CNS Flashcards
Kasi lepas itu paper!
Definition of Mental retardation
Retardation in development of cognitive abilities,
adaptive behaviour,
and communication skills.
Causes of Mental retardation
- Chromosome disorder
- genetic syndrome
- development brain abnormally
- inborn error of metabolism
- congenital infection
- asphyxia, meningitis, PEM
- unknown
Clinical picture of Mental retardation
- Newborn
- major organ dysfunction - Early infancy (2-6 month)
- failure interaction w enviroment
- vision, hearing impair - Later infancy (6-18 month)
- gross motor delay - Toodlers (2-3 years)
- language delay - Preschool (3-5 years)
- languange delay
- behavior delay
- delay motor skill - School age (more 5 years)
- academic underachievement
Complication of Mental retardation
- increase hearing, vision defact
- orthopedic disability
- behavior, emotional disorder
- seizure disorder
- fragile x syndrome
- down syndrome
Causes and clinical picture of Febrile Convulsion
- Causes
- extra cranial infection
- viral infection - CP
a) patient
- 6month-6years
- male than female
- strong family history
b) type of seizure
- Preictal: onset on temperature more 39*c
- ictal: generalize tonic clonic
- short duration (5-15min)
- convulsion fit during same illness
- short postictal stupor
Definition of atypical febrile seizure
Seizure persisting more than 15 minute, same illness,
focal seizure
Investigation of Febrile Convulsion
- CSF
- lumbar puncture
- EEG
- neuro imaging
Factor effect later epilepsy
- initial febrile seizure before 12 month
- +ve family history
- delay development
Treatment of Febrile Seizure
- Immediate 1st aid measure
- posture
- suction
- mouth piece
- oxygen - Cold the temperature
- cold formentation
- antipyretic - Ttt cause of fever: Ab
- Anticonvulsion
- Diazepam 0.3mg/kg/dose IV
Definition of Cerebral Palsy
Purely central motor disorder, non progressive, non familial, non fatal, non curable
Causes of Cerebral Palsy
- Prenatal
- fetal hypoxia
- TORCH infection
- drug
- maternal disease, HTN - Natal
- birth asphyxia
- birth trauma
- prematurity - Postnatal
- hypoxia
- infection
- cerebro vascular accident
Clinical picture of Cerebral Palsy
- spastic diplegia
- spastic quadriplegia (most serious)
- hemiplegia: hemiplegia + seizure
- extrapyrimidal: hypotonia + poor head central
- atonic cp:
>severe hypotonia
>deep reflex exaggerated - ataxia cp:
>hypotonia
>hyporeflexia
>uncoordinate movement - mixed
Early warning sign of cerebral palsy
- below 6 month
- head lag
- severe cry
- difficult swallow
- leg shift and cross
- seizure
- delay development
Investigation of Cerebral Palsy
- MRI
- Hearing and visual test
- genetic evaluation
- TORCH screen
- EEG
Treatment of cerebral palsy
- team of physician must contribute
- parent taught how to work with their child
- drug treat spasticity
>benzodiazepam
>baslofen
>botulism toxin - physiotherapy
Clinical picture of grand mal epilepsy (generalized tonic clonic)
- Aura: unusual behavior
- Tonic:
- powerful sustain contraction of all muscle
- arm flex
- leg extended
- 5 minute - Clonic
- contract and relax of muscle limb& face
- biting tongue
- incontinence - Post epileptic
- fall deep sleep
- confused
Treatment of Grand mal epilepsy
- Na valproate (20-40mg/kg)
- Diazepam (0.3mg/kg)
- Phenytoin (4-8mg/kg)
- Carbamazepine (10-20mg/kg)
Cause of 1ry inability to work with hypotonia
- Central
- cerebral palsy
- mental retard
- down syndrome
- hydrocephalus
- cretinism - Peripheral
- traumatic birth injury
- poliomyelitis
- congenital peripheral neuropathy
- congenital myopathy - Ricket
- Osteogenesis imperfecta
* 1ry cause: infang never walk up to 18 month
DD of flaccid paralysis
- Cerebral hypotonia
- down syndrome
- cerebral palsy - Spinal cord disorder
- poliomyelitis
- spinal muscular atrophy
- spinal cord trauma
- pressure of tumour - Polyneuropathies
- gullien barre syndrome
- infection
- DM - Neuromuscular junction disorder
- organophosphorus poisoning - Muscle disease
- congenital myopathies
- muscular dystrophies
Explain about Gullien Barre Syndrme. Predisposing factor, CP, investigation.
- Predisposing factor
- above 3 years
- has history of infection 1-2 weeks before - Cp
a) acute symmetrical paralysis
- start LL to trunk
- limb flaccid
- lost tendon reflex
- respiratory paralysis
- bulbar paralysis
b) other
- peripheral sensory lost
- urinary retention
- usually recover in weeks / month
- investigate
- nerve conduction velocity
- CSF examination
Clinical picture of Petit Mal Epilepsy ( generalize absence)
- sudden cessation of motor activity/ speech
- blank facial expression
- flicker of eyelid
- common in 5-9 y.o girls
- never associated with aura
- frequent associated simple absence seizure
- recurrence up to 100 time/ day
Treatment Petit Mal Epilepsy
- Ethosuximide 20-40mg/kg
- Na valporate 10-20mg/kg
- 1-2 years after lost convulsion
- advice parent:
> full information about dry therapy
> allow normal activity
> instruction about 1st Aid.
Definition , DD of large head
- Definition
- enlarged head more than 2sd above expected for age and sex - DD
a) cranial
- family large head
- rickets
- chronic hemolysis anemia
- cretinism
- achondroplasia
b) intra cranial
- hydrocephalus
- hydran encephaly
- megalo encephaly
- cause of IC
> tumour
> mass
> chronic abscess
> hemorrhage
Causes of floppy infant
- Cerebral palsy
- Cogenital
- poliomyelitis
- peripheral neuropathy
- myopathy
- myesthenia gravis - Benign congenital hypotonia
- Down syndrome
- Severe PEM
Explain about Brain tumour. Type amd cp
- Type
- predominantly infratentorial involving cerebellum, midbrain, brain stem
- astrocytoma
- medulloblastoma
- germ cell tumour - CP
- vomiting
- morning headache
- increase head circumference
- ataxia
