Neurological Disorders of the Neonate Flashcards
What are seizures?
excessive, repetitive electrical discharges in the CNS
Is seizure a symptom or a disease?
Symptom –> represents an underlying disease process that causes disturbances in the brain
What are the common causes of neonatal seizures?
hypoxic-ischaemic encephalopathy
cerebral infarction
cerebral trauma
sepsis
metabolic abnormalities
narcotic drug withdrawal
What is the differential diagnosis for jitteriness?
no autonomic charges
symmetrical rapid movements of the hands and feet
stimulus sensitive, initiated often to sudden movement and noise
no associated eye movements
What is the differential diagnosis of benign neonatal sleep myoclonus?
bilateral/unilateral jerking during sleep
occurs during active sleep
not stimulus sensitive often involve upper > lower trunk
What are the subtle seizure cues?
eye signals: staring, deviation, blinking
buccal-oral-lingual: chewing, lip smacking, sucking
limbs: cycling, rowing
systemic: apnoea, BP alterations
What are the clonic seizure cues?
rhythmic jerks
slow decline in rate as seizure persists
focal/multifocal
What are the myoclonic seizure cues?
rapid, isolated jerking of muscles
upper limb movement more common
What are the tonic seizure cues?
sustained posturing of the limbs or trunk/neck
generalized tonic seizures often manifest with tonic extension of the upper and lower limbs in an opisthotonic fashion
What does CFM stand for?
Cerebral function monitoring
What are the steps of seizure management?
medications
check blood glucose
check electrolytes
maintain airway
maintain breathing
maintain circulation
What is HIE?
Hypoxic Ischemic Encephalopathy
form of brain injury caused by the restricted flow of oxygen to the brain
What is the primary energy failure (mechanism of hypoxic brain injury)?
hypoxia –> diving reflex –> anaerobic metabolism –> rapid depletion of ATP/severe cell oedema –> accumulation of lactic acid –> failure of normal metabolic activity –> intracellular dysfunction/multi-organ failure –> nuronal ell apoptoaia/neonatal death
What is the pathophysiology of HIE in primary energy failure?
primary energy failure
latent phase commences
complete recovery OR
development of secondary energy failure
What is the pathophysiology of HIE in secondary energy failure?
occurs 6-15hrs after initial hypoxic insult
What are the moderate clinical signs of encephalopathy?
reduced response to stimulation
lethargic
hypotonia
incomplete moro
complete extension
weak suck
constricted pupils
bradycardia
periodic breathing
What are the severe signs of encephalopathy?
absent response to stimulation
stupor/coma
flaccid
absent moro reflex
decerebrate
absent suck
pupil deviated
variable HR
apnoea
What is TH?
Therapeutic Hypothermia
What’s the criteria for TH?
> 36 wks gestation
1,800 grams
<6 hrs old
pH <7.0
BE >16.0mmol/L within 60 mins
Apgar <5 at 10 mins
Hx of acute event, or symptoms of HIE
What is IVH?
Intraventrical Haemorrhage
What is autoregulation?
the ability to maintain cerebral blood flow despite changes in cerebral perfusion pressure
What A/N risk factors are there for developmental of IVH?
premature birth
maternal nfection
maternal inflammatory responses
maternal hypertension
maternal bleeding disorders
absent maternal steroid administration
absence of A/N administration of MgSO4
maternal diabetes
placental insertion disorders
oligohydramnios
maternal alcohol use
maternal smoking
poor prenatal care
infertility treatments
What is a PVL?
Periventricular Leukomalacia
