24 terms

Children's Health: Neurology

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4th week of gestation
Neural tube closure occurs when?
1. Spina bifida occulta - 10% of population
2. Spina bifida cystica - 1/1000 birth. Severe. Sensory and motor loss.
3. Meningomyelocele - Surgical intervention for closure and shutning of hydrcephalus
4. Arnold Chiari Malformation - Displacement of medulla/cerebellum through foramen. 4th ventricle is obstructed.
List a few common neural tube defects.
Normal: Slight depression with pulsation in sitting/standing position. It is diamond shaped. Can be various sizes around 2cm. Closes by 24 months.
Abnormal: Bulge can indicate increased intra cranial pressure. Excessively large fontanelle indicates pathology.
What does a normal and abnormal anterior fontanelle look like?
Rickets
Hypothyroid
Achondroplasia
Osteogenesis Imperfecta
Cleidocranial dysplasia
Hypophosphatasia
Uterine growth retardation.
Name as many conditions as you can that are seen with a large fontanelle.
8 months
Posterior fontanelle closes when?
True
T/F: The posterior fontanelle is typically clinically insignificant.
Simple: No LOC, dizzy, twitches, visual change
Complex: LOC, + simple symptoms or repetitive motions.
What is a partial seizure?
A subcategory of generalized seizures which is further divided into...

Typical: Loss of awareness, eye blinking/fluttering, or lip smacking.
Atypical: Typical symptoms plus body stiffening
What is an absence seizure?
Generalized seizure with a sudden loss of muscle control. Can cause collapse or falling
Atonic Seizure
Generalized stiffening, especially of the back, arms, and legs. May cause you to fall to the ground.
Tonic seizures
Generalized seizure. Repeated or rhythmic, jerking muscle movements of the neck, face, arms, and or legs
Clonic Seizures
Generalized seizure. Previously called a gran mal. This has aburpt loss of consciousness, body stiffening and shaking, sometimes loss of bladder control and biting tongue
Tonic-Clonic Seizures
Head thrown backward or forward for 2-10 seconds with peak onset at 3-8 months. Can have clusters up to hundreds per days.
Infantile Spasm
2-3% of children.
How common are febrile seizures?
50% recurrence if onset less than 1 yoa

28% recurrence if onset over 1yoa

10% reoccurence if onset over 3 yoa.
How likely are febrile seizures to reoccur?
Early: Seizures within 1 week of TBI. 25% will have at least 1 more seizure within months to years.
Late: Seizure greater than 7 days after TBI. 80% will have further seizures.
Post-Traumatic Seizures
With arms outstretched to the sides, balance on one foot, then shift balance to opposite foot.

Positive: Falling
Moro Refex
Stroke from lateral nares to lateral mouth and/or lateral cheek to lateral mouth

Positive: Head turn or lip twitch
Rooting Reflex
Elbows flexed and palms upward: stroke 3 times from thumb web to wrist

OR

Arms outstretched directly in front of body, wiggle fingers like piano playing.

Positive: Finger flexion or wrist motion more than isolated finger motion
Palmar Reflex
Quadruped pose: parent passively turns head right or left
Positive: Elbow bends on opposite side of head rotation
ATNR reflex
Quadriped Pose: Stroke along side of spine from S to I

Positive: Movement or twitch of the spine laterally.
Galant Reflex
Stand with legs together, eyes closed, tip head down/up slowly.

Positive: Lateral sway, locked knees, breath-holding
TLR Reflex
Prone with palms to floor: lift head and extend legs at hips (superman). OR, standing tape opposite hand/knee alternating.

Positive: Knee Flexion or body rotation
Landau Reflex
Quadriped pose: flex neck, hold 5 seconds, extend neck; hold 5 seconds. OR standing with arms held outstretched directly in front f body and turns head in either direction.

Positive: In quadriped, trunk arching, elbow flexion, or shifting weight forward/back. In standing: trunk and/or arms drop or rotate with head.
STNR Reflex