Neurological Dysfunction in Children Flashcards
ICP consists of
Brain - 80%, CSF - 10% and blood - 10%
GCS parts
eye opening, verbal response and motor response
highest GCS score
15
lowest GCS score
3
when to intubate
<8 GCS, “less than 8, intubate”
pinpoint pupils indicate X2
opioid/barbiturate poisoning, brain stem dysfunction
dilated/reactive pupils common after
after seizures
dilated and fixed pupils indicate X7
damage to CN III, herniation, hypothermia, anoxia, ischemia, poisoning with atropine, instilling mydriatic drugs
bilaterally fixed pupils over 5 minutes
brain stem damage
sudden appearance of fixed/dilated pupils
neuro emergency - remain with child d/t high risk for respiratory arrest
decorticate/flexion posturing
dysfunction of the cerebral cortex or legions above brain stem
decerebrate posturing
dysfunction at midbrain or lesions to brain stem
unilateral decerebrate posutring
herniation - neurological emergency
early signs of increased ICP
HA, vomiting, slight personality changes, irritability, fatigue
late signs of increased ICP X5
bradycardia (<80), decreased response, posturing, pupil changes, cheyne stokes respiration,
indications for invasive ICP monitoring
GCS = 8, GCS >8, TBI with abnormal CT, deterioration of condition, subjective judgment by neurosurgeon
mannitol
osmotic diuretic used in ICP reduction
hypertonic saline
pulls fluid into vascular system
meds to sedate and paralyze in ICP issues
midazolam/versed, fentanyl, vecuronium
most common cause of death in 9-19 years old
unintentional injuries
coup
point of impact
contrecoup
point opposite of impact
linear fracture
single fracture that does not cross suture lines
comminuted skull fractures
multiple associated linear fractures
comminuted skull fractures often suggest
child abuse
open skull fractures cause communication between
skull and scalp or mucose and URI
treatment for open skull fractures
increased risk of CNS infection
depressed skull fractures
bone broken into several irregular fragments and pushed inward
basilar skull fractures
bones broken at the base of the skull that usually result in dural tear
s/s of basilar skull fractures
bleeding at the nape of the neck, raccoon eyes, bleeding behind tympanic membrane, CSF, clear fluid around blood on sheets
epidural hemorrhage
blood accumulates rapidly between the dura and the skul
epidural hemorrhage incidence in <2
very low incidence
s/s of epidural hemorrhage
momentary unconsciousness, often not evident in children
subdural hemorrhage
a vascular injury causing bleeding between the dura and the cerebrum
what causes subdural hemorrhage
birth trauma, falls, assaults, violent shaking
s/s of subdural hemorrhage
standard increased ICP s/s, with battle signs
subdural hemorrhage treatment
observation, subdural taps in infants, SDH, burr hole
drwoning
survival at least 24 hours after submersion
highest age group at risk of drowning
0-4
<1 y/o drown in
bath tub
toddlers drown in
buckets
pre schoolers drown in
swimming pools
school aged and adolescent kids drown in
lakes, ponds, rivers and ocenas
seizures diagnosed by
Labs, LP, CT/MRI, EEG, split screen EEG
partial seizures
involve one area of the brain
generalized seizures
involve both hemispheres of brain
ketogenic diet is helpful in
seizure disorders
vagus nerve stimulation
implanted device that sends impulses to the vagus nerve with a magnet in children over 12
bacterial meningitis patho
inflammation of the membranes covering the brain and spinal cord
bacterial meningitis s/s
fever, nuchal rigidity, back pain, kernig sign, brudzinski sign,
bacterial meningitis dx
lumbar puncture, csf fluid analysis
CSF WBC bacterial
elevated neutrophils
CSF WBC viral
elevated lymphocytes
CSF protein bacterial
elevated
CSF protein viral
normal to slightly increased
CSF glucose bacterial
decreased
CSF glucose viral
normal
CSF gram stain bacterial
positive
CSF gram stain viral
negative
CSF color bacterial
turbid or cloudy
CSF color viral
clear
CSF opening pressure bacterial
elevated
CSF opening pressure viral
normal
bacterial meningitis tx
antibiotics, seizure control, 1/2 MIVF
complications of bacterial meningitis
cerebral edema, subdural effusion, seizures, shock, disseminated IV coag, hydrocephaly
viral meningitis s/s
HA, fever, photophobia, nuchal rigidity
viral meningitis tx
mostly symptomatic
rabies patho
acute infection of the nervous system that is almost always fatal
rabies incubation period
1-3 months but may be as short of 5 days or as long as 8 months
rabies s/s
agitation, LOC changes, attempts at swallowing causes hydrophobia
rabies tx
passive immunization asap after exposure
active immunity given at same time as passive and on 3, 7, 14, 28
reye syndrome patho
acute illness causing encephalopathy and liver dysfunction
reye syndrome s/s
fever, impaired consciousness and liver dysfunction
reye syndrome dx
liver biopsy
cerebral palsy patho
non-progressive impairment of motor function
prenatal CP causes
maternal infection or substance abuse
perinatal CP causes
nuchal cord, ischemic stroke
postnatal CP causes
meningitis
spastic CP
hypertonicity
dyskinetic CP
abnormal movement
ataxic CP
coordination, balance, posture
mixed CP
combination of spastic and dyskinetic
medications for CP
dantrolene sodium, baclofen, diazepam, botox, gabapentin, anti-epiletic, levodopa, trihexyphenidyl, reserpine
carbamazepine
anti-epileptic
divalproex
antiepileptic
lacosamide
antiepileptic
levitiracetam
antiepileptic
oxcarbazepine
antiepileptic
lamotrigine
antiepileptic
what does levodopa treat
dystonia
trihexyphenidyl treats
dystonia
reserpine treats
hyperkinetic movement disorders
GBS patho
inflammation and edema of the spinal cord and cranial nerves
acute phase BGS
symptoms begin, may last up to 4 weeks
plateau GBS
consistent symptoms, days to weeks
recovert GBS
improvement begins, weeks to month
