13. Neurology Part 2 Flashcards
How do you assess a child with an unusual head?
Accurate measurements and interpretation as part of a childs physical exam
Head size problems (macrocephaly and microcephaly)
Head shape problems
Refer early to specialist
How do the fontanelle’s close?
Posterior fontanelle closes 2-3 months after birth
Anterior fontanelle’s close between 1-3 years of age
What is microcephaly?
Head circumference <2SD- mild
<3SD- moderate
typically indicates small brain (micranecephaly
Prenatal or post natal onset
Timing of onset may be a clue
Can be caused antenatally, postnatally, from genetics or the environment
What is macrocephaly?
HEAD circumference >2SD
Caused by sutures not closed
Can be caused by hydrocephalus, familial microcephaly
Look for other physical abnormalities- storage problem, bony deformities, splenomegaly/hepatomegaly, abnormal facial features
What are the different types of head shape problems can you get?
Plagiocephaly- flat head
Brachiocephaly- short head or flat at back (common in down syndromes)
Scaphocephaly- boat shaped skull
Craniosynostosis- treat under age 1 (crystal skull)
What is a deformations plagiocephaly?
Cuase by squishing in utero
Look top down
Babies head looks like a parralelogram
When should you suspect a neuromuscular weakness in babies?
Floppy baby Slips from hands Paucity of limb movements Alert but less motor activity Delayed motor milestones Able to walk but frequent falls
What are classic signs of muscle weakness?
Lift from stomach and is like rag doll, won’t raise head
Lift from arms, head drops back, won’t support head
What is the most common neuromuscular condition?
Duchess muscular dystrophy X lined, only affects boys Symmetrical proximal weakness Muscles look big but are weak Lumbar lordosis Swaying of shoulders
How do you tests for DMD?
Lie prone and get up, have to role onto stomach and get up slowly
Creatinine kinase- always raised in neuromuscular problems
What other symptoms are present in neuromuscular disorders?
Facial muscle weakness
Myotonic dystrophy- muscles contract but can relax
Pes cavis- chariots-Marie-tooth disease most common mononeuropathy
What are the different classes of neuromuscular syndromes?
Muscle: muscular dystrophies, myopathirs, congenital and inflammatory, myotonic syndromes
Neuromuscular junction- myasthenic syndromes
Nerve: hereditary or acquired syndromes
anterior horn cell: spinal cell syndromes
What table should you learn to help you with neuropathies in exams
The one at the end of her slides
