Cortical and Pediatric Exam (2) Flashcards
(63 cards)
What are key principles of neurodevelopment
development of motor control proceeds in head to toe fashion, primitive reflexes normally present in term infant, diminish over 4-6 months, postural reflexes emerge at 3 to 8 months of age
What is the hallmark of an upper motor neuron abnormality in the infant
Persistence of primitive reflexes and the lack of development of the postural reflexes
What are the steps of the pediatric neuroexam?
1)stop, look, and listen; 2) hands-on part, further clarifies initial observations (game, non-threatening) 3) save all the threatening parts of examination until last
How is somatic growth examined and used in the pediatric exam?
measure height and weight and compare percentiles with head circumference
Why do we look for dysmorphic facial features in the pediatric exam?
anomalies of the midface are often associated with underlying brain malformations
Where and why is the head circumference measured?
largest from frontal to occipital; proportional to brain size, 80% of size by 2
What and why do we do an abdominal exam in the pediatric neuro exam?
palpate for visceromegaly which can indicate the presence of one of the
storage diseases
What are you looking for in the spine in pediatric exam?
look for scoliosis and any sacral anomalies
What is completed by 28 days of gestation?
Formation of the neural tube
What occurs 2 to 4 months gestation neuronally?
neuronal proliferation
What occurs 3 to 5 months gestation neuronally?
neuronal migration
What is responsible for most of the brain’s growth?
Growth of the individual neurons plus elaboration and proliferation of
dendritic and axonal processes and connections (increasing dendritic arborization, synaptogenesis, and axonal connections,)
How much bigger does a neuroblast get by maturity?
5-50 microns, 1000x
When does myelination start? Most rapid period? What parallels the time course and pattern?
3rd trimester, first two years of life, acquisition of neurodevelopmental milestones
Myelination occurs early for what structures? Why?
motor-sensory roots, special senses and the
brainstem; necessary for reflex behavior and survival
The corticospinal tract starts to myelinate when? complete when?
36 wks gestation, by second year of life, trunk and upper extremity to lower extremity, correlates to milestones
The areas of the cerebral hemispheres that are first to myelinate are what?
posterior portion of the frontal lobes, the parietal lobes and areas of the occipital lobes; followed by frontal and temproal
By the end of the second year, myelination of the cerebrum is what? What still needs myelination?
largely completed; interconnections of the association cortex are still being
myelinated into 2nd and 3rd decades of life
What primitive reflexes are tested in the pediatric exam?
suck, root, moro, gallant (trunk incurvation), grasp, and ATNR
What postural reflexes are tested in the pediatric exam?
positive support reflex, landau, lateral propping, and parachute
Independent walking is achieved between what ages? An infan is delayed when?
11-15 months; aren’t walking by 16 months
What are the charcteristics of the toddler’s gait?
wide-based, unsteady, Arms held at near shoulder level- high guard position, probably aids in balance
What cortical area is responsible for Attention?
dorsolateral frontal lobe/anterior cingulate gyrus
What cortical area is responsible for awareness?
Sensation-primary cortex, Perception- association cortex
