Nervous System Disorders

Question 1

Major neuropathology lesions associated with VLBW infants

Answer 1

1) IVH 2) Periventricular leukomalacia

Question 2

Where does IVH occur in premature infants

Answer 2

Gelatinous subependymal germinal matrix (site of origin for embryonal neurons and fetal glial cells)

Question 3

IVH Grading by CT scan

Answer 3

Gr I - Subependymal area, Gr II - Within ventricle w/o evidence of dilatation, Gr III - IVH with dilatation, Gr IV - intraventricular and parenchymal

Question 4

IVH Grading by Ultrasound

Answer 4

Gr I - confined to the germinal matrix-subependymal region or to less than 10% of the ventricle, Gr II - 10-50% of ventricle, Gr III >50% of the ventricle with dilatation

Question 5

Ventriculomegaly spectrum

Answer 5

Mild - 0.5-1cm, Moderate - less than 1.5cm but more than 1cm, Severe - >1.5cm

Question 6

Routine real-time CUTZ is recommended in

Answer 6

Premature infants less than 32 weeks AOG

Question 7

All at risk infants should undergo ff up CUTZ at ___ to evaluate adequately for PVL

Answer 7

36-40 weeks PMA

Question 8

20-30% of infants with HIE die within

Answer 8

Neonatal period

Question 9

___ of HIE survivors are left with permanent neurodevelopment abnormalities

Answer 9

~33-50%

Question 10

The initial circulatory response of the fetus in cases of HIE is

Answer 10

Increased shunting through the ductus venous, ductus aretriosus, and foramen ovale

Question 11

Organs of priority blood flow in cases of shock

Answer 11

Brain, heart adrenals

Question 12

May be the first indication of fetal hypoxia

Answer 12

IUGR with increased vascular resistance

Question 13

Stages of HIE in term infants: Level of consciousness

Answer 13

St 1 Hyperalert, St 2 Lethargic, St 3 Stuporous/coma

Question 14

Stages of HIE in term infants: Muscle tone

Answer 14

St 1 Normal, St 2 Hypotonic, St 3 Flaccid

Question 15

Stages of HIE in term infants: Posture

Answer 15

St 1 Normal, St 2 Flexion, St 3 Decerebrate

Question 16

Stages of HIE in term infants: Tendon reflexes/clonus

Answer 16

St 1 Hyperalert, St 2 Hyperactive, St 3 Absent

Question 17

Stages of HIE in term infants: Myoclonus

Answer 17

St 1 Present, St 2 Present, St 3 Absent

Question 18

Stages of HIE in term infants: Moro reflex

Answer 18

St 1 Strong, St 2 Weak, St 3 Absent

Question 19

Stages of HIE in term infants: Pupils

Answer 19

St 1 Mydriasis, St 2 Miosis, St 3 Unequal, poor light reflex

Question 20

Stages of HIE in term infants: Seizures

Answer 20

St 1 None, St 2 Common, St 3 Decerebrate

Question 21

Stages of HIE in term infants: EEG

Answer 21

St 1 Normal, St 2 Low voltage changing to seizure activity, St 3 Burst suppression to isoelectric

Question 22

Stages of HIE in term infants: Duration

Answer 22

St 1 Less than 24h if progresses, otherwise may return to normal; St 2 24h-14 days; St 3 Days to weeks

Question 23

Stages of HIE in term infants: Outcome

Answer 23

St 1 Good, St 2 Variable, St 3 Death, severe deficits

Question 24

Preferred imagine modality in neonates with HIE because of its high sensitivity and specificity early in the process and its ability to outline topography of the lesion

Answer 24

Diffusion-weighted MRI

Question 25

Has limited utility in the evaluation of TERM INFANTS, but is the preferred modality in the evaluation of preterm infants with HIE

Answer 25

UTZ

Question 26

May help determine which infants are at highest risk for long-term brain injury

Answer 26

Amplitude-integrated EEG

Question 27

Mechanisms by which hypothermia benefits neonates with HIE

Answer 27

1) Decreases rate of apoptosis 2) Suppresses production of mediators known to be neurotoxic, including glutamate, free radicals, NO, and lactate (Downregulation of secondary mediators of injury resulting from edema, accumulation of cytokines, and seizures)

Question 28

Poor predictor values of HIE

Answer 28

1) pH less than 6.7 2) APGAR 0-3 at 5 min 3) High base deficit (>20-25 mmol/L) 4) Decerebrate posture 5) Lack of spontaneous activity

Question 29

Clinical criteria for brain death after neonatal HIE

Answer 29

1) Coma 2) Apnea with pCO2 rising from 40 to >60 mmHg without ventilator support 3) Absence of brainstem reflexes - Persistence of these 3 criteria for 2 days in term infants and 3 days in preterm infants predicts brain death