neurologic

Question 1

Erb-duchenne palsy

Answer 1

Damage to upper spinal roots c5 and c6.
Bad shoulder, good hand scenario. An infant with this type of upper arm paralysis holds the affected arm adducted and internally rotated, with extension at the elbow, pronation of the forearm, and flexion of the wrist. The grasp reflex remains intact, but the Moro reflex is absent on the affected side.

Question 2

Klumpke palsy

Answer 2

lower lesion injury presenting clinically as the good shoulder, bad hand scenario. This palsy involves cranial nerve 8 (CN VIII) and thoracic nerve 1 (T1), with complete or partial paralysis of the forearm and hand muscles. This lower arm paralysis is rare. When the lower plexus is involved, the shoulder is in a relatively normal position with the wrist and hand flaccid, having little or no control

Question 3

Brachial plexus injury

Answer 3

1. Erb-Duchenne palsy: bad shoulder, good hand
2. Klumpke palsy: bad hand, good shoulder
3. Complete arm palsy
   If accompanied by resp distress, consider phrenic nerve involvement with paralysis of diaphragm (5%).
   Should have great functional improvement in 3 months. Otherwise, consider surgery (20%).

Question 4

Bell palsy

Answer 4

Temporary facial asymmetry or unilateral lack of expression. The etiology may be intrauterine positioning with pressure on the fetal facial nerve from the maternal sacral prominence or secondary to direct trauma from a difficult extraction or forceps delivery. Bruising is often present

Question 5

Congenital hypoplasia of depressor angularis muscle

Answer 5

The essential finding is a failure of one corner of the mouth to move down and out. Other functions of the facial muscles are normal. The clinical significance of this disorder is its association with other abnormalities—commonly, congenital cardiovascular anomalies and, rarely, neuroblastoma

Question 6

Causes of generalized facial weakness

Answer 6

1. Mobius syndrome
2. Myasthenia gravis
3. Infantile botulism
4. Posterior fossa hematoma
5. Cerebral contusion
6. Neonatal encephalopathy

Question 7

optical blink reflex

Answer 7

tests cranial nerves II, III, IV, VI
When shining light, note rapid closure of eyes, size and equality of pupils.
Eyes follow movement.

Question 8

cranial nerve I

Answer 8

smell

Question 9

cranial nerve V

Answer 9

rooting reflex ,sucking reflex

Question 10

cranial nerve VII

Answer 10

facial movements when crying

Question 11

cranial nerve VIII

Answer 11

startles and blinking in response to sounds, eyes follow direction of sounds

Question 12

cranial nerve IX and X

Answer 12

swallowing and gag reflex

Question 13

cranial nerve XI

Answer 13

head turns side to side, shoulder height equal

Question 14

cranial nerve XII

Answer 14

When pinching nose, mouth will open and tongue will rise in midline
Can coordinate suck and swallow

Question 15

encephalocele

Answer 15

Protrusion of menginges and sometimes cerebral tissue covered by skin.
“Cranium bifidum” in the defect in the skull allowing protrusion.

Question 16

spina bifida occulta

Answer 16

Incomplete closure of posterior portion of vertebrae. Meninges and spinal cord are normal. Look for tufts of hair, lymphomas, or other abnormalities along the spine.

Question 17

meningocele

Answer 17

The meninges, covered by thin atrophic skin, protrude through the bony defect. The spinal roots and nerves are normal, and neurologic deficits are unusual.

Question 18

myelomeningocele

Answer 18

bilateral broadening of the vertebrae or absence of the vertebral arches. In this type of lesion, the meninges, spinal roots, and nerves protrude. Remnants of the spinal cord are fused and the neural tube is exposed on the dorsal portion of the mass. Attention should be paid to examination of the motor, sensory, and sphincter functions, and to the reflexes. Hydrocephalus is a frequent finding associated with myelomeningocele, esp. via Chiari malformation

Question 19

arnold chiari malformation

Answer 19

inferior displacement of the medulla and fourth ventricle into the upper cervical canal and elongation and thinning of the upper medulla and lower pons. Hydrocephalus is thought to result from aqueductal stenosis and blockage of the cerebrospinal fluid outflow from the fourth ventricle

Question 20

Primary subarachnoid hemorrhage

Answer 20

Bleeding occurs from vessels within the subarachnoid space, and the blood (hemorrhage) is usually most prominently located over the surface of the cerebral hemispheres. Etiology is thought to be trauma or hypoxia. Complications are rare, but moderate hemorrhage can cause seizures. Monitor for development of secondary hydrocephalus.

Question 21

Subdural hemorrhage

Answer 21

occurs when bridging veins carrying blood through the dura mater to the arachnoid mater of the meninges are torn. This causes bleeding, with blood collecting below the dura and superior to the subarachnoid villi. Monitor for clinical evidence of expansion.
In severe cases, secondary seizures or
encephalopathy may be present and
require management.

Question 22

Subgaleal hemorrhage

Answer 22

risk factors: vacuum- of forceps deliveries, coagulopathies
Monitor for hypovolemia.
May require transfusion and volume repletion.

Question 23

periventricular-intraventricular hemorrhage

Answer 23

Hemorrhage that starts in the PV germinal matrix can be localized in this area, or it may rupture into the ventricular system and, if large enough, cause distention of the lateral ventricles. Adjacent cerebral tissue can also be damaged as a result of hemorrhage in the germinal matrix, resulting in a parenchymal clot or infarction.
Risk for hydrocephalus: hydrocephalus occurs as a result of inflammation of the arachnoid villi, which absorb cerebrospinal fluid. With hemorrhage, they become inflamed or scarred from blood and particulate matter in the cerebrospinal fluid. Obstruction to absorption of cerebrospinal fluid then occurs. It is less common for obstruction to occur at the outlet of the third ventricle, the aqueduct of Sylvius, when debris and tissue reaction combine to lead to a blockage there

Question 24

cephalohematoma

Answer 24

located below periosteum and confined by cranial sutures

Question 25

causes of seizures

Answer 25

central nervous system infection, metabolic derangements such as hypoglycemia or hypocalcemia, hypoxic/anoxic or ischemic–hemorrhagic events, developmental defects, or neonatal abstinence. In some cases, seizures have a familial basis.

Question 26

Subtle seizures

Answer 26

Seen in term and preterm infants; apneic spells; tonic horizontal eye deviation, jerking, sustained eye opening, eyelid blinking or fluttering; sucking, drooling, oral buccal movement; swimming, pedaling, rowing movements

Question 27

Generalized tonic seizures

Answer 27

Primarily seen in preterm infants; characterized by tonic extension of all limbs or by tonic flexion of arms and extension of legs

Question 28

Multifocal clonic seizures

Answer 28

Seen primarily in term infants; clonic movement migrating from limb to limb in a sporadic pattern (e.g., right leg, then left arm)

Question 29

Focal clonic seizures

Answer 29

Seen more commonly in term than in preterm infants; well-localized clonic jerking in a conscious state

Question 30

Myoclonic seizures

Answer 30

Seen in both term and premature infants; synchronous jerks of flexion, single or multiple, affecting upper more than lower limbs

Question 31

Large anterior fontanel

Answer 31

may be associated with congenital hypothyroidism, achondroplasia, hypophosphatasia, chromosomal abnormalities such as Down syndrome, and with IUGR

Question 32

categories of hypoxic-ischemic encephalopathy

Answer 32

Mild encephalopathy is associated with irritability, jitteriness, and hyperalertness. Moderate encephalopathy is characterized by lethargy, hypotonia, a decrease in spontaneous movements, and seizures. Severe encephalopathy is characterized by coma, flaccidity, disturbed brainstem function, and seizures.