E3: pediatric neurological disorders Flashcards
what are the three neural tube defects
- anencephaly
- encephalocele
- spina bifida
at 20 days of gestation, what happen
a neural groove appears in the ectoderm of embryo
the nural groove does what after 20 days gestation
deepens and fuse together and the tube forms in both directions from center of embryo outward
when is the neural tube closed off
by the 4th week of gestation
why have CNS disorders decreased
- early prenatal diagnosis
- termination of pregnancies
- maternal intake of folic acid before conception
cause of CNS disorders
- maternal heat exposure
- maternal age, obesity, zinc deficiency
- drugs
- familia; tendency
anencephaly
soft pony part of skull and part of brain is missing
characteristics of anencephaly
child has frog-like appearance from the front
prognosis of anencephaly
- most die shortly after moth, have only premie reflexes
- candidate for organ donation
encephalocele
herniation and protrusion of the brain and meninges through the skull. usually the occipital area
spina bifida
the failure of the bony spine to close
the two types of spina bifida
- occulta
2. cystica
cause of spina bifida
- maturnal heat exposure (sauna, hot tub)
- drugs (anti-epileptic, valporic acid)
- familial tendency has been reduce in families when mother takes a B vitamin folic acid supplement before conception
spina bifida occulta
no visible defect
- most common in lumbosacral area
- may appear as a dimple, nevi, dark tufts of hair or soft lipomas
10-30%
spina bifida cystica
-visible sack-like protrusion, covered with skin or thin membrane
meningocele
present in SBC
-contains meninges and spinal fluid
myelomeningocele
present in SBC
-contains the meninges, spinal fluid and NERVES
clinical mani of spina bifida
depensds on location, may or may not involve sensory and motor impulses of bladder, rectum, lower extremities, may also have related joint deformities of hip back and feet as well as possible visual perceptual problems
how to prevent spina bifida
folic acid-1 month before pregnancy and during first trimester
hydrocephalus
increase in CSF volume secondary to blockages or decreased absorption.
this imbalance of secretion and absorption causes increased enlargement of the ventricles of the brain which compresses the brain against the cranium
in infants, the fontanels and sutures are not fused which causes enlargement of the skull as well as dilation of the ventricles
in older children, lines may re open
hydrocephalus is often associated with
spina bifida
how much CSF is produced daily in hydrocephalus
600cc produced in choroid plexus of lateral ventricles of the brain
cause of hydrocephalus
- congenital: usually related to developmental abnormalities in utero
- acquired: result of hemorrhage, infections or neoplasms
noncommunicating/obstructive hydrocephalus patho
- obstruction to the flow of CSF through ventricular system
- causes dialation and increased pressure
most common sites for hydrocephalus
- aqueduct of sylvius-post hemorrhagic (seen in preturms and congenital stenosis or atresia)
- forth ventricle and foramen magnum (50% of all hydrocephalus)
communicating hydrocephalus
there is impaired absorption of the CSF by the arachnoid villa within the subarachnoid space
infant clinical mani of hydrocephalus
- bulging fontanels
- abnormally large heads (non-c tend to be larger)
- setting sun (sclera visible above the pupil
- high pitched cry
- irritability and lethargy
- poor feeding with vomiting
- opisthotonos (spasm which head and heals are bend back wards and body bowed)
older children clinical mani of hydrocephalus
- s/s related to increased intracranial pressure
- headache on arising with improvement with emesis or upright position
- papiledema
- strabismus
- lethargy
- irritability
meningitis
an acute infection of the meninges and CSF
who is most affected by bacterial meningitis
children (1mo - 5 years)
cause of meningitis
- haemophilus influenzae (B)
- streptococcus and E. Coli
- meningococcus
how is meningococcus seen and how is it transmitted
seen in epidemic form and is the only type readily transmitted by droplet incection
what type of meningitis does streptococcus and e. coli cause
neonatal meningitis
where does flu b meningitis start
in nasopharynx, ears or sinuses
patho of meningitis
- bac spread to CSF by blood
- bac then invade subarachnoid space and inflammatory process starts
- brain becomes hyperemic and edematous and is covered with purulent exudate
INCREASES ICP
infants clinical mani of meningitis
- bulging fontanel
- fever
- poor feeding
- v
- marked irritability
- seizures accompanied by high pitched cry
- nuchal rigidity
- positive Kernig and brudzinski
children clinical mani of meningitis
- fever, chills
- headache
- v
- extreme drowsiness, stupor agitation
- nuchal rigidity and opisthotonos
- positive kernig and brudzinski signs
aseptic/viral meningitis
- limited to meninges
- caused by viruses
- similar to B meningitis but mild
- treatment is symptomatic
cerebral pasly
nonprogressive disorders characterized by early onset of impaired movement and posture, abnormal muscle tone and coordination
most common permanent physical diability of kids
cerebral palsy (motor and sensory deficits)
causes of cerebral palsy
- prenatal (tetrogens)
- genitic syndromes
- chromosome abnormalities
- brain malformations
- intrauterine infections
- placental problems
- labor and delivery (pre elcampsia
- complications of labor
- sepsis/CNS infection
- asphyxia
- prematurity
- childhood meningitis
- toxins
- traumatic brain injury
- not known 24%
