Lecture 2: Pediatric Neuro Conditions I Flashcards
most common developmental disability
Intellectual disability
Children with IDs have significant problems with:
- intellectual functioning
- Adaptive behavior
Signs of intellectual disability
- Sit, up, crawl, or walk later than other children
- Learn to talk later, or have trouble speaking
- find it hard to remember things
- have trouble understanding social rules/appropriate behaviors
- have trouble seeing the results of their actions
- trouble solving problems
- problems with receptive/expressive language
Management of Intellectual disability
- Timely identification and referral
- Early intervention services, special education & vocational rehab
- Interdisciplinary care to manage ID and comorbidites
Autism Spectrum Disorder Definiton
- persistent, significant impairments in social interaction and communication as well as restrictive, repetitive behaviors and activities.
- Wide spectrum
- Neurobiological disorder
- Behaviorally diagnosed
- Apparent early in life
- Lasts for the lifetime
ASD newest terminology
Neuroatypical
ASD is primarily a disorder of ___
communication, social relating and sensory processing
ASD can occur with ___ disability
any other
ASD is a disorder of ____ processing
disorder of higher-order processing
What ASD is not:
- a mental illness
- Behavioral disorder
- Emotional disorder
- hopeless condition
Neuro issues common in individuals with ASD
- Apraxia
- Sensory processing problems
- Epilepsy
- Cognitive impairments
- Failure to develop speech
- doesn’t respond to name
- auditory discrimination problems
- lack of eye control
- hypotonia
- difficulty with motor planning
- toe walking
- lack of fear - risk takers/impulsive
ASD prevelance
- 18.5/1000 (1/54)
- 4.3X more prevelant in boys
ASD pts have ___ unimodal sensory connectivity
-
Increased unimodel sensory connectivity
- (motor, auditory, visual)
- the greater the clinical severity associated with greater unimodal connectivity
- ppl w difficulty sensory processing have higher connectivity
ASDs have ____ supramodel connectivity
-
Decreased supramodel connectivity
- higher cognitive functioning - default mode, dorsal-attention, executive and salience
- the higher the clinical severity, the lower supramodel connection
- pts who have a hard time w social interactions (more severe) have decreased supramodel connections
ASD causes
- environmental and genetic
- no evidence between MMR vaccine and ASD
Management of ASD
- No cure or one size fits all model
- Early Intervention
- Social, communication, functional, and social behavioral skills
- No medications impact underlying pathology
- Some medications to address: hyperactivity, antipsychotics, antidepressants, anti-anxiety
- Epilepsy, sleep disorders, nutritional defencies
Seizure definition
transient occurence of signs/symptoms due to abnormal excessive or synchronous neuronal activity in the brain
epilepsy
enduring predisposition to generate epileptic seizures with cognitive, psychological and social consequences of the condition
Epilepsy criteria
- ≥ 2 unprovoked seizures occurirng > 24 hours apart
- One unprovoked seizure has similar probability of recurrence risk as 2 unprovoked seizures
- Diagnosis of epilepsy syndrome
Generalized seizures
affect both sides of the brain
- (petit mal)
- Tonic-clonic (grand mal)
petit-mal seizure (absence)
- Generalized seizure
- rapid blinking or a few seconds of staring into space
tonic-clonic (grand mal)
- Generalized seizure
- Cry out
- Lose consiousness
- Fall to the gorund
- Have muscle jerks or spasms
- pt may feel tired after clonic-tonic seizure (grand mal) ; monitor for post-seizure state
Focal (partial seizures)
- Located in just one side of the brain
- Simple focal
- complex focal
- secondary generalized seizures
Simple focal seizure
Focal (partial seizure)
Affect a small part of the brain (twitching; change in sensation - stange taste or smell)
Complex focal seizure
Focal (partial) seizure
can make a person with epilepsy confused or dazed (unresponsivle for a few minutes)
Secondary generalized seizures
- Begin in one part of the brain, but then spread to both sides of the brain (i.e., a focal seizure followed by a generalzied seizure)
Unprovoked (epileptic) seizure disorder
Absence of temporary or reversible factor lower the threshold and producing a seizure at that point in time
Provoked (un-epileptic) seizure disorder
- Presence of a temporary or reversible factor:
- fever
- substance withdrawl
- concussion/TBI
- Lack of sleep
- Flashing lights
- tumor
- COVID
- dehydration
- side effect
top 4 anti-epileptic drugs
- sodium valporate (depakote)
- Phenobarital
- Cabamazepine (tegretol)
- Keppra
other seizure disroder/epilepsy
- Deep brain stimulation
- Keto diet
- Resection (laser ablation)
- Vagus nerves stim (??)
often times have to play with epileptic dosage because of
lethargy
Down syndrome AKA
Trisomy 21
- most common chromosomal abnormality
- most common genetic cause of intellectual disability
- Increasing prevalence
- Increasing maternal age
Down syndrome signs - key sings
- **Single palmar crease
- Congenital heart disease (66%)
- Intestinal defects (3.7%)
biggest thing to consider with Downs syndrome
Atlantoaxial instability
DS pts more likely to develop
- testicular or blood cancer
- mental health conditions
- bronchitis
- pneumonia
- GI, neuro, thyroid, bone disease
DS pts less likely to develop
- Solid tumors
- Heart disease
- STDs
- Influenza
- Sinuitis
- Diabetes
Spina bifidia
condiiton where the neural tube fails to close in utero
Occulta spina bifida
hairy tuft on lumbosacral region
usually no neural defects
Meningocele spina bifida
neural tissues in tact w/in the body
meninges are external to the body
Myelomemingocele spina bifida
neural tissue and meninges are outside of body
Lipomyelomemingocele spina bifida
Myelomemingocele symptoms and cyst on the spinal cord
spina bifida can occur anywhere from:
lower thoracic to lumbosacral
not naming a specific vertebrae - will likely just say region of involvement based on sensory and motor defecits
spina bifida prevelance decreasing due to:
folic-acid supplementation
controlling preexisting conditions prior to conceiving
avoid overheating your body (including fever)
treat every kid with spina bifida as if they have a ____ Allergy
LATEX
with increasing exposure comes an increase in severity of an allergic response
Spina bifida - hydrocephalus
something that occured during sac closures that were done after birth & CSF mass would shoot directly back into the brain = hydrocephaly (build up in brain)
- less likely when sac closure done in utero (CSF absorbed naturally through lymphatics)
Spina bifida - Charli II Malformation (herniated cerebellum)
difficulty breathing and or swallowing
reccommend decompression surgery
Spina bifida tethered cord symptoms
- back pain
- changes in bladder
- LMN symptoms (causa equina down)
- UMN signs: tension in spinal cord
- Feet deformities
spinal dedformities in spina bifida
- Hyperkyphosis in lumbosacral region
- Kyphoscoliosis in thoracic
definition of CP
- disorder of the development of movement and posture causing activity limitation
-
attributed to non-progressive disturbances that occured in the developing brain
- lesion itself in the brain does not proress but the interaction of the lesion and developing body causes proressice motor symptoms
biggest risk factor for CP
Prematurity and LBW (low birth weight)
pathophysiology of CP - preterm infant
- periventricular leukomalacia
- ischemic necrosis to periventricular white mater
- Periventricular hemorrhagic infarction
- hemorrhage into germinal matrix and ventricles
- Affects ascending and decescing tracts
- topgraphic and size relationship.
pathophysiology of CP - term infant
- Infarction in parasaggital, watershed area, MCA stroke
- Basal ganglia and thalamic injury
CP
hypertonia
spasticity, dystonia, rigidty
CP
hyperkinetic
athetosis, chorea, dystonia, myoclonus, tics, tremor
CP
negative
ataxia, weakness, decreased selective motor control
CP tone management
- oral medications
- anti-spasmodic injections
- Selective dorsal Rhizotomy
- Bacloen pump implantation
CP general orthopedic procedures
Muscle/tendon lengthening
Tendon transfers
Osteomies
Athrodesis
