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

by Learning Pediatrics · 2,759 words · 506 segments · language en · Watch on YouTube

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0:00[Music]
0:00hello everyone
0:02today in this video i will tell you the
0:04details of granular 8th to 12th i have
0:08already uploaded the first two part and
0:11the
0:12first seven cranial nerve of the cranial
0:14nerve examination
0:16so 8th cranial nerve is the
0:18vestibulocochlear now
0:20there are two division vestibular and
0:22the cochlear
0:23so cochlear division is for hearing and
0:26the vestibular division is for
0:28equilibrium and the coordination
0:30for assessment of the cochlear division
0:32we have to assess the hearing both the
0:35year should be examined separately so
0:38the known tested year should be occluded
0:40by the tragal pressure we have to stand
0:43behind the child
0:45at the distance of 6 centimeter then we
0:47have to whisper a sound if child is
0:50turning the face toward the sound that
0:52means child is hearing our sound
0:55then we have to increase the distance
0:57between
0:59ourselves and the child
1:01if child is able to hear the whispered
1:03sound even at the distance of 15
1:06centimeter
1:07that means child is able to hear the 35
1:10decibel
1:11at the distance of 15 centimeter some
1:14conventional sound should be produced
1:17example we can clap or we can say the
1:20name of the child
1:21or we can play the music or we can ring
1:24the bell if child is turning the face
1:27toward the sound
1:29that means child is having the
1:3250 to 60 decibel hearing if the child is
1:35having hearing loss then we have to
1:37perform the tunic fork test and for
1:40these tests we use the 512 hertz tunic
1:43form
1:44in this we perform the release test
1:46weber test and absolute bone conduction
1:49test
1:50so for all these tunic fork tests first
1:53we will explain to the child
1:55then we will charge the tunic fork on
1:57hard surface so in this video you can
1:59see i have charged the tunic fork on my
2:02elbow
2:03then we will keep the vibrating tunic
2:05fork in front of the external auditory
2:08meters at least one to two centimeter
2:10far from the external auditory meter for
2:13the air conduction
2:15and then we have to tell the child once
2:17the child will stop hearing
2:20child should tell us then we will keep
2:22the tunic fork on the mastoid process to
2:26check the bone conduction
2:28normally air conduction is better than
2:31bone conduction label as a ring is
2:33positive
2:35if the child is having conductive
2:37hearing loss
2:38then bone conduction is better than air
2:40conduction
2:42label as a ring is negative
2:44in sensory neural hearing loss both air
2:47conduction and bone conduction
2:49will be affected
2:50but the ear conduction will be better
2:52than bone conduction so we will label as
2:54a release positive then we have to
2:57perform the vapor test
2:59we will explain to the child first then
3:01we will keep the vibrating tunic fork
3:04over the central part of the skull bone
3:06so we can keep over the vertex or
3:08forehead
3:09or over the
3:11roof of nose even on the incisor teeth
3:14or chin
3:15we will explain to the child child
3:17should compare the loudness of sound in
3:19both ear
3:21normally sound will be equally heard in
3:23both the ear if sound is lateralized
3:26that means child is having hearing loss
3:28in conductive hearing loss sound will be
3:31better heard in the affected or worse
3:33year
3:35while in the sensory neural hearing loss
3:37sound will be better heard in the normal
3:39ear so sound is lateralized to the
3:41normal ear
3:43after that we have to perform the
3:44absolute bone conduction test
3:47in which we will compare the
3:49bone conduction of the child with our
3:52own bone conduction
3:55first close the external auditory canal
3:57of the chai
3:58by the trigger pressure and then keep
4:01the vibrating tunic fork over the
4:02mastoid process of the child when the
4:05child stop hearing
4:07then we have to keep the tunic fork for
4:09the our own mestroid process after
4:12closing the external auditory canal
4:15normally and in conductive hearing loss
4:18examiner will not hear any sound
4:21but if the child is having sensory
4:23neural hearing loss in this case
4:26examiner will be able to hear the sound
4:29so this is about the cochlear part
4:32now the assessment of vestibular
4:34component vestibular component is
4:37mainly for the
4:39equilibrium coordination so whenever the
4:42child is having dysfunction of the
4:44vestibular component child will have the
4:46vertigo nystigmas then we have to
4:49perform the sum test
4:51fukuda stepping test romberg test
4:54calorie test oculocephalic test in this
4:57video you can see the child is having
4:59the nystagmus so whenever vestibular now
5:02dysfunction is there
5:04child will have the nystigmas
5:06in which the fast component is directed
5:09away from the affected now if the child
5:12is having vertigo
5:14then we will perform the fukuda stepping
5:16test we will tell the child to stand
5:19and extend both the arm
5:21close the eyes
5:22then we will tell the child to walk in
5:24place for 50 steps
5:27so in this video you can see
5:29if the child is having normal vegetable
5:31then child will walk with no rotation on
5:34either side
5:36if the child is having vestibular noun
5:38dysfunction
5:39then child will walk with more than 45
5:42degree rotation to the affected side
5:47then we have to perform the romberg test
5:50in which we will tell the child to stand
5:53with the arm extended
5:54and make sure child should not fall so
5:57the examiner should stand behind the
5:59child in a
6:00manner that child should not fall
6:03without touching the child
6:05and then we will observe the balance of
6:08a child for full one minute
6:10then we will tell the child to close the
6:12eyes
6:13then again observe that child is
6:16maintaining the balance or child is
6:19showing to the one side
6:21loss of balance is labeled as a positive
6:24romberg test and when the child is
6:27losing the balance even when eyes are
6:29open that means
6:31child is having the vestibular
6:33dysfunction on the side of the fall
6:36if the child is
6:38maintaining the balance with eyes open
6:40but lows the balance with eyes closed
6:43only
6:44that means child is having posterior
6:46coulomb defect
6:48spinal disorder then we have to perform
6:50the tandem walk test in which we will
6:53tell the child to walk in one line
6:56if the child will have the vestibular
6:57dysfunction then child will sway toward
7:00the affected side then we can perform
7:03the calorie test practically in exam we
7:06don't perform this test unless you
7:08should remember how to perform this test
7:12in this first we will check the
7:13integrity of the tympanic membrane if it
7:16is intact unobstructed then we will
7:18elevate the head of the patient up to
7:20the 30 degree
7:21with the help of the syringe we will
7:23take the 2 ml of the cold water 3 degree
7:26centigrade temperature and similarly
7:29also with the warm water 44 degree
7:31centigrade temperature
7:33we will instill into the external
7:35auditory canal
7:37for the calorie test
7:39if the child is having normal brain stem
7:41function
7:42then i will be deviated toward the
7:44irrigation side
7:46and also child will have the nystagmus
7:49and the fast component of the nystagmus
7:52will be
7:53opposite side with the cold water and
7:56similarly we have to perform with the
7:58warm water of the 44 degree centigrade
8:01and the child will have the fast
8:03component of the nystigmas toward the
8:06same side and we have to perform the
8:08oculocephalic test or the dual side
8:11phenomena child should be in lying down
8:13position and we will turn the head
8:15toward the one side suddenly
8:18and the conjugate deviation of the eyes
8:21toward the opposite side occur
8:23if the child is having normal brain stem
8:26functions
8:27then ninth green and now
8:29glossopharyngeal now
8:31as its name suggests that it supplies
8:34the tongue and the pharynx
8:36so the function of the ninth cranial
8:39nerve sensory function it supplies the
8:41ocean one third of the tongue fairing
8:43stone cell internal surface of the
8:45tympanic membrane skin of the external
8:48ear
8:49also
8:50test sensation to the posterior one
8:52third of the tongue and its motor
8:54function it supplies the stylophiles
8:56muscle
8:58as the most of the function of the ninth
9:00cranial nerve are sheared by the tenth
9:03vegas now
9:04so in exam we have to simultaneously
9:07assess the both 9th and 10th cranial now
9:11for 9th cranial now we have to check the
9:13test sensation over the position one
9:15third of the tongue
9:16then we have to check the swallowing
9:18difficulty is there or not
9:21then we will perform the gig reflex
9:24in this we have to touch the pharynx or
9:26pellet by the tongue blade
9:28and when we are touching the lateral
9:31oropharyngeal region we label as a
9:33pharyngeal reflex when we are touching
9:36the soft pellet or eula we will label as
9:39a palatal reflex efferent for the gig
9:41reflexes ninth cranial nerve and
9:44efferent
9:45are both ninth and tenth cranial nerve
9:49in response to this
9:50there will be elevation of the soft
9:52pellet and uvula occur
9:54and constriction of the oral firing
9:57sucker
9:58and also the closure of glottis occur to
10:01protect the airway so these three
10:05mechanisms occur together
10:07when we perform the gig reflex
10:10now if the ninth cranial nerve pulse is
10:12there
10:13if the child is having unilateral
10:15supranuclear lesion then there will be
10:18no deficit because of the bilateral
10:21corticobulbar innervation
10:23if the child is having bilateral
10:25supranuclear lesion
10:27then hyperactive gig reflex will be
10:29there as seen in the pseudobulbar palsy
10:31or amyotrophic lateral sclerosis
10:35if unilateral nuclear or infra nuclear
10:38lesion is there
10:39then the child will have the unilateral
10:42pharyngeal weakness
10:44and palatal rafi will be deviated toward
10:46the normal side
10:48it is generally seen whenever child is
10:50having the intra medullary or extra
10:52medullary
10:54mass
10:55or having
10:56trauma or motor neurone disease or gbs
11:00in this case patient will have the
11:02difficulty in swallowing
11:04now the 10th cranial nerve vegas now it
11:07is the longest cranial nerve
11:09there are 10 term branches of the vegas
11:11now meningeal branch auricular branch
11:14carotid cardiac branch
11:15pulmonary branch superior laryngeal
11:18recurrent laryngeal
11:20pharyngeal branch esophageal branch and
11:22gastrointestinal branch
11:24now the function of the
11:2710th cranial nerve
11:28its motor function
11:30by its pharyngeal superior and recurrent
11:33laryngeal now it supply all the striated
11:37muscle of the soft palate fairings and
11:39larynx except stylopharynges which is
11:42supplied by the ninth cranial nerve
11:45and tensor valley palatine which is
11:47supply by fifth cranial nerve and by its
11:50superior laryngeal now
11:53there are again two uh
11:55branches of superior laryngeal now
11:57internal branch and external branch
12:00internal branch is sensory
12:03while the external branch supply the
12:05cricothyroid while all other intrinsic
12:09laryngeal muscles are supplied by the
12:13recurrent larynx then the sensory
12:15function of the tenth cranial nerve it
12:17supply the sensation of the pain
12:19temperature touch to the pharynx larynx
12:22ear canal external surface of the
12:24tympanic membrane and
12:26manages of the posterior fossa
12:29now for the examination of the 10th
12:31cranial nerve we will
12:33perform the gig reflex as i have
12:35explained in the ninth grain in our
12:37examination also we will assist child is
12:39able to swallow or not
12:41then we will tell the child to open the
12:43mouth and say the ah
12:45then observe the elevation of the soft
12:48palate bilaterally present or not then
12:52also check the phonation character of
12:54the voice the child is having unilateral
12:57tenth green and now passy then the child
13:00will have dysphysia more for liquid than
13:03solid
13:04also child will have the nasal
13:05regurgitation because of well of
13:08pharyngeal insufficiency
13:10when you will check the phonation you
13:12will find that your child is having
13:13nasal quality hoarseness of voice will
13:16be there
13:17also because of the weakness of the
13:20ipsilateral soft pellet there will be
13:22drooping of the pellet or flattening of
13:25the palatal arc occur
13:27and the euler will be deviated toward
13:29the normal side
13:31during the phonation and when you will
13:33tell the child to say ah
13:35also
13:37tachycardia loss of oculocardiac reflex
13:40can be there
13:41when the child is having bilateral tenth
13:43rain in a parsy then it is incompatible
13:46with life because child will have the
13:48respected stress
13:49there will be marked dysphasia nasal
13:52regurgitation pulling of the secretion
13:54occur
13:55pellet cannot elevate on the phonation
13:59absent gig reflex will be there impaired
14:01cup reflex will be there
14:03child will have the
14:05complete paralysis of the fairings and
14:07larynx
14:09also tachycardia will be there gi atonia
14:12vomiting and respiration can be slow
14:14irregular
14:16in vasovagal attic because of the
14:19stimulation of the wiggle now
14:22because of its parasympathetic action
14:25it will lead to the bradycardia
14:28hypotension
14:29faintness or unconsciousness can occur
14:33bronchoconstriction bronchoria and
14:35increase gi peristalsis increase gi
14:38secretions
14:39and it will inhibit the adrenal function
14:42now the 11th cranial now spinal
14:45accessory now there are two parts of the
14:48spinal necessary now spinal now and the
14:51accessory now
14:52spinal now is the major part of the 11th
14:55cranial nerve it arrives from the
14:57ventral horn of the c2 to c6
15:00it supplies the
15:02sternocleidomastoid muscle and the
15:04trapezius muscle
15:05while the accessory now the cranial
15:08portion
15:09also known as ramus internus it arrives
15:13from the codal nucleus ambiguous
15:16it emerged from the medulla laterally
15:18and it supplies
15:20motor fiber to the larynx with the vegas
15:23now we cannot directly assess the
15:26function of the accessory portion of the
15:2811th karina because it supply the larynx
15:31with vegas now
15:33so we have to assess
15:35the function of the accessory portion
15:38with vegas now only now for the spinal
15:41portion we have to assess the function
15:43of
15:44sternocleidomastoid and the trapezius
15:46muscle
15:47sternocleidomastoid muscle helps to turn
15:50the face to the opposite side
15:53and when both the sternocleidomoistured
15:55muscle contract right and left
15:58then
15:59flex the neck and bring the head forward
16:02and the down
16:04while the trapezius muscle help in
16:07elevating
16:08retracting and
16:10rotating the scapula
16:13also it will help in abduction of the
16:16arm above the horizontal position
16:18for the examination of the spinal
16:21portion of the 11th cranial nerve we
16:23have to assess the function of
16:25astronoclidomastoid and the trapezius
16:27muscle
16:28for the sternocleidomastoid muscle we
16:31will tell the patient to turn the head
16:33to one side
16:35and also we have to
16:37assess against the resistance by keeping
16:40our hand on the child phase at the same
16:42time we will observe the contour of the
16:45sternocleidomastoid muscle also we will
16:48palpate
16:49if the child will contract the
16:51left-sided sternocleidomastoid muscle
16:54face will be turned to the
16:57right side
16:58and for the assessment of both
17:01right and left esternocleidomastoid
17:03muscle
17:05tell the patient to flex the neck
17:07for against resistance we will keep our
17:10hand over the forehead or
17:12over the chin
17:14now for the assessment of the trapezius
17:17muscle function
17:18tell the patient to shrug the shoulder
17:21for against resistance we will keep our
17:23hand over the shoulder and we will again
17:26tell the patient to elevate the
17:27shoulders
17:29then we will tell the patient to
17:31approximate the occipital to acromion
17:33also observe the contour of the
17:35trapezius scapula position any asymmetry
17:38is there or not
17:41now if the child is having 11th cranial
17:43nerve palsy due to the weakness of
17:46histanoclidomastoid muscle child will
17:48not be able to
17:50flex the neck and also will not be able
17:53to turn the face opposite side
17:56and due to the weakness of trapezius
17:59muscle there will be drooping of the
18:01shoulder occur and flattening of the
18:04trapezius recur
18:06now the 12th cranial now
18:08hypoglossal now it supplies the muscle
18:12of the tongue and the function of the
18:15twelfth cranial nerve is it will help in
18:18protruding the tongue
18:20retracting and elevating the tongue
18:23so for the assessment of the twelfth
18:25cranial now
18:27tell the patient to open the mouth then
18:30observe the contour and the bulk of the
18:32tongue
18:33observe any atrophy or fasciculation is
18:35there or not
18:37then tell the child to protrude the
18:39tongue move it in and out and from side
18:42to side
18:44if child is able to move the tongue
18:46freely that means it is normal
18:50now if the child is having the 12th
18:52cranial nerve palsy in unilateral
18:55tongue will be deviated toward the
18:57paralyzed side
18:59while in the bilateral child will not be
19:02able to protrude the tongue
19:04and in infra nuclear and nuclear lesion
19:07child will have the atrophy and the
19:10fasciculation of the tongue also
19:13so this is all about the 8th to 12th
19:16cranial now
19:18in next video i will tell you the
19:20details of
19:21motor system examination thank you so
19:24much

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