neurologic Flashcards
Erb-duchenne palsy
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.
Klumpke palsy
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
Brachial plexus injury
- Erb-Duchenne palsy: bad shoulder, good hand
- Klumpke palsy: bad hand, good shoulder
- 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%).
Bell palsy
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
Congenital hypoplasia of depressor angularis muscle
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
Causes of generalized facial weakness
- Mobius syndrome
- Myasthenia gravis
- Infantile botulism
- Posterior fossa hematoma
- Cerebral contusion
- Neonatal encephalopathy
optical blink reflex
tests cranial nerves II, III, IV, VI
When shining light, note rapid closure of eyes, size and equality of pupils.
Eyes follow movement.
cranial nerve I
smell
cranial nerve V
rooting reflex ,sucking reflex
cranial nerve VII
facial movements when crying
cranial nerve VIII
startles and blinking in response to sounds, eyes follow direction of sounds
cranial nerve IX and X
swallowing and gag reflex
cranial nerve XI
head turns side to side, shoulder height equal
cranial nerve XII
When pinching nose, mouth will open and tongue will rise in midline
Can coordinate suck and swallow
encephalocele
Protrusion of menginges and sometimes cerebral tissue covered by skin.
“Cranium bifidum” in the defect in the skull allowing protrusion.
spina bifida occulta
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.
meningocele
The meninges, covered by thin atrophic skin, protrude through the bony defect. The spinal roots and nerves are normal, and neurologic deficits are unusual.
myelomeningocele
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
arnold chiari malformation
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
Primary subarachnoid hemorrhage
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.
Subdural hemorrhage
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.
Subgaleal hemorrhage
risk factors: vacuum- of forceps deliveries, coagulopathies
Monitor for hypovolemia.
May require transfusion and volume repletion.
periventricular-intraventricular hemorrhage
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
cephalohematoma
located below periosteum and confined by cranial sutures
