NCC content Flashcards
what is caput succedaneum?
accumulation of serum above the periosteum
what can a caput be confused with?
subgaleal hemorrhage
what is a cephalohematoma?
accumulation beneath the periosteum
-not usually present right away at birth, but appears within 24 hours
how long can it take for a cephalohematoma to heal?
3 months
what other complications are associated with cephalohematoma?
- skull fracture
- hyperbili
- mild anemia
what is a subgaleal hemorrhage?
- extracranial bleed
- bleeding into the subaponeurotic space
what type of instrumentation is associated with a subgaleal hemorrhage?
vacuum-assisted delivery
what is a subarachnoid hemorrhage?
-intracranial hemorrhage (most common)
bleeding into the subarachnoid space from ruptured vessels
-relatively benign and often asymptomatic
presentation of subarachnoid hemorrhage
- transient seizure activity on day 2-3
- abnormal neuro exam
prognosis for subarachnoid hemorrhage
generally good unless a massive hemorrhage develops
what is a subdural hemorrhage?
- intracranial hemorrhage
- hemorrhage between the dura and the arachnoid
presentation of subdural hemorrhage?
- presents within first 12 to 72 hours
- severity ranges from asymptomatic lesions to massive hemorrhage
- seizures and neurologic changes
prognosis with subdural hemorrhage
- depends one extent and severity
- ranges from complete recovery to rapid deterioration and death
symptoms of facial nerve palsy
- drooping mouth
- perpetually open eye
- ineffective suck and swallowing problems
- persistant drooling
nerves effected in Erb’s palsy
C5 and C6
nerves effected in Klumpke’s palsy
C7 to T1
brachial plexus injury prognosis
- full spontaneous recovery if some improvement within 2 weeks
- partial recovery if initial improvement is delayed until 4 to 6 weeks
- significant permanent deficit if no improvement by 3 months
what is scaphocephaly?
premature closer of the sagittal sutures
elongates in the occipitofrontal diameter
what is brachycephaly?
premature closure of the coronal sutures
overgrowth of the vertex and lateral aspects of the head
what is spina bifida occulta?
- a defect in only the vertebral arch
- usually asymptomatic
what is a meningocele? (spina bifida cystica)
- sac contains meninges
- spinal cord is in normal position and doesn’t protrude
- dermal covering is often present
what is a myelomeningocele? (spina bifida cystica)
- sac contains meninges and neural tissue
- functional abnormalities are dependent on the level of the defect
what is an arnold-chiari malformation?
- displacement of the medulla oblongata, the fourth ventricle and some of the cerebellum into the cervical canal
- CSF flow is impaired
what is rachischisis?
- open spinal cord; failure of the neural folds to fuse
- often associated with anencephaly
what is anencephaly?
failure of the rostral neuropore to close
- missing forebrain, remainder of the brain is degenerative
- spontaneous/pain induced movements; intact reflexes
anencephaly pregnancy
- increased alpha fetoprotein
- polyhydramnios
- postterm delivery
what is hydranencephaly?
- complete or nearly complete absence of the cerebral hemispheres
- intact brain stem
etiology of hydranencephaly
- severe hydrocephaly
- inutero infection
- vascular occlusion
clinical manifestations of hydranencephay
may appear normal at birth
- irritability/hyper/hypotonia
- intact reflexes
- usually die early in infancy
what causes holoprosencephaly?
failure of the prosencephalon (forebrain) to cleave to the telencephalon and diencephalon
why is pachygyria?
-few broad gyro and shallow sulci
define hydrocephaly
imbalance between CSF production and absorption from excess formation of CSF, decreased absorption of CSF or obstruction of flow
define communicating hydrocephalus
obstruction occurs after CSF exits the ventricles
define noncommunicating hydrocephalus
obstruction occurs along the passages connecting the ventricles
when do most IVH occur?
50% by 24 hours
90% by 72 hours
almost 100% by 1 week
describe the germinal matrix
- beneath the ventricular wall
- produces glial cells and neurons
- primitive and highly vascular
- most common area of origination for IVH
what happens with bleeding into the germinal matrix?
- hematoma forms
- blood is released into the ventricular system if the hematoma ruptures
causes of IVH
- fluctuating cerebral blood flow
- arterial hypotension
- increased venous pressure impedes cerebral venous return
- excess fibrinolytic activity
- platelet and coagulation disturbances
describe posthemorrhagic hydrocephalus
usually with grade III/IV
- blood clot obstruction
- obstructive inflammation and scarring (inhibits absorption)
treatment of posthemorrhagic hydrocephalus
-maintain normal ICP
-prevent compression of the periventricular white matter
-sustain cerebral perfusion
(serial LPs, VP shunts)
-50% resolve with no treatment
about PVL
- occurs only in premature infants
- 27 to 30 weeks have the highest incidence
- often associated with IVH
- may be an infectious component
- highest incidence PROM + chorio
what is PVL
- ischemic lesion
- periventricular white matter necrosis
- small cysts in white matter (where brain death has occurred)
best way to diagnose PVL
-MRI
ultrasound only detects 40-60%
prognosis for PVL
- majority will have cerebral palsy, especially of the lower limbs
- developmental delays
effects of HIE
- conversion to anaerobic metabolism
- intracellular pump function failure: accumulation of Na, Ca, and H20 in brain cells, causing cellular death
- accumulation of fatty acids and free radicals
- excess release of neurotoxic excitatory neurotransmitters
- cell apoptosis
early phase of HIE
body is trying to compensate
- decreased brain temperature
- local release of GABA
- temporarily decrease cerebral oxygen demand and limit impact
latent phase of HIE
when intervention may be effective
secondary phase of injury
-apoptosis: programmed cell death
how does therapeutic hypothermia work?
- decreases rate of cellular death
- decreases cellular metabolism
- conserves ATP stores
- limits free radical release
describe neonatal seizures
A symptom of neurologic dysfunction
-excessive simultaneous electrical discharge or depolarization
pathophysiology of neonatal seizures
- excessive excitatory amino acid release
- deficient inhibitory neurotransmitters (GABA)
