Neurology Flashcards
Most common complication from perinatal asphyxia
Renal failure (40-70%)
When to initiate therapeutic hypothermia
Within 6 hours- reperfusion injury stage
NNT to prevent neuro disability for TH
<10
What stage of encephalopathy do you cool for?
MODERATE
SEVERE
MILD IS NOT PROVEN!!
Gold standard for seizure detection
Continuous EEG- at least 24 hours
aEEG useful adjunct or alternative
Monitoring for seizures is recommended by AAP, ACNS
25-40% of babies cooled for HIE have seizures in first 72 hrs of birth
HIE typical patterns of injury on MRI
Basal ganglia and thalami (relay station)
Posterior limb of the internal capsule (dense motor pathway through BGT)
Brain stem (preterm or severe)
Watershed- cortex and white matter
Most predictive of severity of motor in patient with HIE
Severity of basal ganglia and thalamus injury
Most predictive of walking at age 2 in HIE MRI
PLIC
Most common type of stroke
Arterial ischemic stroke (80%)
Seizures are most common presenting sign (>75%) - DO NOT PRESENT WITH HEMIPLEGIA but can have hemiplegia on contralateral side as sequelae
Vein of Galen
High output heart failure
Subgaleal bleed at risk for brain injury- how?
Size of bleed leads to ischemic brain injury
Major cause of neuro developmental impairment in preterm infants
IVH
Classification of IVH
Severity of outcome of IVH related to
Grade of hemorrhage
Unilateral/bilateral, midline shift
Extent of parenchyma involvement
Most common outcome from IVH/PVL
Spastic diplegia- hypertonia with spasticity
LE>UE
PVL outcomes
Increasing rates of disability with severity of white matter abnormalities
Pupillary response
CN 2,3
28 weeks
Extra-ocular movements
CN 2, 3, 4, 6
Fix/follow at 34 weeks
Disconjugate if not fixing
Dolls eyes
Facial grimace
CN 5 & 7
Strength, symmetry
Suck
Cranial nerves 5, 7, 12
Swallow
CN 9, 10
MORO
3 components:
1. ABDUCTION - arms/hands spread open (25-28 wks)
2. ADDUCTION- arms/shoulders “hugging/embracing” (33/34 wks)
3. Audible cry- may not always be elicited
Absent/incomplete- upper motor neuron
Asymmetric- consider brachial plexus injury
True or false?
Neonatal seizures are not reliably diagnosed by clinical observation alone
TRUE
True/false
Most neonatal seizures are symptomatic of acute brain illness (~80%)
TRUE!!
Most common:
- HIE (~50% in US)
- stroke/hemorrhage
- infection
- malformations
- electrolytes/hypoglycemia