Common Pediatric Disorders

Question 1

What is OBPI?

Answer 1

Injury of BS during delivery (traction and rotation during delivery)
Most common at C5-C6 (Erb’s Palsy)
-Other version (C7-T1) = Klumpke’s Palsy

Complete UE paralysis possible but unlikely
-Check for fracture of clavicle and humerus.

RARELY BILATERAL!!!!!!!!!!!!!!!!!!!!

Treat early; prognosis is good with treatment

Question 2

What is Hydrocephalous?

Answer 2

Water in the brain

• Increased production
• Decreased absorption
• Decreased flow (obstruction)

Common cause = subarachnoid hemorrhage
Obstructive causes = ductal stenosis and brain tumor

May or may not be associated with increased intracranial pressure

Question 3

Symptoms in Hydrocephalous?

Answer 3

Wide head
Downward eyes (Setting Sun)
-Spasticity, Clonus, brisk reflexes
\+Babinski
-Lethargy, mood changes, papilledema, etc

Treat with VP shunt

Question 4

Flow of CSF?

Answer 4

Per Rijo:

CSF Flow

1. lateral ventricles
2. interventricular formamina
3. 3rd ventricle
4. cerebral aqueduct
5. 4th ventricle
6. subarachnoid space
7. returns to venous system via arachnoid granulations
8. most of the CSF empty into the superior sagittal sinus

Question 5

Know what an MRI of Hydrocephalus looks like

Answer 5

LVs look huge

Diagnosed in newborns with ultrasound
(For children, CT and MRI are used. And fundoscopic eye exam)

Question 6

Risks and mechanisms for shunting

Answer 6

VP Shunt: blocked easily, high risk for infection.
Some develop aggressive behaviors
If VP Shunt is dysfunctional, there may be an acute onset of hydrocephalus

Question 7

Myelodysplasia Occulta?

Answer 7

Not visible - defect of vertebral body; no protrusion of spinal cord

No treatment!

Question 8

Myelodysplasia (Aperta) - Myelocele

Answer 8

Protrusion of spinal cord at the back with no cystic meningeal covering

Question 9

Myelodysplasia (Aperta) - Myelomeningocele

Answer 9

Protrusion of spinal cord and meninges through back - cystic

Question 10

Myelodysplasia (Aperta) - Meningocele

Answer 10

Bulging of meninges through back without presence of spinal cord, usually well-covered with skin (may also protrude anteriorly into abd)

• ** All 4 use MRI for diagnosis (after birth; prenatal = US)
• 3 Apertas can use CT w/ contrast too
• –Treated with surgery and PT after

Question 11

Arnold Chiari?

Answer 11

Downward displacement of cerebellar tonsils through foramen magnum - sometimes causing non-communicating hydrocephalus as a result of obstruction of CSF outflow

Question 12

Clinical manifestations of Down Syndrome?

Answer 12

Widen nasal bridge
Low set ears
Single palmar crease
Wide-spaced 1st toe
Hypotonia
Pelvic dysplasia
Mental retardation
Cardiac malformations (AV canal)
Ligamentous laxity (AAI)

Question 13

Diagnosis and Prognosis of DS?

Answer 13

Diagnosis:

• Prenatal: Serum for MSAFL, US, Aminocentesis at 15-20 wks GA, Chorionic villus sampling at 11-12 weks GA
• Post-natal: Karotype, Cardiac evaluation, Thyroid function

Treatment: Management is most services for development. Radiographs NOT RECOMMENDED for cervical instability

Prognosis: depends on:

• Level of mental retardation
• Access to services
• Good muscular training for stability
• Presence of co-morbidities

Question 14

What is CP?

Answer 14

Group of motor syndromes resulting from disorders of early brain development (4 types). Commonly caused by early brain injury from infection, ischemia, endocrine/genetic disorders, prematurity, asphyxia, kernicterus

Question 15

Is UE or LE affected more in hemiplegic CP?

Answer 15

UE

-Growth arrest of one arm or hand is common

Question 16

What is seen in Spastic Diplegia?

Answer 16

Severe adduction of hips, dragging of legs while crawling, brisk reflexes, +Babinski, ankle clonus, Equinovarus (walks on tip-toes, if walking). Normal intellect common

Best prognosis of all 4.

Question 17

Characteristic of Sapstic Quadriplegia?

Answer 17

Swallowing difficult
Mos severe
MOST OFTEN ASSOCIATED WITH MENTAL RETARDATION AND SEIZURES!
Flexion contractures of knees and elbows

Question 18

Athetoid (Dyskinetic CP)

Answer 18

Hypotonia!! (others show spansticity)
Poor head control
Feeding and speech dysfunctions
UMN dysfunction and seziures uncommon
Intellect usually preserved

Ataxia, writing movements, etc.