic
9:45nerve damage
9:46example
9:48if child is having left optic now
9:50damaged
9:51then left to direct and the right
9:53indirect plr will be absent
9:55but the patient will have the normal
9:58right direct and left indirect
10:01pupillary light reflex if the left optic
10:04noun image at any level is present
10:07if the efferent limb for the pupillary
10:10light reflex is affected example if the
10:12child is having left o kilomotor now
10:14listen in this case both left-sided
10:18direct and indirect pupillary light
10:20reflex will be absent
10:22while the right sided direct indirect
10:24both will be normal
10:26then we will examine for the
10:28accommodation reflex also known as near
10:30reflex or convergence reflex
10:33in this we will tell the child to look
10:35at the far object in examination hall
10:38then suddenly we will bring our finger
10:41in front of the nose and
10:43we will tell the child to fix the gauge
10:46on our finger
10:48so the point of focus of the eyes change
10:50from distant object to the near object
10:53in accommodation reflex
10:55the result to this there is convergence
10:58of both the eyes contraction of the
11:01ciliary muscle result in the change in
11:03shape of the lens and the pupillary
11:05constriction all three action occurs
11:08simultaneously in accommodation reflex
11:11afferent and efferent limb of the
11:13accommodation reflex is similar to the
11:15pupillary light reflex second and the
11:18third cranial nerve
11:19in spite of the same neural pathway
11:23sometime patient is having the normal
11:25accommodation reflex but the lowest
11:28pupillary light reflex
11:30we label as a light near dissociation it
11:34occur because the midbrain center for
11:36the accommodation reflex is more ventral
11:39in position
11:40than the pre-tactile nucleus
11:42which control the light reflex example
11:45of the light near dissociation are
11:47neurosyphilis known as argyl robertson
11:51pupil
11:52also seen in the dorsal mid brain
11:54syndrome diabetes mellitus
11:57eddie's pupil
11:59after third fourth and sixth cranial
12:01nerve examination i will perform the
12:03fifth cranial nerve examination
12:05trigeminal now it is the mix now having
12:08both sensory and the motor component
12:11in sensory component there are three
12:13branches of trigeminal now ophthalmic
12:16maxillary and the mandibular
12:18all three branches supply the
12:21face for the sensation except the angle
12:25of jaw which is supplied by the c3 and
12:28c2
12:30so for examination of the sensation over
12:32the face first we will explain to the
12:34child then we will tell the child to
12:36close the eyes
12:37touch sensation we can use the wisp of
12:39cotton
12:41and in all three divisions of the
12:44trijamanda now
12:46we will touch the cotton wisp and
12:49child will say yes whenever child is
12:51having the
12:52feeling of touch
12:54by localizing the touch side
12:57and for the pain sensation we can use
12:59the pin but it is not
13:01possible in children for temperature we
13:04can use the cold and hot water
13:07when there is sensory loss
13:10over the face
13:11child will have the
13:13feeling of broken glass on the affected
13:15side when the child will drink any
13:18liquid now after the assessment of the
13:22sensation
13:23over the face we have to assess the
13:25motor component of the trigeminal nerve
13:28it supplies the muscles of mastication
13:31masseter temporalis and the terry good
13:34we will ask the child to clench the
13:36teeth
13:37then we will see the contraction of the
13:40masseter and the temporalis muscle
13:43and we will also feel the contraction of
13:46both the muscles
13:47for pterygoid we will tell the child to
13:50open and close the mouth
13:52also protrude and retract the jaw
13:55also move the jaw from side to side
13:59for the pterygoid muscle
14:01we should also assess all the
14:03mastication muscle power against the
14:05resistance by putting our hand
14:08if the child is having fifth granular
14:11palsy then joe will be deviated toward
14:13the paralyzed side when child will open
14:15the mouth because of the action an
14:18opposed action of healthy terry gold
14:20muscle example in right fifth green
14:23inner parsy joe will be deviated toward
14:25the right side when child will open the
14:27mouth
14:29then we have to perform the corneal
14:31reflex efferent limb for the corneal
14:33reflex is ophthalmic division of the
14:35fifth cranial nerve and the efferent
14:37limb is facial now seventh gradient to
14:39perform the corneal reflex first we will
14:42explain to the child child should keep
14:43the eyes open
14:45and we will touch the limbus of cornea
14:48by cotton
14:49either from the side or from below in
14:51response to this
14:53there will be
14:54bilateral blinking response occur
14:57so this is all about the trigeminal
14:59nerve examination
15:01i have covered the first six cranial now
15:03today in next video rest of the cranial
15:06nerve from 7th to 12th
15:08i will explain
15:10thank you so much

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