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When evaluating child for neuro illness, important to establish the ___ of the illness
evolution; progressive, static, saltatory?
Areas of assessment for developmental milestones (4)
gross motor, fine motor, language, social
name milestone: crawls, cruises, pulls to stand, runs, throws toys froms standing, raises head slightly when prone
gross motor skills
name milestone: alerts to sound, smiles, bubbles, coos, knows 8 body parts
language
name milestone: regards face, recognizes parent, comes when called, parallel play, imitates actions
social
name milestone: fist tight, moves arms in unison to grasp, raking grasp, pincer grasp, throws objects, feeds self, removes clothes
Fine motor skills
Ranges from anencephaly to spina bifida occulta
neural tube defects
Open neural tube defects are assoc w/an inc serum level of __
alpha-feto protein (AFP)
AFP screening traditionally offered __-__ wks of gestation
16-18
How prevent neural tube defects
folic acid 400 mcg/day prior to conception
Anencephaly is uniformly ___
lethal
Disorder of motor fxn against a static or non-progressive brain injury
cerebral palsy (static encephalopathy)
S/Sx: cerebral palsy
motor dysfxn mild/sev, may be assoc w/MR, seizures, visual or auditory impairment
Cerebral palsy etiology assoc with (4)
prematurity, asphyxia, infxn, congenital disorders
S/Sx: hypotonia, floppiness, hypomotility develop, only a small loss observable strength
Floppy infant syndrome
MC neurologic disorder of children
epilepsy
Randomly recurring Sx complex resulting from an episodic disturbance in CNS assoc w/excessive, self-limited, neuronal discharge
Epilepsy
Peak incidence age 2-7 mths, unique to infancy & early childhood
Infantile spasms (west syndrome)
Commonly used Rx in epilepsy
pheobarbital, phenytoin, carbamazepine, ethosuximide, valproic acid, primidone
Management of status epilepticus
lorazepam, diazepam, phenobarbital, phenytoin
S/Sx: brief episode of altered awareness, stare blankly (often assumed to be daydreaming)
Absence seizure (petite mal)
T/F: child not aware seizure has occurred
TRUE
EEG: generalized, symmetric 3/second spike wave pattern
Absence seizures
Tx: Absence seizures
Valproic acid, ethosuximide
S/Sx: convulsion assoc w/elevated temp greater than 100.4 F
febrile seizures
febrile seizure: #1 DDx to R/O
bacterial meningitis
febrile seizure: if no source of infxn found…
full septic work-up indicated (CBC, urine & blood cultures, LP, CXR)
Tx: febrile seizure
prental education, Tx controversial. Prophylactic pheonbarb, rectal valium
S/Sx: weakness on both sides body may develop w/numbness that starts legs -->trunk, arms, neck. DTRs dec or absent
Guillain barre syndrome
Acute & rapidly progressive inflammation of nerves that causes loss of sensation & muscle weakness; destruction, removal, or loss of myelin sheath
Guillain barre syndrome
Guillain barre: Sxs often begin 5d-3wks after (3)
viral infxn, immunization, surgery
Group of >30 genetic Dzs characterized by progressive weakness & degeneration of skeletal muscles that control movement
Muscular dystrophy
MC form of MD and primarily affects boys
Duchenne MD
Duchenne MD: onset is b/w __-__yrs and most boys unable to walk by __yrs & later need respirator
onset 3-5yrs; unable to walk 12yrs
Tx: MD
supportive
S/Sx: weakness & wasting of voluntary muscles; weakness most severe in legs than arms
Spinal muscular atrophy
genetic, motor neuron Dz caused by progressive degeneration of motor neurons in spinal cord
Spinal muscular atrophy
Neurologic evaluation of pediatir pt must include detailed ___ & meticulous ___
detailed history & meticulous PE
x of y cards