Neurologic Dysfunction Flashcards
Potential signs of neurologic complications
Development of handedness before 1 year, absence/persistence/asymmetry of reflexes
Spinal cord in neonates ends at ____
L13
L1-L12 in adults, affects lumbar puncture placement
Children have ____ of CSF
60-140ml
Adults have 90-150ml
Increased ICP
Excessive pressure in the rigid cranial vault that disrupts neurologic function
Caused by tumors, accumulation of CSF in the ventricular system, intracranial bleeding, edema of cerebral tissues, craniocerebral trauma, hydrocephalus, meningitis, encephalitis, Guillain-Barre syndrome
Increased ICP signs - infants and young children
Tense, bulging anterior fontanel, high-pitched cry, increased head circumference, “setting sun” sign (eyes), Macewen’s sign (cracked pot sign), irritability, restlessness, changes in feeding habits, crying with cuddling and rocking
Increased ICP signs - older children
Headache, vomiting, cognitive/personality/behavior changes, diplopia, blurred vision, anorexia, nausea, weight loss, seizures
Late manifestations of increased ICP
Decreased LOC (lethargy, coma), abnormal pupil size and reactivity, abnormal sensation, decerebrate and decorticate posturing, papilledema, abnormal breathing, Cheyne-Stokes respirations
Increased ICP treatment
Medications - diuretics, steroids Keep head and neck neutral No suctioning, percussion, fast movements, flexion or extension of neck Strict I/Os Laxatives to prevent straining Prevent weight loss Monitor for DI and SIADH
Generalized seizure
Involves both hemispheres of the brain, are bilateral and symmetrical
Includes tonic, clonic, tonic-clonic, absence, atonic, myoclonic, and febrile seizures
Tonic seizure
Rigidity, extension and stiffening of extremities, fixed jaw, respiratory cessation, dilated pupils, loss of consciousness
Clonic seizure
Rhythmic jerking
Absence seizure
Staring spell, may not remember what happened during seizure, usually returns to normal state of awareness immediately afterward
Atonic seizure
Sudden loss of muscle tone
Myoclonic seizure
Short muscle contractions - body “jolts”
Infantile spasms - occurs in first few months of life - sudden jerk then stiffening that lasts 1-2 seconds, can occur in clusters, most often just after waking up or falling asleep
Partial seizure
Occurs in a limited area of the cerebral cortex - symptoms vary depending on what area it affects - one-sided contractions, abnormal head and eye movements, lip smacking, sensory issues, inappropriate behavior
Includes simple and complex partial seizures
Simple partial seizure
Maintains consciousness, no memory loss
Complex partial seizure
Progress to unconsciousness
Neural tube defects
Group of related defects of the CNS involving the cranium or spinal cord that vary from mild to severely disabling
Cystic or non-cystic
Include anencephaly, encephalocele, spina bifida
50% of neural tube defect cases are due to ____
Deficiency of folic acid in diet
Anencephaly
Absence of entire brain or cerebral hemispheres - incompatible with life
Encephalocele
Meningeal and cerebral tissue protrudes in a sac through a defect in the skill
In mild forms, there is little to no residual neurologic impairment
Spina bifida
Defective closure of the vertebral column, most common defect in the CNS
Types - occulta, meningocele, myelomeningocele
Spina bifida occulta
Does not usually affect the spinal cord - dimpling of the skin, nevi, or tufts of hair over a dural sinus
Meningocele
Characterized by a sac which contains meninges and CSF protruding outside of the vertebrae, but the spinal cord is not affected
Myelomeningocele
Spinal cord and accompanying nerve roots are involved - most severe type of spina bifida - causes sensorimotor deficits, urinary and bowel problems, joint deformities
Thoracic myelomeningocele
Causes leg paralysis
L3 myelomeningocele
Causes ankle and toe paralysis
L4-5 myelomeningocele
Causes weak or absent ankle and toe flextion
Sacral myelomeningocele
Causes mild ankle and toe weakness, may have bladder or bowel issues
Neural tube defects pre-op care
Preventing infection
Sterile dressing to lesion, constantly moisten with saline, examine for leakage
Avoid placing diaper or other covering over lesion to prevent fecal contamination
Place in prone or side lying position to prevent contamination
Prevent hip subluxation by maintaining legs in abduction with pad between knees, keep feet in neutral position
Use protective devices, handle infant with care
Hydrocephalus
Caused by imbalance in production and absorption of CSF in the ventricular system - production exceeds absorption, CSF accumulates and produces dilation of ventricles
Communicating hydrocephalus
Caused by impaired absorption of CSF - meningitis, leukemia, lymphoma
Non-communicating hydrocephalus
Caused by obstruction of flow of CSF - trauma, infection
Hydrocephalus signs
abnormal rate of head growth, bulging fontanel, dilated scalp veins, Macewen’s sign (cracked pot sign), “sun setting” sign, sluggish pupils
Hydrocephalus treatment
Placement of shunt
Signs of shunt malfunction
Rapid onset of vomiting, severe headache, irritability, lethargy, fever, redness along shunt tract, fluid around shunt valve
Reye’s syndrome
Acute, multi-system disorder that follows viral infection, usually flu A/B or varicella zoster - can lead to death within hours
Causes brain encephalopathy and fatty degeneration of liver, hyperammonia results from reduction in enzyme that converts ammonia to urea
Causes of Reye’s syndrome
Salicylates (aspirin), toxins, antidiarrheals
Reye’s syndrome stages
Stage 1 - vomiting, lethargy, confusion, slowing of EEG, liver dysfunction
Stage 2 - disoriented, combative, hallucinations
Stage 3 - coma, decorticate rigidity, hyperventilation, preservation of pupillary and ocular reflexes
Stage 4 - deep coma, decerebrate rigidity, large fixed pupils, brain stem dysfunction
Stage 5 - seizures, respiratory arrest, loss of deep tendon reflexes
Reye’s syndrome treatment
Supportive care, ICU setting
Comminuted fracture
Eggshell appearance
Basal fracture
Linear fracture through base of skull - raccoon eyes, blood leakage into frontal sinuses, battle sign (bruising behind ears from blood leakage into mastoid sinus)
Can cause cranial nerve damage
Diastatic fracture
Occurs along a suture line
Cervical injury
Do not move child until possibility of injury is ruled out or managed
HOB 30 degrees if there is NO cervical injury
Subdural hematoma
Bleeding between dura and arachnoid layers, occurs within 48 hours of head injury
Lead toxicity
Results from ingesting or inhaling lead containing substances - common cause is household dust or contaminated yard soil
No safe blood lead level (BLL) in children - intervention is warranted for BLL ≥5
Lead toxicity signs
Behavioral changes, distractibility, learning problems, cramping pain, vomiting, constipation, anorexia, anemia, glycosuria, proteinuria, ketonuria, hyperphosphaturia
High dose - encephalopathy, seizures, paralysis, blinding, coma, death
Lead toxicity treatment
Chelation therapy, succimer - binds with lead and is eliminated through urine
BLL ≥70 - immediate hospitalization for inpatient lead chelation
BLL 45-69 - hospitalization if child is symptomatic
Submersion injury
Survival for at least 24 hours after submersion (death within 24 hours = drowning)
Good prognosis if submersion was less than 5 mins and required resuscitation for less than 10 mins
