NEURO EXAM Flashcards
(35 cards)
Head circumference of an average term infant
- 34-35 cm at birth,
- 44 cm at 6 mo,
- 47 cm at 1 yr of age
2 fontanels at birth
- A diamond-shaped anterior fontanel at the junction of the frontal and parietal bones that is open at birth
- A triangular posterior fontanel at the junction of the parietal and occipital bones that can admit the tip of a finger or may be closed at birth
- gestational age, a premature infant blinks in
response to a bright light - the infant maintains eye closure until the light source is removed.
- turns the head and eyes toward a soft light, and a
term infant is able to fix on and follow a target, such as the examiner’s face.
- 28 WK
- 32 WK
- 37 WK
- Assess the posterior segment of the eye using the
- Normal results shows
- red reflex test
- symmetric reddish-pink retinal reflections
CRANIAL NERVES
- Oculomotor (Cranial Nerve Ill),
- Trochlear (Cranial Nerve IV),
- Abducens Nerves (Cranial Nerve VI)
- Facial Nerve (Cranial Nerve VII)
- Vestibulocochlear Nerve (Cranial Nerve VIII)
- Glossopharyngeal Nerve (Cranial Nerve IX)
- Accessory Nerve (Cranial Nerve X!})
- Hypoglossal Nerve (Cranial Nerve XII)
refers to muscle tissue that has been replaced
by fat and connective tissue, giving ita bulky appearance with a paradoxical reduction in strength, as in Duchenne muscular dystrophy
Pseudohypertrophy
3 key tests for assessing postural tone in neonates
- the traction response,
- vertical suspension,
- horizontal suspension
Timing of Selected Primitive Reflexes
Onset: 28 wk GA
Fully Developed: 32 wk GA
Duration: 2-3 mo postnatal
Palmar grasp
Timing of Selected Primitive Reflexes
Onset: 32 wk GA
Fully Developed: 36 wk GA
Duration: less prominent after 1 mo postnatal
Rooting
- Soft Tissue of the Scalp
- Presenting part
- May extend across the midline and across suture lines
- Edema disappears within the 1” few days of life
- No treatment
Caput Succedaneum
- Subperiosteal hemorrhage
- Firm tense mass with a palpable rim localized over 1 area of the skull
- Reabsorbed within 2wks-3mos
- Calcify by end of the 2nd week
- No treatment
- Associated with skull fracture, usually linear10-25%
- May develop hyperbilirubinemia
Cephalhematoma
- Beneath the aponeurosis
- Secondary to rupture of emissary veins connecting the dural sinuses within the skull with the superficial veins of the scalp
- Associated with vacuum delivery
- Fluctuating mass that straddles cranial sutures or fontanels that increases in size after birth
- Resolve over 2-3 wk
Subgaleal hemorrhage
Fractures of the skull
- Most common
- result of pressure from forceps or from the maternal symphysis pubis, sacral promontory, or ischial spines
- Asymptomatic
- No treatment needed
Linear
Fractures of the skull
- complication of forceps delivery or fetal compression
- usually indentations of the calvaria similar to the dents in a ping-pong ball
- advisable to elevate severe depressions to prevent cortical injury from sustained pressure
Depressed
- May have acute deterioration on the 2. and 3 day of life
- Hypotension, apnea, pallor, or cyanosis
- Poor suck, abnormal eye signs, high-pitched, shrill cry
- Convulsions, or decrease muscle tone
- Metabolic acidosis, shock
- Decrease hematrocrit or failure of the hematocrit to increase after transfusion
Severe Intraventricular Hemorrhage (IVH)
Usually present later in an early echo dense phase (3-10 days of life), followed by the typical echolucent (cystic) phase (14-20days of life)
Periventricular leukomalacia
Classification of Brain Hemorrhage
bleeding into the germinal matrix only
GRADE 1
Classification of Brain Hemorrhage
Germinal matrix with blood in the ventricles
GRADE 2
Classification of Brain Hemorrhage
Intraventricular and parenchymal bleeding other than the germinal matrix
GRADE IV
Classification of Brain Hemorrhage
Germinal matrix with blood in the ventricles and ventricular dilation
GRADE 3
Dx for IVH
- 32 wks of gestation and/or <1,000 g cranial ultrasound
- Screening within | (detects 75% of lesions)
- Follow-up ultrasound at 36-40 wks of postmentrual age to evaluate for PVL where cystic changes become visible
ventriculoperitoneal shunt insertion
posthemorrhagic hydrocephalus (PHH)
Tx for IVH
- NONE
> Seizures should be treated with anticonvulsant drugs
Anemia and coagulopathy require transfusion with PRC or FFP
Progressive and symptomatic PHH should have a
ventriculoperitoneal shunt inserted
Diuretics and acetazolamide are not effective
Fetal hypoxia may be caused by:
- Inadequate oxygenation of maternal blood = s )
- Low maternal blood pressure
- Inadequate relaxation of the uterus to permit placental filling
- Abruptio placenta
- Impedance to the circulation of blood through the umbilical cord
- Placental insufficiency
