3 Peds Neurology Flashcards
(86 cards)
____% of kids 18 or younger experience some sort of developmental delay
18%
Common concern presenting to primary care, with many etiologies
What is important to ascertain when investigating a potential developmental delay?
You want to see a TREND over time, not a single out-of-range measurement/milestone
Non-progressive central motor impairment secondary to fetal or infantile brain injury
Cerebral Palsy
Incidence: 2 per 1,000 births
Possible etiologies of cerebral palsy
Hypoxia*** Trauma Premature birth Infections Toxins Structural abnormalities
What are the different subtypes of cerebral palsy?
SPASTIC - most common (70-80%)
Muscles appear stiff and tight, arises from MOTOR CORTEX damage
ATAXIC (6%)
Characterized by the shaky movements; affects balance and sense of positioning in space; arises from CEREBELLUM damage
DYSKINETIC (6%)
Involuntary movements, arises from BASAL GANGLIA damage
Can have a combo, sometimes not noticed until 18-24 months
SSx of Cerebral Palsy
Abnormal tone and/or posture RETAINED PRIMITIVE REFLEXES Not reaching milestones Excessive irritability Poor feeding, drooling Poor visual attention Difficult to hold, cuddle
What are some retained primitive reflexes common in cerebral palsy
ATNR (Asymmetric tonic neck reflex - the fencer’s pose) - baby turns head to extended arm; usually gone by 4-6 months
Moro Reflex - baby stretching out his arms with a startle on suddenly being released for an instant
Management of Cerebral Palsy
EARLY RECOGNITION, REFERRAL, AND INTERVENTION
Parental support and counseling
Symptomatic management
• OT, PT, bracing
• Anti-spasmodic
• Botulism toxin
Nervous system malformations are present in ____% of infants who die <1 year
40%
Type of malformation dependent on what gestational period the insult occurs
Etiologies of congenital malformations of CNS
Infections Toxins Genetic Metabolic Vascular
Cerebellum tonsils displaced causally below the forsaken magnum
Chiari Type I
Can be associated with syringomyelia (fluid filled cyst within spinal cord)
Chiari Type I
Symptoms of this CNS malformation often don’t present until teen or adult years
Chiari Type I
Loss of abdominal reflex
Neurological Sx assoc with syringomyelia
Cape-like numbness
Chiari Type I
What’s the other name for Chiari Type II?
Arnold-Chiari malformation
It’s a Type I + myelomeningocele
CNS malformation usually detected prenatally or at birth
Chiari Type II
Hydrocephalus
Dysphagia
UE weakness
Apneic spells and aspiration
Chiari Type II
What are the three types of Spinal Dysraphism?
Spina Bifida Occulta (most mild)
Meningocele
Myelomeningocele (most severe)
Incomplete closure of the spinal canal, usually on the lower back but can be anywhere
Spina Bifida Occulta
Hairy patch, lumbar dimple, dark spot, swelling on the back at the site of the gap in the spine
Spina Bifida Occulta
Outpouching of the spinal fluid and meninges through a vertebral cleft
Meningocele
Mild problems associated with the sac protrusion
Spinal cord and/or nerves protrude from the vertebral cleft
Myelomeningocele
Most severe form of spina bifida
Weakness, loss of bladder and/or bowel control, hydrocephalus, and inability to walk result
Spinal Dysraphisms can occur anywhere along the spine but _________ is most common
Lumbar spine
What are some common etiologies of spina bifida
Genetics
LOW FOLATE***
Medications during pregnancy (esp anti seizure meds)
Poorly managed diabetes
