E3: pediatric neurological disorders

Question 1

what are the three neural tube defects

Answer 1

• anencephaly
• encephalocele
• spina bifida

Question 2

at 20 days of gestation, what happen

Answer 2

a neural groove appears in the ectoderm of embryo

Question 3

the nural groove does what after 20 days gestation

Answer 3

deepens and fuse together and the tube forms in both directions from center of embryo outward

Question 4

when is the neural tube closed off

Answer 4

by the 4th week of gestation

Question 5

why have CNS disorders decreased

Answer 5

• early prenatal diagnosis
• termination of pregnancies
• maternal intake of folic acid before conception

Question 6

cause of CNS disorders

Answer 6

• maternal heat exposure
• maternal age, obesity, zinc deficiency
• drugs
• familia; tendency

Question 7

anencephaly

Answer 7

soft pony part of skull and part of brain is missing

Question 8

characteristics of anencephaly

Answer 8

child has frog-like appearance from the front

Question 9

prognosis of anencephaly

Answer 9

• most die shortly after moth, have only premie reflexes

- candidate for organ donation

Question 10

encephalocele

Answer 10

herniation and protrusion of the brain and meninges through the skull. usually the occipital area

Question 11

spina bifida

Answer 11

the failure of the bony spine to close

Question 12

the two types of spina bifida

Answer 12

1. occulta

2. cystica

Question 13

cause of spina bifida

Answer 13

• 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

Question 14

spina bifida occulta

Answer 14

no visible defect

• most common in lumbosacral area
• may appear as a dimple, nevi, dark tufts of hair or soft lipomas

10-30%

Question 15

spina bifida cystica

Answer 15

-visible sack-like protrusion, covered with skin or thin membrane

Question 16

meningocele

Answer 16

present in SBC

-contains meninges and spinal fluid

Question 17

myelomeningocele

Answer 17

present in SBC

-contains the meninges, spinal fluid and NERVES

Question 18

clinical mani of spina bifida

Answer 18

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

Question 19

how to prevent spina bifida

Answer 19

folic acid-1 month before pregnancy and during first trimester

Question 20

hydrocephalus

Answer 20

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

Question 21

hydrocephalus is often associated with

Answer 21

spina bifida

Question 22

how much CSF is produced daily in hydrocephalus

Answer 22

600cc produced in choroid plexus of lateral ventricles of the brain

Question 23

cause of hydrocephalus

Answer 23

• congenital: usually related to developmental abnormalities in utero
• acquired: result of hemorrhage, infections or neoplasms

Question 24

noncommunicating/obstructive hydrocephalus patho

Answer 24

• obstruction to the flow of CSF through ventricular system

- causes dialation and increased pressure

Question 25

most common sites for hydrocephalus

Answer 25

- aqueduct of sylvius-post hemorrhagic (seen in preturms and congenital stenosis or atresia) - forth ventricle and foramen magnum (50% of all hydrocephalus)

Question 26

communicating hydrocephalus

Answer 26

there is impaired absorption of the CSF by the arachnoid villa within the subarachnoid space

Question 27

infant clinical mani of hydrocephalus

Answer 27

- 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)

Question 28

older children clinical mani of hydrocephalus

Answer 28

- s/s related to increased intracranial pressure - headache on arising with improvement with emesis or upright position - papiledema - strabismus - lethargy - irritability

Question 29

meningitis

Answer 29

an acute infection of the meninges and CSF

Question 30

who is most affected by bacterial meningitis

Answer 30

children (1mo - 5 years)

Question 31

cause of meningitis

Answer 31

- haemophilus influenzae (B) - streptococcus and E. Coli - meningococcus

Question 32

how is meningococcus seen and how is it transmitted

Answer 32

seen in epidemic form and is the only type readily transmitted by droplet incection

Question 33

what type of meningitis does streptococcus and e. coli cause

Answer 33

neonatal meningitis

Question 34

where does flu b meningitis start

Answer 34

in nasopharynx, ears or sinuses

Question 35

patho of meningitis

Answer 35

- 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

Question 36

infants clinical mani of meningitis

Answer 36

- bulging fontanel - fever - poor feeding - v - marked irritability - seizures accompanied by high pitched cry - nuchal rigidity - positive Kernig and brudzinski

Question 37

children clinical mani of meningitis

Answer 37

- fever, chills - headache - v - extreme drowsiness, stupor agitation - nuchal rigidity and opisthotonos - positive kernig and brudzinski signs

Question 38

aseptic/viral meningitis

Answer 38

- limited to meninges - caused by viruses - similar to B meningitis but mild - treatment is symptomatic

Question 39

cerebral pasly

Answer 39

nonprogressive disorders characterized by early onset of impaired movement and posture, abnormal muscle tone and coordination

Question 40

most common permanent physical diability of kids

Answer 40

cerebral palsy (motor and sensory deficits)

Question 41

causes of cerebral palsy

Answer 41

- 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%