psychomotor retardation

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psychomotor retardation

  1. 2. Psychomotor Retardation Presented by : Yasrin Berangi M.D. Guilan University of Medical Sciences
  2. 3. DEFINITION <ul><li>The diagnosis of psychomotor retardation diferential (developmental delay) is quite different from that of psychomotor regression. </li></ul>
  3. 4. <ul><li>Slow progress in the attainment of developmental milestones may be caused by either static or progressive encephalopathy. </li></ul><ul><li>But psychomotor regression indicate a progressive disease of nervouse system. </li></ul>
  4. 5. Developmental delay <ul><li>Two important questions must be asked: </li></ul><ul><li>1) Is delay restricted to spescific areas of development or is it global? </li></ul><ul><li>2) Is there only developmental delay, or is there also developmental regression? </li></ul>
  5. 6. The Denver Developmental Screening Test(DDST) <ul><li>Efficient, reliable </li></ul><ul><li>Assesses: Personal-social </li></ul><ul><li>Fine motor adoptive </li></ul><ul><li>language </li></ul><ul><li>gross motor </li></ul>
  6. 7. Language Delay <ul><li>Vocalization of vowels: first month </li></ul><ul><li>Laughing & squealing: 5 mo. </li></ul><ul><li>Articulating consonants: 6 mo. </li></ul><ul><li>Specific use of “mama” & “dady” : 1 years </li></ul><ul><li>To combine at least 2 words: 2years </li></ul><ul><li>Understanding more than 250 words & follow many simple verbal directions:2 years </li></ul>
  7. 8. Hearing impairment <ul><li>The major cause of delay of speech development </li></ul><ul><li>May occure with global developmental retardation: </li></ul><ul><li>rubella emberyopathy </li></ul><ul><li>CMV disease </li></ul><ul><li>neonatal meningitis </li></ul><ul><li>kern icterous </li></ul><ul><li>genetic disorders </li></ul>
  8. 9. Hearing loss should be suspected <ul><li>Global retardation </li></ul><ul><li>Retarded childeren fail to imitate sounds </li></ul><ul><li>Excessive gesturing & staring at the lips of people who are talking </li></ul>
  9. 10. Infantile autism <ul><li>Caused by: </li></ul><ul><li>Abnormal brain developmental </li></ul><ul><li>Clinical features: </li></ul><ul><li>Failure of language developmental impairment of interpersonal relationships </li></ul><ul><li>Restricted activities </li></ul><ul><li>Onset before 3 years </li></ul>
  10. 11. Clinical features <ul><li>Major criteria : Failure of language developmental impairment of interpersonal relationships </li></ul><ul><li>Restricted activities </li></ul><ul><li>Onset before 3 years </li></ul><ul><li>Others:IQ<70 </li></ul><ul><li>Stereotyped behavior </li></ul>
  11. 12. Diagnosis <ul><li>Clinical </li></ul><ul><li>Can not be comfirmed by lab. Tests </li></ul>
  12. 13. Treatment <ul><li>Failure of language development is most likely to bring medical attention & correlates best with outcome </li></ul><ul><li>Failure to develop language before age 5 have the worth outcome </li></ul><ul><li>Naltrexone </li></ul><ul><li>Behavior modification techniques </li></ul>
  13. 14. Delayed motor development <ul><li>Infants with delayed gross motor development but Nl. Language & social skills are Often hypotonic & may have a Neurovascular disease. </li></ul>
  14. 15. <ul><li>Isolated delay in motor function is also caused by ataxia, mild hemiplagia, mild paraplagia & mild cerebral palsy </li></ul>
  15. 16. Global developmental delay <ul><li>Static encephalopathy : antenatal/perinatal disturbance </li></ul><ul><li>Underlying genetic disease </li></ul>
  16. 17. Findings in progressive disease <ul><li>Affected family member </li></ul><ul><li>Parental consanguinity </li></ul><ul><li>Organomegaly </li></ul><ul><li>Absent DTR </li></ul>
  17. 18. Screening test <ul><li>MRI: detect malformations </li></ul><ul><li>Evidence of perinatal disease </li></ul><ul><li>Provides diagnosis that ends uncertainty </li></ul>
  18. 19. Mental retardation <ul><li>Chromosomal abnormality </li></ul><ul><li>Cerebral malformations </li></ul><ul><li>Intrauterine infections </li></ul><ul><li>Perinatal disorder </li></ul>
  19. 20. <ul><li>Chromosal structure or number : </li></ul><ul><li>most comon cause of severe mental retardation </li></ul>
  20. 21. Clinical indication for chromosome analysis
  21. 22. Genitourinary <ul><li>ambiguous genitalia </li></ul><ul><li>polycystic kidney </li></ul>
  22. 23. Head & neck <ul><li>High nasal bridge </li></ul><ul><li>Hyper/hypo telorism </li></ul><ul><li>Microphtalmia </li></ul><ul><li>Mongoloid slant </li></ul><ul><li>Occipital skull defect </li></ul><ul><li>Small mandible </li></ul><ul><li>Small or fish mouth(hard to open) </li></ul><ul><li>Small or low set ears </li></ul><ul><li>Upward slant of eyes </li></ul><ul><li>Web neck </li></ul>
  23. 24. Limbs <ul><li>Abnormal dermathoglyphic </li></ul><ul><li>Low set thumb </li></ul><ul><li>Overlapping fingers </li></ul><ul><li>Polydactily </li></ul><ul><li>Radial hypoplasia </li></ul><ul><li>Rocker bottom feet </li></ul>
  24. 25. Fragile X Synd. <ul><li>The most common cause of severe mental retardation </li></ul><ul><li>The name drives from a site at the Xq 27.3 </li></ul>
  25. 26. Typical synd. <ul><li>Moderate retardation(IQ:40_55) </li></ul><ul><li>Behaivor problems: autism or attention disorders </li></ul><ul><li>Somatic abnormalities:long face,enlarged ears,macro_orchidism </li></ul>
  26. 27. Diagnosis <ul><li>Chromosome analysis </li></ul>
  27. 28. treatment <ul><li>High dose folic acid </li></ul><ul><li>No improvement of IQ but behavioral improvment </li></ul>
  28. 29. Cerebral malformation <ul><li>3% of all childeren have at least 1 major malformation but the responsible etiologic factors can be identified in only 20% of cases </li></ul>
  29. 30. causes <ul><li>Exposure of emberyo to infectious or toxic agants during first week </li></ul><ul><li>Alcohol </li></ul><ul><li>Lead </li></ul><ul><li>Prescription drugs </li></ul><ul><li>cocaine </li></ul>
  30. 31. <ul><li>Cerebral malformation should be susspected in any retarded child with: dysmorphic, malrotation of organs, abnormality of head size & shape </li></ul><ul><li>CT is satisfactory to show but MRI is the better method </li></ul>
  31. 32. Intrauterine infection <ul><li>The most common: </li></ul><ul><li>HIV </li></ul><ul><li>CMV </li></ul>
  32. 33. Congenital syphilis <ul><li>Cases of congenital syphilis have increased scince 1988 </li></ul><ul><li>2/3 infected newborns of asymptomatic </li></ul><ul><li>More common features: condylomata lata,periostitis,osteochondritis,persistent rhinorrhea, maculopapular rash </li></ul>
  33. 34. <ul><li>Onset of neurologic disturbances: after 2 years </li></ul><ul><li>Including: nerve deafness & mental retardation </li></ul>
  34. 35. Hutchinson triad <ul><li>nerve deafness </li></ul><ul><li>interstitial keratitis </li></ul><ul><li>peg shaped upper insisors </li></ul>
  35. 36. Diagnosis <ul><li>Non treponemal Ab tests (VDRL,RPR):screening </li></ul><ul><li>FTA-ABS: confirmation </li></ul><ul><li>AIDS should be suspected in every child with congenital syphilis </li></ul>
  36. 37. Treatment <ul><li>Intravenous crystalline penicilline G,100,000_150,000 U/kg/day in 6 devided dose every 8_12 h, for 10_14 d. </li></ul><ul><li>Intramascularly procaine penicilline G 50,000 U/kg/daily _10-14 d </li></ul>
  37. 38. CMV <ul><li>Transmitted sexually </li></ul><ul><li>Pregnancy may cause reactivation of maternal infection </li></ul><ul><li>1-2% culture + :0.05 % symptoms + </li></ul>
  38. 39. Clinical features <ul><li>Skin rash </li></ul><ul><li>Hepatosplenomegaly </li></ul><ul><li>Juandice </li></ul><ul><li>Chorioretinitis </li></ul><ul><li>microcephaly </li></ul>
  39. 40. Diagnosis <ul><li>Analysis of urine & CSF analysis </li></ul><ul><li>Serologic tests </li></ul>
  40. 41. Treatment <ul><li>Gancylovir </li></ul><ul><li>No treatment can reverse the malformation </li></ul>
  41. 42. Rubella
  42. 43. Clinical Features <ul><li>A multisystem disease characterized by: </li></ul><ul><li>Intrauterine growth retardation </li></ul><ul><li>Cataract </li></ul><ul><li>Chorioretinitis </li></ul><ul><li>Congenital heart disease </li></ul><ul><li>Sensorineuoral deafness </li></ul><ul><li>Thrombocytopenia </li></ul><ul><li>Rash </li></ul><ul><li>Neurologic features:Lethargy,Hypotonia,seizure </li></ul>
  43. 44. <ul><li>Diagnosis : Clinical </li></ul><ul><li>Treatment : No treatment </li></ul>
  44. 45. Toxoplasmosis <ul><li>Transmission: </li></ul><ul><li>by primary maternal infection during pregnancy </li></ul><ul><li>Highest risk: last trimester </li></ul><ul><li>The most serious sequelae: first trimester </li></ul>
  45. 47. Clinical features <ul><li>Multisystem involvement at birth: Fever,rash, hepathosplenomegaly,juandice,thrombocytopenia </li></ul><ul><li>Neurologic dysfunction:seizure,altered state of consciousness,ICP </li></ul>
  46. 48. Congenital toxo. <ul><li>Hallmark: </li></ul><ul><li>Hydrocephalus </li></ul><ul><li>Chorioretinitis </li></ul><ul><li>Intracranial calcification </li></ul>
  47. 49. Diagnosis <ul><li>Sabin-feldman dye test: standard for dignosis </li></ul><ul><li>ELISA: IgM-specific Ab to Toxo. In amblical cord blood: show passive infection </li></ul><ul><li>IgG specific Ab show active infection </li></ul>
  48. 50. Treatment <ul><li>Pregnant: Spiramycine </li></ul><ul><li>Fetal documented infection: pyrimethamine & sulfadoxine/sulfadiazine </li></ul><ul><li>Newborn:pyrimethamine(0.5mg/kg/dose)BID/for 1y. </li></ul><ul><li>Sulfadizine(0.25mg/kg/dose) BID/for 1y. </li></ul><ul><li>Newborns with high prt. In CSF / chorioretinitis: </li></ul><ul><li>Prednisone(1_2 mg/kg/day) </li></ul>
  49. 51. <ul><li>Thanks for your attention </li></ul><ul><li>Special thanks to </li></ul><ul><li>NargessTavakoli M.D . </li></ul>

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