Neurological Disorders PSY 417 Schuetze
Diagnosing Neurological Problems <ul><li>Structural Imaging </li></ul><ul><li>Functional Imaging </li></ul>
Computerized Axial Tomography (CAT Scan)
Magnetic resonance Imaging (MRI)
Positron Emission Tomography (PET Scan) <ul><li>Inject radioisotopes in blood </li></ul><ul><li>Attracted to areas of tiss...
PET Scan
Ultrasound Large hemorrhage in left  ventricular
Electroencephalogram (EEG)
EEG Waves <ul><li>Epilepsy </li></ul>
EEG Waves <ul><li>Unresponsive neonate </li></ul><ul><li>Grade IV Intraventricular Hemorrhage </li></ul>
Areas to be Evaluated <ul><li>Mental Status </li></ul><ul><ul><li>Awareness and interaction with the environment </li></ul...
Reflexes <ul><li>Inborn automatic responses to particular form of stimulation </li></ul><ul><ul><li>Gradually disappear ov...
Reflexes <ul><li>Eyeblink </li></ul><ul><li>Moro </li></ul><ul><li>Crawling </li></ul><ul><li>Babinski </li></ul><ul><li>P...
Evaluation of Cranial Nerves <ul><li>I.  Olfactory Nerve – identification of smells </li></ul><ul><li>II. Optic Nerve - ey...
Cerebral Palsy <ul><li>Motor problems due to brain damage that occurs before, during or after birth </li></ul><ul><li>Ofte...
Cerebral Palsy – Affected Sites <ul><li>Hemiplegia – one side of body </li></ul><ul><li>Paraplegia – lower extremities </l...
Cerebral Palsy – Types <ul><li>Spastic: muscles contract when stretched </li></ul><ul><li>Athetoid: limbs flail </li></ul>...
Seizures <ul><li>Abnormal electrical discharges in cerebral neurons </li></ul><ul><li>Imbalance between excited versus inh...
Types of Seizures <ul><li>Tonic – rigid muscle contraction </li></ul><ul><li>Clonic: alternate contraction/relaxation of m...
Traumatic Brain Injury <ul><li>Physical Symptoms </li></ul><ul><li>Cognitive Symptoms </li></ul><ul><li>Behavioral Symptom...
Neural Tube Defects
Spina Bifida
Other Neural Tube Defects <ul><li>Anencephaly </li></ul><ul><li>Microcephaly </li></ul><ul><li>Hydrocephaly </li></ul>
Shaken Baby Syndrome <ul><li>Approximately 50,000/year </li></ul><ul><ul><li>25% die </li></ul></ul><ul><li>Mental retarda...
Sudden Infant Death Syndrome (SIDS) <ul><ul><li>􀂄􀂄  The sudden death of an infant under 1 year The sudden death of an infa...
Characteristics of SIDS <ul><li>Peak incidence 2 to 4 months of age </li></ul><ul><li>Slight male predominance </li></ul><...
Characteristics of SIDS <ul><li>Leading cause of postneonatal death (28 to 364 days of age) </li></ul><ul><li>Occurs sudde...
What Causes SIDS? <ul><li>Triple-Risk Model </li></ul>SIDS Exogenous Stressors Vulnerable Infant Critical Development Peri...
Risk Factors for SIDS <ul><li>Prone sleep position </li></ul><ul><li>Preterm birth </li></ul><ul><li>LBW </li></ul><ul><li...
“Back to Sleep” Campaign <ul><li>1992 – American Academy of Pediatricians (AAP) recommendation  </li></ul><ul><li>1994 – N...
Mortality Rates Due to SIDS, U.S., 1980-2001 AAP Position Statement Back to Sleep Campaign initiated Change to ICD-10 Codes
SIDS* mortality rates by race of mother *SIDS – Sudden Infant Death Syndrome SOURCE: CDC/NCHS, National Vital Statistics S...
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Neurological Disorders PSY 417 Schuetze

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  • SIDS is the 3rd leading cause of infant mortality in the U.S. and the leading cause of postneonatal death (infants between 1 month -1 year of age) SIDS occurs suddenly without warning, often during periods of sleep Not due to suffocation, aspiration, abuse or neglect SIDS is a syndrome that it typically peaks between ages of 2 and 4 months. SIDS occurs during a critical period of development that coincides with a period of rapid growth and development of the brain during the first 6 months of life. This period accounts for 90% of all SIDS-related deaths. a developmental disorder, there is no adequate unifying pathological explanation for SIDS. The cause of SIDS is unknown. Knowledge acquired during the last decade supports the general “triple-risk hypothesis” that infants who die from SIDS have an underlying vulnerability in homeostatic control at birth that makes them vulnerable to exogenous stressors at a critical developmental period. [Homeostatic control includes the vital functions of cardiorespiratory control, chemoreception, upper airway reflexes, and thermoregulatory control.]
  • Some infants are born vulnerable, with certain brain stem abnormalities that make them susceptible to sudden death during a critical developmental period once an exogenous stressor (such as being overheated, being exposed to second-hand smoke, or entrapment from stuffed animals or pillows) or environmental challenge is presented. The triple risk theory: The vulnerable infant is one with an intrinsic developmental defect that is undetectable. The critical development period coincides with a period of rapid growth and development of the brain during the first 6 months of life. This period accounts for 90% of all SIDS-related deaths. The third and only currently modifiable area is the external stressors or environmental factors such as sleeping on the stomach, loose bedding, inappropriate sleep surfaces (eg, couches, water beds), or smoking. The bottom line is that researchers believe that no single risk factor is likely to cause a SIDS-related death. Rather, the convergence of several risk factors may contribute to what causes an infant to die from SIDS. Throughout this presentation, we will be discussing how we can limit the exogenous stressors. (Guntheroth WG, Spiers PS. The triple risk hypotheses in sudden infant death syndrome. Pediatrics. 2002;110:e64)
  • Since 1990, the SIDS rates have declined 57% from 130 to 56 deaths per 100,000 live births in 2001. Decline attributed to a decrease in prone sleeping following release of AAP sleep position statement in 1992 CLICK and the introduction of the national “Back-to-Sleep” education campaign in 1994 CLICK . [National Infant Sleep Position Study -- frequency of prone sleeping decreased from 70% in 1992 to 14% by 2000] More recently CLICK, researchers have suggested that the continued decline may be due to a change in the way SIDS deaths are classified, but to date we have limited evidence to support this. 1992 -the American Academy of Pediatrics (AAP) recommends placing babies to sleep on their back or side to reduce the risk of SIDS. 1994 -the National Institute of Child Health and Human Development (NICHD) launches National Back-to-Sleep campaign. 1996 -AAP amends recommendation stating that the back sleep position offers lowest risk of SIDS.
  • All the SIDS rate has declined by more than 50% since the early 1990s as the result of the Since 1990, the SIDS rates have declined 57% from 130 to 56 deaths per 100,000 live births in 2001. The decline is likely due to a decrease in prone sleeping following release of AAP sleep position statement in 1992 and the introduction of the national “Back-to-Sleep” education campaign in 1994. In spite of this decline, Indian families experience the heartbreak of losing a child to SIDS at more than twice the rate for other U.S. Non-Hispanic White families. SIDS rates for infants of American Indian and Alaska Native mothers are the highest of all races and ethnic groups, and 2.3 times the rate for non-Hispanic white mothers.
  • Neurological Disorders PSY 417 Schuetze

    1. 1. Neurological Disorders PSY 417 Schuetze
    2. 2. Diagnosing Neurological Problems <ul><li>Structural Imaging </li></ul><ul><li>Functional Imaging </li></ul>
    3. 3. Computerized Axial Tomography (CAT Scan)
    4. 4. Magnetic resonance Imaging (MRI)
    5. 5. Positron Emission Tomography (PET Scan) <ul><li>Inject radioisotopes in blood </li></ul><ul><li>Attracted to areas of tissue that are metabolically active </li></ul>
    6. 6. PET Scan
    7. 7. Ultrasound Large hemorrhage in left ventricular
    8. 8. Electroencephalogram (EEG)
    9. 9. EEG Waves <ul><li>Epilepsy </li></ul>
    10. 10. EEG Waves <ul><li>Unresponsive neonate </li></ul><ul><li>Grade IV Intraventricular Hemorrhage </li></ul>
    11. 11. Areas to be Evaluated <ul><li>Mental Status </li></ul><ul><ul><li>Awareness and interaction with the environment </li></ul></ul><ul><li>Motor Function and Balance </li></ul><ul><li>Sensory Examination </li></ul><ul><li>Reflexes </li></ul>
    12. 12. Reflexes <ul><li>Inborn automatic responses to particular form of stimulation </li></ul><ul><ul><li>Gradually disappear over 1 st 6 months, probably due to increase in voluntary control </li></ul></ul><ul><ul><li>Reflexes index health of nervous system </li></ul></ul><ul><ul><li>Week or absent reflexes </li></ul></ul><ul><ul><li>Overly exaggerated/rigid reflexes </li></ul></ul>
    13. 13. Reflexes <ul><li>Eyeblink </li></ul><ul><li>Moro </li></ul><ul><li>Crawling </li></ul><ul><li>Babinski </li></ul><ul><li>Palmar Grasp </li></ul>
    14. 14. Evaluation of Cranial Nerves <ul><li>I. Olfactory Nerve – identification of smells </li></ul><ul><li>II. Optic Nerve - eye </li></ul><ul><li>III. Oculomotor – pupil of eye </li></ul><ul><li>IV. Trochlear – movement of eyes </li></ul><ul><li>V. Trigeminal – ability to feel face </li></ul><ul><li>VI. Abducens – movement of eyes </li></ul><ul><li>VII. Facial – tastes, smiling </li></ul><ul><li>VIII. Acoustic - hearing </li></ul><ul><li>IX. Glossopharyngeal - taste </li></ul><ul><li>X. Vagus - swallowing </li></ul><ul><li>XI. Accessory – moving shoulders/neck </li></ul><ul><li>XII. Hypoglossal – movement of tongue </li></ul>
    15. 15. Cerebral Palsy <ul><li>Motor problems due to brain damage that occurs before, during or after birth </li></ul><ul><li>Often due to anoxia </li></ul><ul><li>General symptoms: muscular incoordination; postural/balance problems; secondary impairments </li></ul><ul><li>Not progressive </li></ul><ul><li>Hypertonia versus hypotonia </li></ul>
    16. 16. Cerebral Palsy – Affected Sites <ul><li>Hemiplegia – one side of body </li></ul><ul><li>Paraplegia – lower extremities </li></ul><ul><li>Quadriplegia – all extremities </li></ul><ul><li>Diplegia – all extremities </li></ul><ul><li>Monoplegia – one extremity </li></ul><ul><li>Triplegia – three extremities </li></ul>
    17. 17. Cerebral Palsy – Types <ul><li>Spastic: muscles contract when stretched </li></ul><ul><li>Athetoid: limbs flail </li></ul><ul><li>Ataxia: loss of coordination </li></ul><ul><li>Mixed </li></ul>
    18. 18. Seizures <ul><li>Abnormal electrical discharges in cerebral neurons </li></ul><ul><li>Imbalance between excited versus inhibited neurons </li></ul><ul><li>Epilepsy: recurrent seizures </li></ul><ul><li>3 Categories </li></ul><ul><ul><li>Partial: activation of one area of brain </li></ul></ul><ul><ul><li>Generalized: activation of entire brain </li></ul></ul><ul><ul><li>Unclassified </li></ul></ul>
    19. 19. Types of Seizures <ul><li>Tonic – rigid muscle contraction </li></ul><ul><li>Clonic: alternate contraction/relaxation of muscles </li></ul><ul><li>Tonic-clonic/grand mal: contraction followed by clonic activity </li></ul><ul><li>Myoclonic: sudden, brief, shock-like muscle contractions </li></ul><ul><li>Atonic: sudden reduction in muscle tone </li></ul><ul><li>Infantile: poor long-term prognosis </li></ul><ul><li>Febrile: tonic-clonic from high fever </li></ul>
    20. 20. Traumatic Brain Injury <ul><li>Physical Symptoms </li></ul><ul><li>Cognitive Symptoms </li></ul><ul><li>Behavioral Symptoms </li></ul>
    21. 21. Neural Tube Defects
    22. 22. Spina Bifida
    23. 23. Other Neural Tube Defects <ul><li>Anencephaly </li></ul><ul><li>Microcephaly </li></ul><ul><li>Hydrocephaly </li></ul>
    24. 24. Shaken Baby Syndrome <ul><li>Approximately 50,000/year </li></ul><ul><ul><li>25% die </li></ul></ul><ul><li>Mental retardation </li></ul><ul><li>Cerebral Palsy </li></ul>
    25. 25. Sudden Infant Death Syndrome (SIDS) <ul><ul><li>􀂄􀂄 The sudden death of an infant under 1 year The sudden death of an infant under 1 year of age, which remains unexplained after a of age, which remains unexplained after a thorough case investigation, including thorough case investigation, including performance of a complete autopsy, performance of a complete autopsy, examination of the death scene, and review examination of the death scene, and review of the clinical history.” of the clinical history.” – </li></ul></ul><ul><ul><ul><li>Willinger Willinger 1991 </li></ul></ul></ul>
    26. 26. Characteristics of SIDS <ul><li>Peak incidence 2 to 4 months of age </li></ul><ul><li>Slight male predominance </li></ul><ul><li>More prevalent in cold, winter months </li></ul><ul><li>Not considered genetic or hereditary </li></ul><ul><li>Not due to suffocation, aspiration, abuse or neglect </li></ul>
    27. 27. Characteristics of SIDS <ul><li>Leading cause of postneonatal death (28 to 364 days of age) </li></ul><ul><li>Occurs suddenly without warning, often during periods of sleep </li></ul><ul><li>Occurs during critical development period </li></ul><ul><li>Triple-risk hypothesis </li></ul>
    28. 28. What Causes SIDS? <ul><li>Triple-Risk Model </li></ul>SIDS Exogenous Stressors Vulnerable Infant Critical Development Period Some infants are born vulnerable, with certain brain stem abnormalities that make them susceptible to sudden death during a critical developmental period once an exogenous stressor or environmental challenge is presented. Source: Filiano JJ, Kinney HC.  Biology of the Neonate, 1994 <ul><li>overheated </li></ul><ul><li>exposed to second-hand smoke </li></ul><ul><li>entrapment from stuffed animals or pillows </li></ul><ul><li>environmental challenge </li></ul>
    29. 29. Risk Factors for SIDS <ul><li>Prone sleep position </li></ul><ul><li>Preterm birth </li></ul><ul><li>LBW </li></ul><ul><li>No/late prenatal care </li></ul><ul><li>Maternal smoking during pregnancy </li></ul><ul><li>ETS exposure </li></ul><ul><li>Young maternal age </li></ul><ul><li>Single marital status </li></ul><ul><li>Soft bedding </li></ul><ul><li>Co-sleeping (possibly) </li></ul><ul><li>Infections (possibly) </li></ul>
    30. 30. “Back to Sleep” Campaign <ul><li>1992 – American Academy of Pediatricians (AAP) recommendation </li></ul><ul><li>1994 – National public education campaign begins </li></ul><ul><li>Prone sleep position drops from 62% in 1993 to 20% in 1998 </li></ul><ul><li>SIDS incidence has fallen 30-50% </li></ul>
    31. 31. Mortality Rates Due to SIDS, U.S., 1980-2001 AAP Position Statement Back to Sleep Campaign initiated Change to ICD-10 Codes
    32. 32. SIDS* mortality rates by race of mother *SIDS – Sudden Infant Death Syndrome SOURCE: CDC/NCHS, National Vital Statistics System, Linked Birth-Infant Death data set. Data not available for 1992-94.

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