The infant or child with abnormal development or poor school performance Flashcards
Neurological assessment history
- Pregnancy/neonatal
- Development
- >Regression in developmental milestone
- >Pattern of the delay - Headache
- Vomiting early morning
- Involuntary movements, convulsions, unexplained collapse, ALOC
- Sensory
- Bladder and bowel
- Ataxia, clumsiness, incoordination
- Hearing and vision
- Behaviour, mood, apathy, concentration
- School performance
- Function
- Home environment->parents, siblings
- Additional support->parental respite
- Family history of neurological->epilepsy, hearing/vision,metabolic, congenital, learning difficulty
Neurological physical examination
- Observation
- >AVPU, GCS
- >Posture, movement, gait
- >Limb deformity
- >Growth/HC
- >Skin sigs->pigmentation, vascular birth marks
- >dysmorphic features, xsomal, CNS malformation, FAS
- >equiptment to aid neurological problems - Eye->movement, pupils, fundoscopy
- Peripheral
- >Muscle bulk, tone, power, coordination, reflexes
- >Sensory - Developmental exam
- Hepatosplenomegaly (metabolic)
Neurological examination in infants
- Moving spontaneously
- Positioning->hypoT= frogs legs
- Palpate posterior fontanelle/head circumference
- Assess tone by posture and handling->ventral position, pull to sit->++tone= resistance, scissoring of legs
Define cerebral palsy
Motor impairment
Permanent
Non-preogressive lesion in developing brain->however clinical picture changes
Most common form of cerebral palsy and location of lesion
Spastic type
Types of cerebral palsy (5)
- Hemiplegia
- Diplegia
- Total body involvement
- Atatxic
- Athetoid
Features of hemiplegia
Arms more affected than legs
Delayed walking
Tiptoe gait, dystonic posture when running
Athetoid cerebral palsy
Basal ganglia
Writhing movement
Intelligence often normal
Major physical impairment
Ataxic cerebral palsy
Cerebral damage
Ataxia and poor coordniation
Diplegia
Both legs
++Hip adduction, nappy difficult to put on
Scissoring of legs
Feet in equinovarus and walking on tiptoe
Total body involment
All limbs \+Learning difficulties Seizures Swallowing difficulties and GOR Flexion contractur es of knees and elbows often present by late childhood
Prevalence of cerebral palsy
Is 2 / 1000
Etiology- pre, peri, post-natal of cerebral palsy
1. Prenatal Cerebral malformation Maternal infection Metabolic 2. Perinatal Birth trauma Hypoxic-ischemic Prematurity 3. Postnatal Head injury Non-accidental injury Meningitis/encephalitis Cardiopulmonary arrest
Diagnosis of cerebral palsy
Clinical, based on findings abnormalities:
- Tone->spasticity
- Patterns of development ->abnormal in quality
- Motor developmental delay
- Persistent reflexes
If cause not clear:
- Urine/plasma metabolic screen
- Consider congenital infections
- Xsomal analysis
- MRI->vascular, malformations, periventricular leucomalacia
Associated problems (8) in cerebral palsy
Hearing Vision->50%, squint Epilepsy->50% Respiratory problems Undernutrition, poor intake Learning difficulties Behavioural