CONGENITAL AND BRAIN MALFORMATIONS (based on Tagnawa T) PART 1 Flashcards
What is the importance of a pediatric neurological examination?
It provides essential data for anatomical localization, reassures families, and helps evaluate disorders over time.
What are the main points to remember in pediatric neurological examination?
Adapt the exam to the child’s temperament and developmental level; know the expected neurodevelopmental milestones; observe the child’s behavior, walking, talking, and playing.
What are the elements of a complete neurological assessment?
Focused clinical history, physical examination, and complete neurological examination.
What is the first step in diagnosing a neurological problem?
Identify if there is a neurologic problem and localize where the lesion is.
What should be considered in the history of present illness for a neurological issue?
Duration of symptoms, whether they are constant/episodic, static/progressive/resolving, and the anatomical localization suggested by the history.
What are common red flags in pediatric neurology history?
Headache, changes in sensorium, weakness, changes in vision/hearing/response, and developmental milestone delays.
What is the difference between upper motor neuron and lower motor neuron lesions?
Upper motor neuron lesions involve the brain and spinal cord, while lower motor neuron lesions involve the anterior horn cell, nerve, neuromuscular junction, and the muscles it innervates.
What are the four basic questions to clarify the history of a current illness?
Is the process acute or insidious? Is it focal or generalized? Is it progressive or static? At what age did the problem begin?
What is the temporal profile of neurological disease?
Acute (seconds, minutes, hours), subacute (hours to 10 days), chronic (2 weeks or more), paroxysmal (episodic with returns to baseline).
What are examples of acute focal neurological conditions?
Vascular/infarct (e.g., ruptured aneurysm, stroke), hypoxic events, and trauma.
What are examples of subacute neurological conditions?
Inflammatory/infectious conditions, immune-mediated disorders, and toxic/metabolic issues.
What are examples of chronic neurological conditions?
Congenital abnormalities, degenerative diseases, and neoplastic conditions.
What are paroxysmal neurological conditions?
Seizures (focal or diffuse), vascular/syncope (diffuse), and pain/headache (focal or diffuse).
What is the difference between progressive and static neurological conditions?
Progressive conditions worsen over time (e.g., growing brain tumor), while static conditions remain unchanged (e.g., cerebral palsy).
What are examples of diagnostic tools in pediatric neurology?
Focused history, physical and neurological examination, developmental screening tests, and laboratory evaluations.
How can the age of onset help in diagnosing a neurologic condition?
Congenital problems are present at birth, while acquired problems develop later in life.
What is the most severe cause of an acute headache in the first 24 hours?
A vascular problem, such as a ruptured aneurysm or stroke.
What is the usual cause of an insidious or chronic headache?
A brain tumor, which progressively worsens over time.
What are common congenital anomalies of the CNS?
Conditions like neural tube defects, Chiari malformations, and agenesis of the corpus callosum.
What are the clinical features of cerebral palsy?
Motor impairments that are static over time, often involving spasticity, dyskinesia, or ataxia.
What are examples of neurocutaneous syndromes?
Neurofibromatosis, Tuberous Sclerosis, and Sturge-Weber Syndrome.
What are key features of seizures?
Episodic disturbances of movement, sensation, behavior, or consciousness caused by abnormal neuronal activity.
What conditions mimic seizures?
Syncopal events, migraines, and psychogenic nonepileptic seizures.
What are common pediatric CNS infections?
Meningitis, encephalitis, and brain abscess.
What are signs of a pediatric stroke?
Focal neurological deficits such as hemiparesis, aphasia, or visual disturbances.
What are examples of demyelinating disorders of the CNS?
Multiple sclerosis and acute disseminated encephalomyelitis (ADEM).
What are examples of neuromuscular disorders?
Muscular dystrophies, myasthenia gravis, and Guillain-Barré Syndrome.
What is Bell’s Palsy?
A condition characterized by sudden, unilateral facial paralysis due to facial nerve dysfunction.
What is the main purpose of a neurological examination?
It serves as the window through which the clinician views the nervous system.
What tools can be used to attract a child’s attention during a neurologic examination?
Tennis ball, small toys, bell, or any object that attracts attention.
Why should uncomfortable tasks in a neurologic exam be postponed until the end?
Because once the child cries, it becomes difficult to elicit other symptoms or findings.
How can observation during play help in a neurologic examination?
It can reveal handedness, motor deficits, gait abnormalities, or lack of response to stimuli.
How should a younger child be positioned during the neurologic examination?
They should be examined in the parent’s lap.
What additional tools are useful for a comprehensive neurological exam?
Snellen chart, tongue depressor, cotton wisp, percussion hammer, sensory reflex hammer, and items like coins, paper clips, or substances with distinct smells and tastes.
What should be the first step in documenting a pediatric neurological examination?
Start with a general physical examination and mental status evaluation.
Why must the mental status assessment be age-appropriate?
You cannot describe behaviors or responses that are developmentally impossible for the child’s age.
What are the key components of a mental status examination?
Appearance, behavior, social interaction, motor activity, mood, affect, speech, thought processes, and intellectual functioning.
What is lethargy in terms of consciousness levels?
A state where the child has difficulty maintaining arousal and sleeps most of the time.
What does obtundation mean?
The child is responsive to stimulation like sound or touch but not to pain.
What is stupor in consciousness levels?
The child is only responsive to painful stimuli.
What is the definition of coma in terms of consciousness?
A state of unresponsiveness to pain or any stimuli.
What are the primary signs of craniosynostosis?
Ridging of cranial sutures and early closure of the anterior fontanelle before 9–18 months.
What is the significance of scalp vein prominence in children?
It may indicate increased intracranial pressure (ICP).
What does a flattened occiput indicate?
It is often associated with hypotonia.
What is the function of cranial nerve I (olfactory)?
It is responsible for the sense of smell.
What tools can be used to test cranial nerve II (optic nerve)?
Snellen chart, Ishihara test for color vision, and fundoscopic examination.
What is the function of cranial nerves III, IV, and VI?
They control eye movements and are tested through observing movements in various visual fields.
How can cranial nerve V (trigeminal nerve) be tested?
Sensation over the forehead, cheeks, and chin, and motor functions like clenching teeth.
What is the motor function of cranial nerve VII (facial nerve)?
It controls movements of facial muscles, such as raising eyebrows and smiling.
What is the sensory function of cranial nerve VII (facial nerve)?
Taste from the anterior two-thirds of the tongue.
How can cranial nerve VIII (vestibulocochlear nerve) be evaluated?
Through hearing tests like Rinne and Weber tests or observing balance and response to auditory stimuli.
What is the function of cranial nerves IX and X?
They are responsible for swallowing, gag reflex, and functions of the soft palate, pharynx, and larynx.
How can cranial nerve XI (accessory nerve) be tested?
By asking the child to turn their head or shrug their shoulders against resistance.
What is the role of cranial nerve XII (hypoglossal nerve)?
It controls tongue movements and is tested by asking the child to stick out their tongue or speak.
What is the normal head circumference for newborns?
33–35 cm.
What is the significance of unusual odors in pediatric patients?
Urine smelling like maple syrup may indicate an inborn error of metabolism like maple syrup urine disease (MSUD).
How is the motor function assessed in a pediatric neurologic exam?
By observing muscle strength, tone, and movements, and checking reflexes.
What are the components of a sensory assessment in a neurologic exam?
Touch, pain, temperature, vibration, and position sense.
What are some examples of developmental screening tests?
Denver Developmental Screening Test and Ages & Stages Questionnaires.
How do you test balance and coordination in a pediatric patient?
Through activities like walking, hopping, or catching a ball.
Why is documenting a neurological exam over time important?
It helps track the progression of disorders that evolve over time.
What are examples of physical signs indicating neurocutaneous syndromes?
Abnormalities in skin pigmentation, hair texture, or scalp lesions.
At what age does the anterior fontanelle usually close?
Between 9 and 18 months.
What is the significance of the Macewen sign (cracked pot sound)?
It indicates increased intracranial pressure or separated cranial sutures.
How do you test for extraocular muscle movement in infants?
By moving a colorful toy and observing their gaze.
What is the caloric test used for?
To determine the status of cranial nerve VIII (vestibulocochlear) and brainstem function, often in brain death assessment.
Why is the Snellen chart used in older children?
To assess visual acuity in children who can identify letters or pictures.
What are motor skills observed in a pediatric neurological examination?
Ability to walk, sit, raise hands, squeeze fingers, hop, skip, or jump.
How can balance be checked in a pediatric patient?
By assessing how the child stands and walks or having them stand with eyes closed while being gently pushed to one side.
What is Romberg’s test used for?
It tests the dorsal column and balance by having the child stand with eyes closed (support required to prevent falls).
How is muscle strength graded on a scale of 0 to 5?
0: No contraction;
1: Slight contraction, no movement;
2: Full range of motion, not against gravity;
3: Full range of motion against gravity;
4: Full range of motion against some resistance;
5: Full range of motion against full resistance.
How is motor strength described in younger children?
By observing movements like flexion, extension, or grasping, since they cannot follow instructions for resistance tests.
Why is sensory examination challenging in children under 7 years old?
They cannot reliably quantify or describe sensations.
What tools are used in a sensory examination?
Dull needles, tuning forks, alcohol swabs, or objects to test sensations like hot, cold, sharp, or dull.
What does cerebellar examination assess?
Coordination, timing of muscle contractions, and smoothness of movements.
What are key tests for cerebellar function?
Finger-to-nose test, dysdiadochokinesia test, and observing gait for ataxia or drunken gait.
What is dysmetria?
A condition where movements are clumsy and overshoot the target, indicating cerebellar dysfunction.
What does an intention tremor indicate?
It appears toward the end of a movement, suggesting cerebellar disease.
What is the function of reflex testing in pediatric neurology?
It helps identify normal, hyperreflexic, or hyporeflexic responses to assess upper or lower motor neuron problems.
How are reflexes tested in children?
By using a reflex hammer on points like the knee or elbow while supporting the area with fingers to reduce discomfort.
What are meningeal signs assessed during a neurologic exam?
Nuchal rigidity, Kernig’s sign, and Brudzinski’s sign.
At what age are meningeal signs like Kernig’s and Brudzinski’s appreciable?
Beyond 18 months; lumbar puncture is recommended for younger children.
What does nuchal rigidity indicate?
A sign of meningeal irritation, such as in meningitis.
What is neuroembryology?
The process of nervous system development from the neural tube to the central and peripheral nervous systems.
Why is the CNS the last to mature postnatally?
Because the nervous system continues to develop and refine connections even after birth.
What is the approach to diagnosing congenital anomalies?
Recognize abnormalities, make an accurate diagnosis, provide a realistic prognosis, and discuss management options with the family.
How does understanding neuroembryology aid in discussing congenital anomalies?
It helps explain when and how anomalies occurred during fetal development.
What common misconceptions exist about congenital anomalies?
Myths and misinformation about their causes persist despite modern resources and internet access.
How can congenital anomalies be identified prenatally?
Through congenital screening during pregnancy.
What are the steps to manage congenital anomalies postnatally?
Accurate diagnosis, discussing prognosis, managing associated medical problems, and delivering appropriate care.
What questions should be answered when assessing congenital anomalies?
Where are the problems? What are the problems? What is the diagnosis? What are the associated problems?
What does overshooting a target during hand movement suggest?
Dysmetria, often caused by cerebellar dysfunction.
How do cerebellar lesions differ from cerebral lesions?
Cerebellar lesions cause ipsilateral symptoms, while cerebral lesions cause contralateral symptoms.
What is the importance of explaining the timing of congenital anomalies to parents?
It helps them understand when the problem occurred and dispels myths about the causes.
What role does gait observation play in a pediatric neurological exam?
It helps identify motor deficits, ataxia, or other abnormalities related to cerebellar function.
What should be noted when assessing reflexes in pediatric patients?
Whether the reflexes are normal, hyperreflexic, or hyporeflexic, and if they indicate an upper or lower motor neuron issue.
Why is it essential to support a child during balance tests?
To prevent falls and ensure the safety of the child.
How is cerebellar function tested in younger children?
By introducing small objects for the child to reach and observing the smoothness of movements.
What are the key signs of cerebellar disease?
Clumsy, unsteady movements, variable speed and force, and intention tremors.
What is the importance of accurate prognosis in congenital anomalies?
It helps families set realistic expectations and plan for management and care.
