Neurological problems & neurological disorder

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Neurological problems & neurological disorder

  1. 1. Neurological Problems & Neurological Disorder Xuqin Chen Lecturer of Pediatrics Department of Pediatrics Children’s Hospital of Soochow University
  2. 2. Section 1. Neurological Examination <ul><li>Aims and claims </li></ul><ul><li>1. Familiar with the general examination of neurological system. </li></ul><ul><li>2. Understanding the examination of the cranial nerves </li></ul><ul><li>3. Get hold of the motor examination,. </li></ul><ul><li>4. Familiar with the sensory examination. </li></ul>
  3. 3. <ul><li>Main contents </li></ul><ul><li>1. Introduce the general examination of neurological system. </li></ul><ul><li>2. Introduce the examination of the cranial nerves . </li></ul><ul><li>3. Emphasize the motor examination,. </li></ul><ul><li>4. Introduce the sensory examination . </li></ul>
  4. 4. Topic 1. General examination <ul><li>Make it as a game playing to meet the children’s needs </li></ul><ul><li>Carefully observe the child when playing and interacting </li></ul><ul><li>Head shape and circumference </li></ul><ul><li>Pay attention to the relative symptoms: neurocutaneous stigmata, hepato-splenomegaly------- </li></ul>
  5. 5. 2. What from G.E.? <ul><li>Consciousness: </li></ul><ul><li>sleepy (drowsy, 嗜睡 ) </li></ul><ul><li>unconsciousness (意识不清) </li></ul><ul><li>lethargy ( 昏睡) </li></ul><ul><li>coma (昏迷) </li></ul>Topic 1. general examination (con.1)
  6. 6. Topic 1. general examination (con.2) <ul><li>Mental condition: </li></ul><ul><li>delirium( 谵妄) </li></ul><ul><li>irritable ( 烦躁) </li></ul><ul><li>obtuse ( 迟钝) </li></ul><ul><li>depression( 忧郁) </li></ul>
  7. 7. Topic 1. general examination (con.3) <ul><li>Action and reaction: </li></ul><ul><li>IQ: </li></ul><ul><li>Special features: </li></ul><ul><li>Neurocutaneous stigmata( 神经皮肤症) </li></ul><ul><li>Dysmorphic feature (畸形特点) </li></ul>
  8. 8. Topic 2. The cranial nerves <ul><li>Table 32. cranial nerve assessment in infants </li></ul>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. 9. Topic 3. Motor examination <ul><li>Muscle tone: </li></ul><ul><li>posture </li></ul><ul><li>movements </li></ul><ul><li>Hypotonic: </li></ul><ul><li>frog-leg in neonates </li></ul><ul><li>floppy ( 松软儿) </li></ul><ul><li>Spasticity: ( 痉挛) </li></ul><ul><li>Rigidity ( 僵直) </li></ul>
  10. 10. Topic 3. Motor examination(con.1) <ul><li>Power: </li></ul>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. 11. Topic 3. Motor examination(con.2 ) <ul><li>Reflexes </li></ul><ul><li>Mobility( 活动) and gait (步态) : </li></ul><ul><li>dystonia (肌张力障碍) </li></ul><ul><li>athetosis (手足徐动症) </li></ul><ul><li>chorea (舞蹈病) </li></ul><ul><li>Speech </li></ul>
  12. 12. Sensory examination <ul><li>The most difficult part of neurological examination: </li></ul><ul><li>Touch </li></ul><ul><li>Pain </li></ul><ul><li>Vibration </li></ul><ul><li>Temperature </li></ul><ul><li>Joint position </li></ul>Topic 3. Motor examination(con.3)
  13. 13. Section 2. Infections of the CNS Aim and claim <ul><li>1. Understanding the causes of meningitis, encephalitis, postinfection syndrome </li></ul><ul><li>2. Get hold of the clinical features of bacterial meningitis, encephalitis and Guilain-Barre Syndrome </li></ul><ul><li>3. Familiar with the diagnosis of meningitis and encephalitis </li></ul><ul><li>4. Understanding the complication of meningitis </li></ul>
  14. 14. Main contents <ul><li>1. Introduce the causes of meningitis, encephalitis, postinfection syndrome </li></ul><ul><li>2. Emphasize the clinical features of bacterial meningitis,encephalitis and Guilain-Barre Syndrome </li></ul><ul><li>3. Emphasize the diagnosis of meningitis and encephalitis </li></ul><ul><li>4. Introduce the complication of meningitis </li></ul>
  15. 15. Topic 1. Meningitis <ul><li>Pathogens of acute meningitis </li></ul>Bacteria; Neisseria meningitidis Strep. Pneumoniae Hemophilus influenzae type B neonatal: GBS E. coli Listeria monocytogenes Virus: Mumos Enterovirus Epstein-Barr virus
  16. 16. Topic 1. Meningitis (con.1) <ul><li>Clinic features: </li></ul><ul><li>Bulging fontanelle </li></ul><ul><li>Neck stiffness and photophobia </li></ul><ul><li>A convulsion </li></ul><ul><li>Meningococcal infection----non-blanching purpuric rash </li></ul>
  17. 17. Topic1. Meningitis(cont.2) <ul><li>Diagnosis: </li></ul><ul><li>Lumbar puncture </li></ul><ul><li>CSF examination </li></ul><ul><li>Special LP indication for younger children </li></ul><ul><li>Focal neurological signs / high intracranial pressure---treatment before LP (risk of coning) </li></ul>
  18. 18. Topic 1. Meningitis(cont.3) <ul><li>Rapid diagnostic tests include; </li></ul><ul><li>Countercurrent immumoelectrophoresis </li></ul><ul><li>Latex agglutination </li></ul><ul><li>PCR </li></ul><ul><li>Blood culture </li></ul>
  19. 19. Topic 1. Meningitis(cont.4) <ul><li>Treatment: </li></ul><ul><li>Broad-spectrum iv antibiotics </li></ul><ul><li>third generation cephalosporin </li></ul><ul><li>Meningococcal sepsis---immediately benzylpenicillin </li></ul><ul><li>Add ampicillin under 3 years </li></ul><ul><li>Dexamethasone reduce neurological sequelae(except neonates) of H.Influ. And S. pneumonia </li></ul>
  20. 20. Topic 1. Meningitis(cont.5) <ul><li>Complication: </li></ul><ul><li>Acute : Inappropriate ADH secretion </li></ul><ul><li>Subdural effusion </li></ul><ul><li>Cerebral oedema </li></ul><ul><li>Convulsions </li></ul>
  21. 21. Topic 1. Meningitis(cont.6) <ul><li>Differential diagnosis; </li></ul><ul><li>Encephalitis: </li></ul><ul><li>A. Causes----herpes simplex virus1/2 </li></ul><ul><li>Enteroviruses </li></ul><ul><li>Varicella </li></ul><ul><li>B. Clinical features---non-specific symptoms </li></ul><ul><li>and signs </li></ul><ul><li>abrupt encephalopathic illness </li></ul>
  22. 22. Topic 1. Meningitis(cont.7) <ul><li>C. Diagnosis---EEG/ MRI temporal lobe </li></ul><ul><li>abnormalities </li></ul><ul><li>D. Management---acyclovir for HSV </li></ul><ul><li>supportive methods: </li></ul><ul><li>ICU intracranial pressure monitor, </li></ul><ul><li>mannitol and Dex. For oedema </li></ul><ul><li>Postinfectious syndromes---Guillain-Barre syndrome </li></ul>
  23. 23. Topic 2. Encephalitis <ul><li>Causes: </li></ul><ul><li>Herpes simplex virus 1&2 </li></ul><ul><li>Enterovirus </li></ul><ul><li>Varicella </li></ul><ul><li>Viral exanthems( 皮疹 ) {measles, </li></ul><ul><li>rubella, mumps} </li></ul>
  24. 24. Topic 2. Encephalitis (con.1) <ul><li>Clinical features: </li></ul><ul><li>Non-specific: </li></ul><ul><li>Fever </li></ul><ul><li>Headache </li></ul><ul><li>Vomiting </li></ul><ul><li>Encephalopathic : </li></ul><ul><li>Altered consiousness, seizure, </li></ul><ul><li>Raised intracranial pressure </li></ul>
  25. 25. Topic 2. Encephalitis (con.2) <ul><li>Diagnosis and management: </li></ul><ul><li>EEG, MRI----temporal lobe abnormality </li></ul><ul><li>Herpes simplex encephalitis ---acyclovir </li></ul><ul><li>Supportive management: </li></ul><ul><li>ICU intracranial pressure monitoring </li></ul><ul><li>Mannitol and Dex. for cerebral oedema </li></ul>
  26. 26. <ul><li>Thank you </li></ul>

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