NEURO EXAM Flashcards
Head circumference of an average term infant
- 34-35 cm at birth,
- 44 cm at 6 mo,
- 47 cm at 1 yr of age
2 fontanels at birth
- A diamond-shaped anterior fontanel at the junction of the frontal and parietal bones that is open at birth
- A triangular posterior fontanel at the junction of the parietal and occipital bones that can admit the tip of a finger or may be closed at birth
- gestational age, a premature infant blinks in
response to a bright light - the infant maintains eye closure until the light source is removed.
- turns the head and eyes toward a soft light, and a
term infant is able to fix on and follow a target, such as the examiner’s face.
- 28 WK
- 32 WK
- 37 WK
- Assess the posterior segment of the eye using the
- Normal results shows
- red reflex test
- symmetric reddish-pink retinal reflections
CRANIAL NERVES
- Oculomotor (Cranial Nerve Ill),
- Trochlear (Cranial Nerve IV),
- Abducens Nerves (Cranial Nerve VI)
- Facial Nerve (Cranial Nerve VII)
- Vestibulocochlear Nerve (Cranial Nerve VIII)
- Glossopharyngeal Nerve (Cranial Nerve IX)
- Accessory Nerve (Cranial Nerve X!})
- Hypoglossal Nerve (Cranial Nerve XII)
refers to muscle tissue that has been replaced
by fat and connective tissue, giving ita bulky appearance with a paradoxical reduction in strength, as in Duchenne muscular dystrophy
Pseudohypertrophy
3 key tests for assessing postural tone in neonates
- the traction response,
- vertical suspension,
- horizontal suspension
Timing of Selected Primitive Reflexes
Onset: 28 wk GA
Fully Developed: 32 wk GA
Duration: 2-3 mo postnatal
Palmar grasp
Timing of Selected Primitive Reflexes
Onset: 32 wk GA
Fully Developed: 36 wk GA
Duration: less prominent after 1 mo postnatal
Rooting
- Soft Tissue of the Scalp
- Presenting part
- May extend across the midline and across suture lines
- Edema disappears within the 1” few days of life
- No treatment
Caput Succedaneum
- Subperiosteal hemorrhage
- Firm tense mass with a palpable rim localized over 1 area of the skull
- Reabsorbed within 2wks-3mos
- Calcify by end of the 2nd week
- No treatment
- Associated with skull fracture, usually linear10-25%
- May develop hyperbilirubinemia
Cephalhematoma
- Beneath the aponeurosis
- Secondary to rupture of emissary veins connecting the dural sinuses within the skull with the superficial veins of the scalp
- Associated with vacuum delivery
- Fluctuating mass that straddles cranial sutures or fontanels that increases in size after birth
- Resolve over 2-3 wk
Subgaleal hemorrhage
Fractures of the skull
- Most common
- result of pressure from forceps or from the maternal symphysis pubis, sacral promontory, or ischial spines
- Asymptomatic
- No treatment needed
Linear
Fractures of the skull
- complication of forceps delivery or fetal compression
- usually indentations of the calvaria similar to the dents in a ping-pong ball
- advisable to elevate severe depressions to prevent cortical injury from sustained pressure
Depressed
- May have acute deterioration on the 2. and 3 day of life
- Hypotension, apnea, pallor, or cyanosis
- Poor suck, abnormal eye signs, high-pitched, shrill cry
- Convulsions, or decrease muscle tone
- Metabolic acidosis, shock
- Decrease hematrocrit or failure of the hematocrit to increase after transfusion
Severe Intraventricular Hemorrhage (IVH)
Usually present later in an early echo dense phase (3-10 days of life), followed by the typical echolucent (cystic) phase (14-20days of life)
Periventricular leukomalacia
Classification of Brain Hemorrhage
bleeding into the germinal matrix only
GRADE 1
Classification of Brain Hemorrhage
Germinal matrix with blood in the ventricles
GRADE 2
Classification of Brain Hemorrhage
Intraventricular and parenchymal bleeding other than the germinal matrix
GRADE IV
Classification of Brain Hemorrhage
Germinal matrix with blood in the ventricles and ventricular dilation
GRADE 3
Dx for IVH
- 32 wks of gestation and/or <1,000 g cranial ultrasound
- Screening within | (detects 75% of lesions)
- Follow-up ultrasound at 36-40 wks of postmentrual age to evaluate for PVL where cystic changes become visible
ventriculoperitoneal shunt insertion
posthemorrhagic hydrocephalus (PHH)
Tx for IVH
- NONE
> Seizures should be treated with anticonvulsant drugs
Anemia and coagulopathy require transfusion with PRC or FFP
Progressive and symptomatic PHH should have a
ventriculoperitoneal shunt inserted
Diuretics and acetazolamide are not effective
Fetal hypoxia may be caused by:
- Inadequate oxygenation of maternal blood = s )
- Low maternal blood pressure
- Inadequate relaxation of the uterus to permit placental filling
- Abruptio placenta
- Impedance to the circulation of blood through the umbilical cord
- Placental insufficiency
Hypoxia after birth may be caused by:
- Failure of oxygenation
- Severe anemia
- Shock severe enough to interfere with the transport of oxygen to vital
organs
is the initial preferred modality in evaluation of preterm infants
Ultrasound
may help an determine which infants are at highest risk for long-term brain injury
Amplitude
- Decreases the rate of apoptosis
- Suppresses the production of neurotoxic mediators
- Core temperature: 33.5°C
- Golden period: 1** 6 hours after birth (primary energy failure)
- Duration: 72 hours (duration of mitochondrial changes)
- Complications: thrombocytopenia, bradycardia, subcutaneous fat necrosis, over-cooling, cold injury syndrome
Therapeutic Hypothermia
- Drug of choice for seizures
- IV loading dose (20mg/kilo)
- Additional doses 5-10mg/kilo (up to 40-50mg/kilo)
- Maintenance therapy 5ma/ka/24hr
Phenobarbital
Poor Prognosis od Hypoxic-Ischemic Encephalopathy
- multiple anticonvulsant medications
- status epilepticus/focal seizures
- therapeutic hypothermia
poor prognostic signs of Spine and Spinal Cord Injury
- Apnea on day 1
- poor motor recovery by 3 mo
- Incidence 0.6-4.6/1,00 live births Brachial Plexus is
stretched due to traction. - Common in macrosomic infants
- When lateral traction is exerted on the head and neck during delivery of the shoulder in a vertex presentation
- When the arms are extended over the head in a breech presentation
- When excessive traction is placed on the shoulders 45% associated with shoulder dystocia
Brachial Palsy
- 5” and 6” cervicalperves
- Adduction and internal rotation of the arm with pronation of the forearm
- Moro reflex is absent on the affected side
- Some sensory impairment of the outer aspect of the arm
- Presence of hand grasp indicates a good prognosis
Erb-Duchenne Paralysis
- Most patients fully recover
- Paralysis secondary to edema and hemorrhage about the nerve, function will return within ~
a few months - Paralysis is due to lacerat would result in pe:
- Initial conservative management with monthly ff-up
- Intermittent immobilization during 1* 1-2wk
- Gentle massage and range of motion exercises may be started by 7-10 days of age
- Surgical intervention by 3 mo if function has not improved
Brachial Palsy
- Results from pressure over the facial nerve in utero, from
efforts during labor, or from forceps use during delivery - Rarely due to nuclear agenesis of the facial nerve
- Peripheral paralysis is flaccid and when complete
involves the entire side of the face, including forehead - central paralysis the forehead wrinkles on the affected side because only the lower 2/3 of the face is involved
- Injured by pressure will improve within a few weeks
- Neuroplasty if the paralysis persists
Facial Nerve Palsy
