Neurological problems & neurological disorder

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  • 1. Neurological Problems & Neurological Disorder Xuqin Chen Lecturer of Pediatrics Department of Pediatrics Children’s Hospital of Soochow University
  • 2. Section 1. Neurological Examination
    • Aims and claims
    • 1. Familiar with the general examination of neurological system.
    • 2. Understanding the examination of the cranial nerves
    • 3. Get hold of the motor examination,.
    • 4. Familiar with the sensory examination.
  • 3.
    • Main contents
    • 1. Introduce the general examination of neurological system.
    • 2. Introduce the examination of the cranial nerves .
    • 3. Emphasize the motor examination,.
    • 4. Introduce the sensory examination .
  • 4. Topic 1. General examination
    • Make it as a game playing to meet the children’s needs
    • Carefully observe the child when playing and interacting
    • Head shape and circumference
    • Pay attention to the relative symptoms: neurocutaneous stigmata, hepato-splenomegaly-------
  • 5. 2. What from G.E.?
    • Consciousness:
    • sleepy (drowsy, 嗜睡 )
    • unconsciousness (意识不清)
    • lethargy ( 昏睡)
    • coma (昏迷)
    Topic 1. general examination (con.1)
  • 6. Topic 1. general examination (con.2)
    • Mental condition:
    • delirium( 谵妄)
    • irritable ( 烦躁)
    • obtuse ( 迟钝)
    • depression( 忧郁)
  • 7. Topic 1. general examination (con.3)
    • Action and reaction:
    • IQ:
    • Special features:
    • Neurocutaneous stigmata( 神经皮肤症)
    • Dysmorphic feature (畸形特点)
  • 8. Topic 2. The cranial nerves
    • Table 32. cranial nerve assessment in infants
    Ⅰ not tested Ⅱ blinks to bright light Ⅲ -Ⅵ assess highlights on pupils Ⅴ corneal reflexes Ⅶ facial asymmetry Ⅷ startles to sound; Ⅸ -Ⅹ gag reflex Ⅺ not tesed Ⅻ tongue movement Nerve test
  • 9. Topic 3. Motor examination
    • Muscle tone:
    • posture
    • movements
    • Hypotonic:
    • frog-leg in neonates
    • floppy ( 松软儿)
    • Spasticity: ( 痉挛)
    • Rigidity ( 僵直)
  • 10. Topic 3. Motor examination(con.1)
    • Power:
    0 No power 1 Barely perceptible power 2 Movement with gravity removed 3 Movement just overcomes gravity 4 Movement against gravity and some resistance 5 Normal power Power Observation
  • 11. Topic 3. Motor examination(con.2 )
    • Reflexes
    • Mobility( 活动) and gait (步态) :
    • dystonia (肌张力障碍)
    • athetosis (手足徐动症)
    • chorea (舞蹈病)
    • Speech
  • 12. Sensory examination
    • The most difficult part of neurological examination:
    • Touch
    • Pain
    • Vibration
    • Temperature
    • Joint position
    Topic 3. Motor examination(con.3)
  • 13. Section 2. Infections of the CNS Aim and claim
    • 1. Understanding the causes of meningitis, encephalitis, postinfection syndrome
    • 2. Get hold of the clinical features of bacterial meningitis, encephalitis and Guilain-Barre Syndrome
    • 3. Familiar with the diagnosis of meningitis and encephalitis
    • 4. Understanding the complication of meningitis
  • 14. Main contents
    • 1. Introduce the causes of meningitis, encephalitis, postinfection syndrome
    • 2. Emphasize the clinical features of bacterial meningitis,encephalitis and Guilain-Barre Syndrome
    • 3. Emphasize the diagnosis of meningitis and encephalitis
    • 4. Introduce the complication of meningitis
  • 15. Topic 1. Meningitis
    • Pathogens of acute meningitis
    Bacteria; Neisseria meningitidis Strep. Pneumoniae Hemophilus influenzae type B neonatal: GBS E. coli Listeria monocytogenes Virus: Mumos Enterovirus Epstein-Barr virus
  • 16. Topic 1. Meningitis (con.1)
    • Clinic features:
    • Bulging fontanelle
    • Neck stiffness and photophobia
    • A convulsion
    • Meningococcal infection----non-blanching purpuric rash
  • 17. Topic1. Meningitis(cont.2)
    • Diagnosis:
    • Lumbar puncture
    • CSF examination
    • Special LP indication for younger children
    • Focal neurological signs / high intracranial pressure---treatment before LP (risk of coning)
  • 18. Topic 1. Meningitis(cont.3)
    • Rapid diagnostic tests include;
    • Countercurrent immumoelectrophoresis
    • Latex agglutination
    • PCR
    • Blood culture
  • 19. Topic 1. Meningitis(cont.4)
    • Treatment:
    • Broad-spectrum iv antibiotics
    • third generation cephalosporin
    • Meningococcal sepsis---immediately benzylpenicillin
    • Add ampicillin under 3 years
    • Dexamethasone reduce neurological sequelae(except neonates) of H.Influ. And S. pneumonia
  • 20. Topic 1. Meningitis(cont.5)
    • Complication:
    • Acute : Inappropriate ADH secretion
    • Subdural effusion
    • Cerebral oedema
    • Convulsions
  • 21. Topic 1. Meningitis(cont.6)
    • Differential diagnosis;
    • Encephalitis:
    • A. Causes----herpes simplex virus1/2
    • Enteroviruses
    • Varicella
    • B. Clinical features---non-specific symptoms
    • and signs
    • abrupt encephalopathic illness
  • 22. Topic 1. Meningitis(cont.7)
    • C. Diagnosis---EEG/ MRI temporal lobe
    • abnormalities
    • D. Management---acyclovir for HSV
    • supportive methods:
    • ICU intracranial pressure monitor,
    • mannitol and Dex. For oedema
    • Postinfectious syndromes---Guillain-Barre syndrome
  • 23. Topic 2. Encephalitis
    • Causes:
    • Herpes simplex virus 1&2
    • Enterovirus
    • Varicella
    • Viral exanthems( 皮疹 ) {measles,
    • rubella, mumps}
  • 24. Topic 2. Encephalitis (con.1)
    • Clinical features:
    • Non-specific:
    • Fever
    • Headache
    • Vomiting
    • Encephalopathic :
    • Altered consiousness, seizure,
    • Raised intracranial pressure
  • 25. Topic 2. Encephalitis (con.2)
    • Diagnosis and management:
    • EEG, MRI----temporal lobe abnormality
    • Herpes simplex encephalitis ---acyclovir
    • Supportive management:
    • ICU intracranial pressure monitoring
    • Mannitol and Dex. for cerebral oedema
  • 26.
    • Thank you