Neurological examination across childhood — formative SAQs

SAQ 1 (10 marks)

A four-month-old infant, born at 30 weeks gestation and now assessed at corrected age, is seen in the neonatal follow-up clinic. The mother reports that the baby is feeding slowly and seems stiff down the right side. On examination, the head circumference is on the 50th centile and tracking along it, the anterior fontanelle is soft and flat, and the baby is alert and socially engaged. The tone is increased in the right arm and leg with a velocity-dependent catch on fast stretch, the right hand is fisted, the deep tendon reflexes are brisk on the right with a few beats of unsustained clonus at the right ankle, and the plantar response is extensor on the right. The General Movements Assessment shows absent fidgety movements. ^{[4] [8]}

a) Explain why an extensor plantar response and a few beats of ankle clonus are interpreted differently in a four-month-old infant than they would be in a four-year-old child. (3 marks) ^[2]

b) Describe how you would assess tone in this infant, naming the bedside manoeuvres, and classify the abnormal tone using the Task Force on Childhood Motor Disorders definitions. (3 marks) ^[6]

c) State the significance of the absent fidgety movements, name the window in which the General Movements Assessment is most informative, and outline the integrated early-detection pathway for suspected cerebral palsy. (3 marks) ^{[4] [8]}

d) Give your disposition, naming the neuroimaging modality of choice and the safety-net you would give the family. (1 mark) ^[9]