Pediatric Brian Injury

Question 1

Where is the site of Intraventricular Hemorrhage in…

• Preterm baby?
• Term baby?

Answer 1

Preterm baby = Germinal Matrix

Term baby = Choroid Plexus

(IMPORTANT for Boards)

Question 2

______ in a neonate ( 0 – 28 days of life) or infant almost always indicates underlying brain injury Brain

Answer 2

Seizures

Question 3

How to define macro- & microcephaly

Answer 3

More than 2 standard deviations from average
Micro = < 3rd percentile
Macro = > 98th percentile

Question 4

What is Cerebral Palsy (CP)?

Answer 4

Disordered motor function evident in infancy (3-6 months)
- Very nonspecific term

*Full extent of motor disability may not be evident until 3 – 4 yrs of age.

Question 5

Is Cerebral Palsy progressive?

Answer 5

No.

It is NOT progressive or episodic.

Question 6

Common ass’d problems w/ CP?

Answer 6

• Mental Retardation: 52 %
• Hearing impairment: 12 %
• Speech and Language disorder: 38%
• Epilepsy: 34 % - 94 %

Question 7

3 causes of Hypoxia-ischemia in Prematurity?

Answer 7

• Defects in auto-regulation of cerebral blood-flow
• Postnatal lung disease and hypotension
• Inflammation contributes to pathogenesis of injury

Question 8

What is Zellweger syndrome?

Answer 8

Polymicrogyria

peroxisomal disorder

Question 9

What is Miller-Dieker syndrome?

Answer 9

Lissencephaly

chromosome 17

Question 10

Features suggesting early developmental defects are caused by CP?

Answer 10

• Microcephaly
• Dysmorphic features
• Congenital anomalies outside the CNS

Question 11

2 most common brain injuries related to Prematurity?

Answer 11

Periventricular leukomalacia

Intraventricular hemorrhage

Question 12

4 most common Perinatal brain injuries (term babies)?

Answer 12

Hypoxia-ischemia
Stroke (focal ischemic injury)
Traumatic brain injury
Intracranial hemorrhage

Question 13

What does “Diplegia” mean when describing CP?

Answer 13

Mainly involves lower extremities

Question 14

T or F?
If a couple has been treated for infertility, there is a higher chance that their child has some type of encephalopathy or CP.

Answer 14

True

Question 15

Most common cause of post-natal brain injury?

Answer 15

CNS infection (meningitis, encephalitis)

Question 16

3 most common specific CP syndromes?

Answer 16

• Spastic Hemiplegia
• Spastic Quadriplegia
• Spastic Diplegia

Question 17

Spastic Hemiplegia:

• Cause?
• Presentation
• Type of movements most affected?

Answer 17

Cause = Perinatal stroke
(left hemisphere > right)

Presentation = Premature handedness @ 3-6 months

Fine distal movements most affected
(obligate palmar grasp, no pincer grasp)

Question 18

Spastic Quadriplegia:

• How often is cognitive disability present?
• Incidence of seizures?

Answer 18

Very high incidence of cognitive disability

- about 50% of them develop seizures

Question 19

CP syndrome w/ widespread cystic encephalomalacia?

Answer 19

Spastic Quadriplegia

Question 20

CP syndrome w/ difficulty swallowing & articulation?

Answer 20

Spastic Quadriplegia (due to deep gray matter involvement)

Question 21

CP syndrome in which 25% will require total care?

Answer 21

Spastic Quadriplegia (most sever of CP syndromes)

Question 22

80% of CP in preterm babies have what type of CP?

Answer 22

Spastic Diplegia

Question 23

Spastic Diplegia:

- Path?

Answer 23

PVL or Porencephalic cysts

pretty much same thing

Question 24

T or F?

Most cases of Spastic Diplegia have some involvement of upper limb dysfunction.

Answer 24

True but this usually very subtle & not problematic long-term (just w/ fine movements)

(leg involvement may be asymmetric)

Question 25

CP - what are major determining factors of Prognosis?

Likelihood they walk?

Answer 25

Cognitive impairment is a major determinant

Likelihood of walking: If they have Spastic…
Hemiplegia > Diplegia > Quadriplegia

Question 26

HIE Dx - preferred modality?

Answer 26

MRI

Question 27

Exam: Nystagmus, hypotonia, dysmetria, gait wide based, difficulty writing

Diagnosis?
Likely sites of injury?

Answer 27

Dx = Ataxic CP

Likely sites of involvement: cerebellum & adjacent brain stem