This document discusses neonatal septic arthritis in India. It begins with an introduction defining septic arthritis and noting the incidence is higher in India (0.6/1000 live births) than Western countries (0.3/1000 live births). There is conflict over several factors regarding neonatal septic arthritis. The pathophysiology involves hematogenous spread of infectious organisms to the joint space, triggering an inflammatory response. Clinical features can be vague but include reduced movement and crying with handling of the affected limb. Risk factors include prematurity, low birth weight, and perinatal infections. The most common causative organisms are Klebsiella and Staphylococcus aureus. Diagnosis involves clinical suspicion plus blood tests, imaging, and
This document discusses neonatal seizures. It begins by defining seizures and describing the different types seen in neonates. The most common type is subtle seizures. Hypoxic ischemic encephalopathy is usually the most common cause, especially within the first 24 hours. Other common causes include intracranial hemorrhage and metabolic disorders. Phenobarbital is the first-line treatment, with phenytoin and benzodiazepines as second-line options. Seizures from subarachnoid hemorrhage or late-onset hypocalcemia typically carry a good prognosis, while those associated with hypoxic ischemic encephalopathy, cerebral malformations or meningitis usually have a poorer neurological outcome.
Acute CNS infection can cause meningoencephalitis, an inflammation of the meninges and brain tissue. Viruses are a common cause, including enterovirus, arbovirus, and herpes virus. These viruses can directly invade and destroy brain cells. Clinical features include acute onset of fever, headache, irritability, and seizures. Diagnosis involves CSF analysis showing lymphocytic predominance and PCR or culture for the infecting virus. Treatment focuses on antivirals like acyclovir for herpes simplex virus. Outcomes depend on the specific virus and extent of brain involvement.
Pediatric meningitis and encephalitis 2021Imran Iqbal
This document provides an overview of pediatric meningitis and encephalitis, including:
1. It discusses the types, epidemiology, clinical features, diagnosis, management, complications, prognosis and prevention of acute bacterial meningitis and viral meningoencephalitis.
2. Key points include the importance of vaccination, the clinical signs and symptoms of each condition, and treatments involving antibiotics, antivirals and supportive care.
3. Rare conditions like cerebral malaria, tuberculous meningitis and SSPE are also briefly covered.
Bronchiolitis is a common viral infection that affects infants under 2 years old, usually caused by RSV. It involves inflammation in the small airways of the lungs. Symptoms include cough, wheezing, difficulty breathing, and low oxygen levels. Infants may require admission if their oxygen levels drop below 94%, respiratory rate is over 70, or they have trouble feeding. Treatment focuses on supportive care like oxygen, feeding support, and nebulized saline. Most infants recover in 4-5 days but cough can last 2-4 weeks.
This document provides an overview of cerebral palsy (CP), including its definition, causes, classifications, clinical manifestations, diagnosis, treatment, and prognosis. CP is a permanent motor disability caused by non-progressive damage to the developing brain. It is classified based on motor type (spastic diplegia, hemiplegia, etc.). Treatment involves a multidisciplinary approach including physiotherapy, orthotics, pharmacotherapy, and surgery to improve mobility and function. Prognosis depends on the type and severity of CP, but a team-based approach aims to maximize development and independence.
Necrotizing enterocolitis is a disease that primarily affects premature infants, causing portions of the intestine to become inflamed and die. It is one of the most serious gastrointestinal diseases in neonates. Risk factors include prematurity, low birth weight, and enteral feeding. Symptoms include abdominal distention, blood in stool, and feeding intolerance. Treatment involves stopping feedings, providing intravenous fluids and antibiotics, and potentially surgery to remove dead intestinal tissue. Complications can include intestinal perforation, stricture, or sepsis. The prognosis depends on severity but the disease has a mortality rate of around 25%.
This document discusses neonatal septic arthritis in India. It begins with an introduction defining septic arthritis and noting the incidence is higher in India (0.6/1000 live births) than Western countries (0.3/1000 live births). There is conflict over several factors regarding neonatal septic arthritis. The pathophysiology involves hematogenous spread of infectious organisms to the joint space, triggering an inflammatory response. Clinical features can be vague but include reduced movement and crying with handling of the affected limb. Risk factors include prematurity, low birth weight, and perinatal infections. The most common causative organisms are Klebsiella and Staphylococcus aureus. Diagnosis involves clinical suspicion plus blood tests, imaging, and
This document discusses neonatal seizures. It begins by defining seizures and describing the different types seen in neonates. The most common type is subtle seizures. Hypoxic ischemic encephalopathy is usually the most common cause, especially within the first 24 hours. Other common causes include intracranial hemorrhage and metabolic disorders. Phenobarbital is the first-line treatment, with phenytoin and benzodiazepines as second-line options. Seizures from subarachnoid hemorrhage or late-onset hypocalcemia typically carry a good prognosis, while those associated with hypoxic ischemic encephalopathy, cerebral malformations or meningitis usually have a poorer neurological outcome.
Acute CNS infection can cause meningoencephalitis, an inflammation of the meninges and brain tissue. Viruses are a common cause, including enterovirus, arbovirus, and herpes virus. These viruses can directly invade and destroy brain cells. Clinical features include acute onset of fever, headache, irritability, and seizures. Diagnosis involves CSF analysis showing lymphocytic predominance and PCR or culture for the infecting virus. Treatment focuses on antivirals like acyclovir for herpes simplex virus. Outcomes depend on the specific virus and extent of brain involvement.
Pediatric meningitis and encephalitis 2021Imran Iqbal
This document provides an overview of pediatric meningitis and encephalitis, including:
1. It discusses the types, epidemiology, clinical features, diagnosis, management, complications, prognosis and prevention of acute bacterial meningitis and viral meningoencephalitis.
2. Key points include the importance of vaccination, the clinical signs and symptoms of each condition, and treatments involving antibiotics, antivirals and supportive care.
3. Rare conditions like cerebral malaria, tuberculous meningitis and SSPE are also briefly covered.
Bronchiolitis is a common viral infection that affects infants under 2 years old, usually caused by RSV. It involves inflammation in the small airways of the lungs. Symptoms include cough, wheezing, difficulty breathing, and low oxygen levels. Infants may require admission if their oxygen levels drop below 94%, respiratory rate is over 70, or they have trouble feeding. Treatment focuses on supportive care like oxygen, feeding support, and nebulized saline. Most infants recover in 4-5 days but cough can last 2-4 weeks.
This document provides an overview of cerebral palsy (CP), including its definition, causes, classifications, clinical manifestations, diagnosis, treatment, and prognosis. CP is a permanent motor disability caused by non-progressive damage to the developing brain. It is classified based on motor type (spastic diplegia, hemiplegia, etc.). Treatment involves a multidisciplinary approach including physiotherapy, orthotics, pharmacotherapy, and surgery to improve mobility and function. Prognosis depends on the type and severity of CP, but a team-based approach aims to maximize development and independence.
Necrotizing enterocolitis is a disease that primarily affects premature infants, causing portions of the intestine to become inflamed and die. It is one of the most serious gastrointestinal diseases in neonates. Risk factors include prematurity, low birth weight, and enteral feeding. Symptoms include abdominal distention, blood in stool, and feeding intolerance. Treatment involves stopping feedings, providing intravenous fluids and antibiotics, and potentially surgery to remove dead intestinal tissue. Complications can include intestinal perforation, stricture, or sepsis. The prognosis depends on severity but the disease has a mortality rate of around 25%.
This document discusses cyanosis in children. It defines cyanosis as a bluish discoloration of the skin caused by increased reduced hemoglobin. There are two types: peripheral cyanosis caused by slowed blood flow and central cyanosis caused by low oxygen saturation. Causes of central cyanosis include respiratory disorders like pneumonia, cardiac disorders like congenital heart diseases, and neurological disorders like seizures. Management involves diagnosis of the underlying cause through history, exams, oxygen testing, and imaging like echocardiograms. Treatment depends on the specific condition but may include oxygen, antibiotics for infection, or surgery for heart defects.
Hydrocephalus is an abnormal increase in cerebrospinal fluid (CSF) within the cranial cavity that results in enlarged ventricles and increased pressure on the brain. It can be caused by obstruction of CSF flow or overproduction of CSF. Common symptoms include headache, vomiting, and enlarged head circumference. Treatment involves managing increased intracranial pressure medically or surgically by placing a shunt to drain CSF and relieve pressure on the brain. Outcomes depend on the cause of hydrocephalus but can include developmental delays and vision problems.
Opisthotonos is a condition characterized by severe muscle spasms that cause arching of the back, bending back of the head and heels, and stiff movement of the hands and arms. It mainly affects babies and children as their nervous systems are not fully developed. Common causes include meningitis, Arnold-Chiari syndrome, subarachnoid hemorrhage, tetanus, and overdose of adrenergic bronchodilators. Symptoms require prompt medical care and treatment depends on the underlying cause, such as antibiotics for conditions caused by brain disorders or surgery to correct structural issues.
Approach to first unprovoked seizure in children uploadAzilah Sulaiman
- One of the most common neurological disorders in children is epilepsy, with over 120,000 children seeing a doctor annually for a new onset seizure. Clinical history is key to determining the likelihood of seizure recurrence after a child experiences their first afebrile seizure. There are 5 important questions to consider: 1) Was it truly an epileptic seizure? 2) What is the cause? 3) Which investigations should be done? 4) Does the child need treatment? 5) What else should be considered? Making an accurate diagnosis, identifying risk factors for recurrence, and considering treatment options on a case-by-case basis are essential in managing a child after their first seizure.
1. Acute flaccid paralysis (AFP) is defined as sudden onset of weakness or paralysis over 15 days in patients under 15 years old. It suggests involvement of the lower motor neuron complex.
2. Common causes of AFP include poliomyelitis, Guillain-Barré syndrome, transverse myelitis, botulism, and non-polio enteroviruses. Clinical features and investigations can help differentiate between these causes.
3. Treatment depends on the underlying etiology but may include supportive care, IV immunoglobulin, plasmapheresis, and corticosteroids. Prognosis ranges from full recovery to residual deficits or death, depending on the cause and extent of
Microcephaly is a head circumference more than 3 standard deviations below the mean. It can be primary/genetic due to defects in cellular migration, neurulation or prosencephalization. Secondary microcephaly has prenatal causes like infections, drugs or postnatal causes like birth injuries or infections. Primary microcephaly is usually autosomal recessive and presents with distinctive facial features and severe intellectual disability. Secondary microcephaly has a varied presentation depending on the cause. Evaluation involves examining for dysmorphism, neurological problems and investigating for possible causes. Treatment focuses on managing symptoms while prevention centers around screening for infections and nutritional supplementation.
This document provides an overview of herpes simplex encephalitis (HSE). It discusses the etiology, epidemiology, pathophysiology, clinical manifestations, diagnosis and treatment of HSE. Key points include: HSE is most commonly caused by HSV-1 and is a leading cause of viral encephalitis in children; presentation varies from non-specific symptoms to seizures, altered mental status and focal neurological deficits; diagnosis involves CSF analysis, neuroimaging and PCR testing; and treatment involves high-dose intravenous acyclovir administered for at least 21 days. Recurrence of HSE is possible due to viral reactivation or immune-mediated processes.
Acute flaccid paralysis (AFP) is characterized by sudden onset of weakness or paralysis over a period of 15 days in patients under 15 years old. The most common causes of AFP are poliomyelitis, Guillain-Barré syndrome, and transverse myelitis. Poliomyelitis is caused by poliovirus and typically causes asymmetric flaccid paralysis that may lead to long-term disabilities. Guillain-Barré syndrome is an acute inflammatory disorder of peripheral nerves caused by post-infectious autoimmunity. Transverse myelitis is spinal cord inflammation that causes symmetric paralysis of the lower limbs.
Seminar on pulmonary hemorrhage in newborn by Dr. Habib, Dr. AshfaqDr. Habibur Rahim
Pulmonary hemorrhage is bleeding into the lungs that commonly affects premature infants. It presents with bloody secretions from the endotracheal tube and causes rapid clinical deterioration. Risk factors include prematurity, respiratory problems, sepsis, and mechanical ventilation. The pathophysiology involves stress on capillaries from transmural pressure, alveolar surface tension, and lung inflation. Management focuses on supportive care like ventilation, volume expansion, and transfusions to improve oxygenation and stop the bleeding. Prognosis depends on the severity and underlying causes, with mortality up to 50% in very premature infants.
1. The document discusses different types of seizures including focal onset seizures, generalized onset seizures, and seizures of unknown onset. It provides definitions and examples of motor and non-motor seizures.
2. Etiologies of seizures in the neonatal period and beyond are outlined, including infections, metabolic disorders, brain malformations, drugs/poisons, and epilepsy syndromes.
3. Febrile seizures are defined as seizures associated with fever in children between 6-60 months old. Simple febrile seizures are brief and do not recur within 24 hours, while complex febrile seizures are prolonged or recurrent.
This document provides an outline for performing a neurological assessment of a child. It discusses obtaining a thorough history, performing a general physical exam including anthropometry, and examining the child's higher mental functions, cranial nerves, motor system, and sensory system. The neurological exam involves developmentally appropriate assessment of reflexes, signs of meningeal irritation, and tests of specific regions like the head, eyes, and muscles. Close attention is paid to examining infants and assessing normal neurologic growth.
Clinically, more term babies suffered from hypoxic ischemic encephalopathy (HIE) than premature babies. However, pathologically, more premature babies suffered from HIE than term babies. HIE manifests clinically as symptoms of consciousness changes that can be excitatory like seizures or depressing like coma. Treatment of HIE focuses on monitoring, controlling seizures, maintaining circulation and glucose levels, with therapies like hypothermia and investigates like amplitude integrated EEG shown to improve outcomes. The prognosis depends on the severity of brain damage and treatment, with mild cases often having a full recovery but severe cases having a high risk of mortality or neurological sequele like cerebral palsy.
Coma is defined as an unresponsive state with closed eyes lasting less than 24 hours that requires medical intervention. Common causes of pediatric coma include trauma, drowning, infection, metabolic disorders, and lack of oxygen or blood flow to the brain. The initial priorities for treatment are stabilizing breathing, circulation, blood sugar, and other vital functions, as well as identifying and treating any underlying medical issues causing the coma. Outcomes depend on the underlying cause, with complete recovery more likely after toxic or metabolic comas, while severe injuries like trauma or hypoxia often result in long-term neurological impairments.
Vitamin K deficiency in newborns can cause a condition called haemorrhagic disease of the newborn (HDN) where there is bleeding due to a lack of vitamin K dependent clotting factors. Newborns are especially vulnerable because of minimal vitamin K transfer from mother and lack of intestinal bacteria. HDN presents as bleeding from the GI tract, skin, or brain. It is classified as early, classical or late-onset depending on timing. Treatment involves vitamin K supplementation while serious or intracranial bleeding may require transfusions. Prophylactic vitamin K shots at birth can prevent most cases of HDN.
Cerebral palsy is a group of disorders that affect movement and posture, caused by damage to the developing brain before or during birth. It involves motor disturbances as well as disturbances of sensation, perception, cognition, communication, and behavior. The main types are spastic, dyskinetic, and ataxic. Cerebral palsy is diagnosed through physical examination, neurological assessment, and imaging tests like MRI and CT scan. Treatment involves physical, occupational, speech, and recreational therapy to improve mobility and function. Medications can help reduce spasticity and seizures, while surgery may correct orthopedic issues. Nursing care focuses on supporting therapies, ensuring nutrition, and educating families.
Central nervous system involvement is a common cause of hypotonia in infants. A thorough history and physical exam seeks to determine if the origin is central or peripheral. Key aspects of the exam include assessing for proximal versus distal weakness, deep tendon reflexes, and distribution of weakness. Investigations such as EMG, nerve conduction studies, muscle biopsy and genetic testing can help characterize disorders of the motor unit to establish a diagnosis. Narrowing the likely etiology is important to guide management and prognostic expectations.
Cerebral palsy is a group of disorders that affect movement and posture as a result of non-progressive damage to the developing brain. It has an incidence of 3 per 1000 children and is commonly caused by cerebral malformations in developed countries and perinatal asphyxia in developing countries. Clinically, it presents with delayed development, abnormal muscle tone and posture, seizures, and intellectual disability. Diagnosis involves assessing developmental history and physical signs of spasticity, contractures, and hyperreflexia. Management is multi-disciplinary and includes medications, physiotherapy, orthotics, and occasionally surgery. Prognosis depends on severity of deficits and early intervention, with earlier ability to sit associated with later ability to
The document contains summaries of 20 OSCE pediatric stations including questions on Down syndrome with esophageal atresia, typhoid vaccination recommendations, hemoglobin disorders, muscular dystrophies, transverse myelitis, Ehlers Danlos syndrome, pulmonary sequestration, Reiter's syndrome, enterobiasis, cleidocranial dysplasia, Wilson's disease, spinal cord injuries, Meckel's scan, congenital hypothyroidism, hemophilia A, neurocysticercosis and their diagnoses and management. The stations cover ethics, clinical examination, choice of investigations, interpretations of tests and forming differential diagnoses.
This document provides information on cerebral palsy, including its definition, causes, classifications, clinical features, complications, investigations, management, and rehabilitation. Cerebral palsy is defined as a static encephalopathy caused by an insult to the developing brain before age 2 that results in motor and/or posture handicaps. It is classified based on etiology, topography, physiology, and functional ability. Spastic cerebral palsy is the most common type. Management involves a multidisciplinary rehabilitation approach including medications, nutrition, physical, occupational, speech, and dental therapies, and surgery if needed. The goals of rehabilitation are to improve functions, develop compensatory abilities, and maximize independence.
This document discusses cyanosis in children. It defines cyanosis as a bluish discoloration of the skin caused by increased reduced hemoglobin. There are two types: peripheral cyanosis caused by slowed blood flow and central cyanosis caused by low oxygen saturation. Causes of central cyanosis include respiratory disorders like pneumonia, cardiac disorders like congenital heart diseases, and neurological disorders like seizures. Management involves diagnosis of the underlying cause through history, exams, oxygen testing, and imaging like echocardiograms. Treatment depends on the specific condition but may include oxygen, antibiotics for infection, or surgery for heart defects.
Hydrocephalus is an abnormal increase in cerebrospinal fluid (CSF) within the cranial cavity that results in enlarged ventricles and increased pressure on the brain. It can be caused by obstruction of CSF flow or overproduction of CSF. Common symptoms include headache, vomiting, and enlarged head circumference. Treatment involves managing increased intracranial pressure medically or surgically by placing a shunt to drain CSF and relieve pressure on the brain. Outcomes depend on the cause of hydrocephalus but can include developmental delays and vision problems.
Opisthotonos is a condition characterized by severe muscle spasms that cause arching of the back, bending back of the head and heels, and stiff movement of the hands and arms. It mainly affects babies and children as their nervous systems are not fully developed. Common causes include meningitis, Arnold-Chiari syndrome, subarachnoid hemorrhage, tetanus, and overdose of adrenergic bronchodilators. Symptoms require prompt medical care and treatment depends on the underlying cause, such as antibiotics for conditions caused by brain disorders or surgery to correct structural issues.
Approach to first unprovoked seizure in children uploadAzilah Sulaiman
- One of the most common neurological disorders in children is epilepsy, with over 120,000 children seeing a doctor annually for a new onset seizure. Clinical history is key to determining the likelihood of seizure recurrence after a child experiences their first afebrile seizure. There are 5 important questions to consider: 1) Was it truly an epileptic seizure? 2) What is the cause? 3) Which investigations should be done? 4) Does the child need treatment? 5) What else should be considered? Making an accurate diagnosis, identifying risk factors for recurrence, and considering treatment options on a case-by-case basis are essential in managing a child after their first seizure.
1. Acute flaccid paralysis (AFP) is defined as sudden onset of weakness or paralysis over 15 days in patients under 15 years old. It suggests involvement of the lower motor neuron complex.
2. Common causes of AFP include poliomyelitis, Guillain-Barré syndrome, transverse myelitis, botulism, and non-polio enteroviruses. Clinical features and investigations can help differentiate between these causes.
3. Treatment depends on the underlying etiology but may include supportive care, IV immunoglobulin, plasmapheresis, and corticosteroids. Prognosis ranges from full recovery to residual deficits or death, depending on the cause and extent of
Microcephaly is a head circumference more than 3 standard deviations below the mean. It can be primary/genetic due to defects in cellular migration, neurulation or prosencephalization. Secondary microcephaly has prenatal causes like infections, drugs or postnatal causes like birth injuries or infections. Primary microcephaly is usually autosomal recessive and presents with distinctive facial features and severe intellectual disability. Secondary microcephaly has a varied presentation depending on the cause. Evaluation involves examining for dysmorphism, neurological problems and investigating for possible causes. Treatment focuses on managing symptoms while prevention centers around screening for infections and nutritional supplementation.
This document provides an overview of herpes simplex encephalitis (HSE). It discusses the etiology, epidemiology, pathophysiology, clinical manifestations, diagnosis and treatment of HSE. Key points include: HSE is most commonly caused by HSV-1 and is a leading cause of viral encephalitis in children; presentation varies from non-specific symptoms to seizures, altered mental status and focal neurological deficits; diagnosis involves CSF analysis, neuroimaging and PCR testing; and treatment involves high-dose intravenous acyclovir administered for at least 21 days. Recurrence of HSE is possible due to viral reactivation or immune-mediated processes.
Acute flaccid paralysis (AFP) is characterized by sudden onset of weakness or paralysis over a period of 15 days in patients under 15 years old. The most common causes of AFP are poliomyelitis, Guillain-Barré syndrome, and transverse myelitis. Poliomyelitis is caused by poliovirus and typically causes asymmetric flaccid paralysis that may lead to long-term disabilities. Guillain-Barré syndrome is an acute inflammatory disorder of peripheral nerves caused by post-infectious autoimmunity. Transverse myelitis is spinal cord inflammation that causes symmetric paralysis of the lower limbs.
Seminar on pulmonary hemorrhage in newborn by Dr. Habib, Dr. AshfaqDr. Habibur Rahim
Pulmonary hemorrhage is bleeding into the lungs that commonly affects premature infants. It presents with bloody secretions from the endotracheal tube and causes rapid clinical deterioration. Risk factors include prematurity, respiratory problems, sepsis, and mechanical ventilation. The pathophysiology involves stress on capillaries from transmural pressure, alveolar surface tension, and lung inflation. Management focuses on supportive care like ventilation, volume expansion, and transfusions to improve oxygenation and stop the bleeding. Prognosis depends on the severity and underlying causes, with mortality up to 50% in very premature infants.
1. The document discusses different types of seizures including focal onset seizures, generalized onset seizures, and seizures of unknown onset. It provides definitions and examples of motor and non-motor seizures.
2. Etiologies of seizures in the neonatal period and beyond are outlined, including infections, metabolic disorders, brain malformations, drugs/poisons, and epilepsy syndromes.
3. Febrile seizures are defined as seizures associated with fever in children between 6-60 months old. Simple febrile seizures are brief and do not recur within 24 hours, while complex febrile seizures are prolonged or recurrent.
This document provides an outline for performing a neurological assessment of a child. It discusses obtaining a thorough history, performing a general physical exam including anthropometry, and examining the child's higher mental functions, cranial nerves, motor system, and sensory system. The neurological exam involves developmentally appropriate assessment of reflexes, signs of meningeal irritation, and tests of specific regions like the head, eyes, and muscles. Close attention is paid to examining infants and assessing normal neurologic growth.
Clinically, more term babies suffered from hypoxic ischemic encephalopathy (HIE) than premature babies. However, pathologically, more premature babies suffered from HIE than term babies. HIE manifests clinically as symptoms of consciousness changes that can be excitatory like seizures or depressing like coma. Treatment of HIE focuses on monitoring, controlling seizures, maintaining circulation and glucose levels, with therapies like hypothermia and investigates like amplitude integrated EEG shown to improve outcomes. The prognosis depends on the severity of brain damage and treatment, with mild cases often having a full recovery but severe cases having a high risk of mortality or neurological sequele like cerebral palsy.
Coma is defined as an unresponsive state with closed eyes lasting less than 24 hours that requires medical intervention. Common causes of pediatric coma include trauma, drowning, infection, metabolic disorders, and lack of oxygen or blood flow to the brain. The initial priorities for treatment are stabilizing breathing, circulation, blood sugar, and other vital functions, as well as identifying and treating any underlying medical issues causing the coma. Outcomes depend on the underlying cause, with complete recovery more likely after toxic or metabolic comas, while severe injuries like trauma or hypoxia often result in long-term neurological impairments.
Vitamin K deficiency in newborns can cause a condition called haemorrhagic disease of the newborn (HDN) where there is bleeding due to a lack of vitamin K dependent clotting factors. Newborns are especially vulnerable because of minimal vitamin K transfer from mother and lack of intestinal bacteria. HDN presents as bleeding from the GI tract, skin, or brain. It is classified as early, classical or late-onset depending on timing. Treatment involves vitamin K supplementation while serious or intracranial bleeding may require transfusions. Prophylactic vitamin K shots at birth can prevent most cases of HDN.
Cerebral palsy is a group of disorders that affect movement and posture, caused by damage to the developing brain before or during birth. It involves motor disturbances as well as disturbances of sensation, perception, cognition, communication, and behavior. The main types are spastic, dyskinetic, and ataxic. Cerebral palsy is diagnosed through physical examination, neurological assessment, and imaging tests like MRI and CT scan. Treatment involves physical, occupational, speech, and recreational therapy to improve mobility and function. Medications can help reduce spasticity and seizures, while surgery may correct orthopedic issues. Nursing care focuses on supporting therapies, ensuring nutrition, and educating families.
Central nervous system involvement is a common cause of hypotonia in infants. A thorough history and physical exam seeks to determine if the origin is central or peripheral. Key aspects of the exam include assessing for proximal versus distal weakness, deep tendon reflexes, and distribution of weakness. Investigations such as EMG, nerve conduction studies, muscle biopsy and genetic testing can help characterize disorders of the motor unit to establish a diagnosis. Narrowing the likely etiology is important to guide management and prognostic expectations.
Cerebral palsy is a group of disorders that affect movement and posture as a result of non-progressive damage to the developing brain. It has an incidence of 3 per 1000 children and is commonly caused by cerebral malformations in developed countries and perinatal asphyxia in developing countries. Clinically, it presents with delayed development, abnormal muscle tone and posture, seizures, and intellectual disability. Diagnosis involves assessing developmental history and physical signs of spasticity, contractures, and hyperreflexia. Management is multi-disciplinary and includes medications, physiotherapy, orthotics, and occasionally surgery. Prognosis depends on severity of deficits and early intervention, with earlier ability to sit associated with later ability to
The document contains summaries of 20 OSCE pediatric stations including questions on Down syndrome with esophageal atresia, typhoid vaccination recommendations, hemoglobin disorders, muscular dystrophies, transverse myelitis, Ehlers Danlos syndrome, pulmonary sequestration, Reiter's syndrome, enterobiasis, cleidocranial dysplasia, Wilson's disease, spinal cord injuries, Meckel's scan, congenital hypothyroidism, hemophilia A, neurocysticercosis and their diagnoses and management. The stations cover ethics, clinical examination, choice of investigations, interpretations of tests and forming differential diagnoses.
This document provides information on cerebral palsy, including its definition, causes, classifications, clinical features, complications, investigations, management, and rehabilitation. Cerebral palsy is defined as a static encephalopathy caused by an insult to the developing brain before age 2 that results in motor and/or posture handicaps. It is classified based on etiology, topography, physiology, and functional ability. Spastic cerebral palsy is the most common type. Management involves a multidisciplinary rehabilitation approach including medications, nutrition, physical, occupational, speech, and dental therapies, and surgery if needed. The goals of rehabilitation are to improve functions, develop compensatory abilities, and maximize independence.
Outline of presentation
Introduction
Epidemiology
Etiology
Clinical manifestations
Diagnosis
Treatment
INTRODUCTION
Cerebral palsy (CP) refers to a heterogeneous group of conditions involving permanent nonprogressive central motor dysfunction that affect muscle tone, posture, and movement.
These conditions are due to abnormalities of the developing fetal or infantile brain resulting from a variety of causes.
The motor impairment generally results in limitations in functional abilities and activity which can range in severity.
The motor disorders are often accompanied by disturbances of sensation , perception, cognition, communication, and behavior as well as by epilepsy and secondary musculoskeletal problems.
CP has historically been considered a static encephalopathy, but some of the neurologicfeatures of CP, such as movement disorders and orthopedic complications can change or progress over time.
Many children and adults with CP function at a high educational and vocational level,without any sign of cognitive dysfunction
Etiology
CP is caused by a broad group of
Developmental,
Genetic,
Metabolic,
Ischemic,
Infectious, and
Other acquired etiologies
Epidemiology
CP is the most common and costly form of chronic motor disability that begins in childhood
Incidence is 3.6 per 1,000 children with a male: female ratio of 1.4 : 1.
Most children with CP had been born at term with uncomplicated labors anddeliveries
Risk factors
Prematurity and VLBW
Heavy maternal alcohol consumption,
Maternal smoking,
Maternal obesity, and
Infections during pregnancy
In 80% of cases, features were identified pointing to antenatal factors causing abnormal brain development
Fewer than 10% of children with CP had evidence of intrapartum asphyxia
Intrauterine exposure to maternal infection (chorioamnionitis, urinary tract infection) was associated with a significant increase in the risk of CP in normal birthweight infants.
Multiple pregnancy was also associated with a higher incidence of CP
Death of a twin in utero carries an even greater risk of CP
Infertility treatments are also associated with a higher rate of CP
CP is more common and more severe in boys than girls, and this effect is enhanced at the extremes of body weight
Elevated levels of inflammatory cytokines have been reported in heelstick blood collected at birth from children who later were identified with CP.
The prevalence of CP has increased somewhat as a result of the enhanced survival of very premature infants weighing < 1,000 g, who go on to develop CP at a rate of ~ 15 per 100.
However, the GA at birth adjusted prevalence of CP among 2 yr old former premature infants born at 20-27 wk of gestation has decreased over the past decade
The major lesions that contribute to CP in preterm infants are intracerebral hemorrhage and periventricular leukomalacia (PVL).
Cerebral palsy (CP) is a group of disorders that affect movement and posture, caused by non-progressive brain damage early in development. It is characterized by abnormal muscle tone or movement, and often accompanied by disturbances of sensation, perception, cognition, communication, and behavior. CP can be caused by various genetic and acquired factors that result in brain abnormalities before, during, or after birth. While historically considered static, some features of CP may change over time. Treatment requires a multidisciplinary approach to manage symptoms, prevent complications, and improve function through therapies, medications, surgery, and equipment.
An Introduction to Cerebral Palsy and Hypoxic Ischaemic Encephalopathymeducationdotnet
Cerebral Palsy is a non-progressive brain lesion that occurs during development and causes motor impairment. The document discusses CP, including defining it as a motor disorder resulting from a brain lesion before maturity. It also outlines the main causes of CP as being prenatal, perinatal, or postnatal events. The classifications of CP are described as spastic, ataxic, or dyskinetic. Hypoxic-ischemic encephalopathy (HIE) is presented as a major cause of CP, with hypothermia therapy emerging as an effective intervention for reducing brain injury in newborns with HIE.
Cerebral palsy is a non-progressive disorder affecting movement and posture, often with associated epilepsy, vision, speech, and intellectual impairments, resulting from brain lesions or defects during development. It is the most common motor disability in childhood, affecting 2-2.5 per 1,000 children in the US. Causes include prematurity, genetic factors, infections, and brain injuries during prenatal, perinatal, or postnatal periods. Common types are spastic diplegia, hemiplegia, and quadriplegia. Diagnosis involves assessing abnormal movements, tone, reflexes and ruling out other causes through history and examination.
Cerebral palsy- Etiology and ClassificationLibin Thomas
This document provides an overview of cerebral palsy, including:
1) The history of cerebral palsy, first identified by William Little in 1843.
2) The etiology and risk factors, which can include prenatal, perinatal, and postnatal brain insults between conception and age 2.
3) The classification of cerebral palsy by anatomical region affected (monoplegia, hemiplegia, diplegia, etc.) and physiological type (spastic, athetoid, ataxic, etc.). Spastic is the most common type, affecting the corticospinal tracts.
This document provides information on cerebral palsy (CP), including its definition, causes, classifications, clinical manifestations, diagnosis and treatment. CP is a permanent motor disability caused by brain insult during development. It is classified based on affected motor function and includes spastic diplegia, quadriplegia and hemiplegia. Treatment involves a multidisciplinary team to address motor impairments, prevent complications, and support normal development through therapies and adaptive equipment.
Cerebral Palsy: PT assessment and ManagementSurbala devi
Cerebral palsy (CP) is a group of disorders caused by damage to the developing brain before, during or after birth. It affects movement and posture, and can cause physical disability. The main types are spastic, athetoid, ataxic and hypotonic CP. Symptoms vary depending on the type and severity. CP is diagnosed based on signs of impaired motor development and abnormal muscle tone or movement. There is no cure for CP, but treatment aims to improve ability and quality of life through therapies and medications.
1. Acute flaccid paralysis (AFP) is defined as sudden onset of weakness or paralysis over 15 days in patients under 15 years old. It suggests involvement of the lower motor neuron complex.
2. Common causes of AFP include poliomyelitis, Guillain-Barré syndrome, transverse myelitis, botulism, and non-polio enteroviruses. Clinical features and investigations can help differentiate between these causes.
3. Treatment depends on the underlying etiology but may include supportive care, IV immunoglobulin, plasmapheresis, and corticosteroids. Prognosis ranges from full recovery to residual deficits or death, depending on the cause and extent of
This 3-year-old male presented with weight loss, chest and leg pain for 3 months. Imaging showed an extensive metastatic neuroblastoma. Biopsy of a chest mass confirmed poorly differentiated neuroblastoma. The patient began induction chemotherapy and supportive care. Prognostic factors including age, tumor histology, MYCN status and staging indicated a high-risk neuroblastoma requiring aggressive multimodal therapy.
HIE has been one of the problems facing newborns due to birth asphyxia caused by variety of conditions during child birth or after childbirth, i hope the readers will learn something from the slides
Progeria is an extremely rare genetic condition where children age rapidly, experiencing many signs of aging at a very early age. It affects about 1 in 4-8 million births. The main symptoms include baldness, wrinkled skin, joint stiffness, loss of body fat and muscle, and cardiovascular problems. Average life expectancy is 13 years. While there is no cure, treatments can help manage symptoms and slow progression, such as low-dose aspirin, physical therapy, and lifestyle modifications. Progeria is caused by a genetic mutation and provides insight into normal human aging processes.
This document provides an outline and overview of asphyxia management. It begins with definitions of related terms like anoxia, hypoxia, and discusses perinatal asphyxia. It then covers clinical features like signs seen in mild, moderate and severe hypoxic-ischemic encephalopathy. Investigations discussed include MRI, CT, ultrasound and EEG. Management involves supportive care, anticonvulsants, fluid management, glucose control and therapeutic hypothermia to reduce secondary brain injury.
Spinal tuberculosis can lead to serious deformities and neurological deficits if left untreated. It is most commonly caused by hematogenous spread from the lungs. Diagnosis involves clinical history, imaging studies like x-rays and MRI, and laboratory tests. Treatment consists of a combination of chemotherapy for at least 18 months and surgery if indicated to decompress the spinal cord and correct deformities. With early detection and proper management, spinal tuberculosis can be cured with good long-term outcomes.
SYBPO - Orthotics.This presentation consists of all the pathological reasons affecting the lower extremity causing various deformities. it consists of Cerebral Palsy, polio, CDH etc.
this presentation is about the spondylosis of the cervical region.
there is information about cervical spondylosis, its etiology, epidemiology, sign symptoms and its treatment options.
This document contains summaries of several pediatric endocrinology case studies presented as multiple choice questions. It discusses the following key points in 3 sentences:
1) A case of a 7-year-old girl with short stature is presented, and bone age assessment is identified as the most appropriate initial diagnostic investigation.
2) An 18-month-old boy with increasing bowing of the legs is described, and Blount's disease, which causes inward bowing of the tibia, is identified as the most likely diagnosis based on the presented x-ray findings.
3) An 8-week-old infant with fractures during birth and eye changes is discussed, and osteogenesis imperfecta, which
1. The patient is a 70-year old woman who presents with jerky movements of her right hand for the past four months and a history of diabetes. After examination and investigations, the neurologist suspects Parkinson's disease.
2. As the SHO, your task is to explain the diagnosis of Parkinson's disease to the patient, answer her questions, and discuss the prognosis, treatment options, and social impacts of the disease.
3. It is important to explain the illness in layman's terms, discuss the likely progression, available medical and surgical treatments, and how the disease may affect her daily activities and family relationships.
Hearing loss (Ear Nose and Throat)... By Shapi.pdfShapi. MD
The document discusses hearing loss, its classification, causes, and terminology. It defines hearing loss as a deficiency in hearing capacity from normal levels (0-20db) and classifies it as either conductive, affecting the external auditory meatus to oval window, or sensorineural, affecting the oval window to the inferior temporal gyrus. Hearing loss is also graded from mild to profound based on decibel levels. Causes of hearing loss are classified as congenital, including infections and drugs during pregnancy, or acquired, including wax buildup, trauma, infections like otitis media, tumors, meningitis, acoustic trauma, drugs, ageing, and more.
Allergic Rhinitis( Ear Nose and Throat).... By Shapi.pdfShapi. MD
This document discusses allergic rhinitis, also known as hay fever. It begins by explaining the immunological mechanisms behind the immediate and late phase reactions to airborne allergens. Common symptoms include nasal congestion, sneezing, and itchy eyes. Diagnosis involves skin testing or blood tests to identify IgE antibodies to specific allergens. Treatment focuses on avoidance of triggers, antihistamines, decongestants, and nasal corticosteroid sprays. Complications can include secondary infection, sinusitis or decreased pulmonary function if left untreated.
Otitis Media and Otitis Externa... By Shapi.pdfShapi. MD
This document discusses otitis media and otitis externa. It provides definitions and classifications of different types of otitis media such as acute otitis media, recurrent AOM, and otitis media with effusion. It describes the pathogenesis, symptoms, investigations, management including medications and surgery, as well as complications. For otitis externa it defines acute diffuse and circumscribed forms and chronic, eczematous, and necrotizing types. It lists causes and risk factors for each condition.
HERPES ZOSTER OTICUS (Ramsey Hunt's Syndrome).. By Shapi.pdfShapi. MD
The document discusses Herpes Zoster Oticus (Ramsey Hunt's Syndrome), caused by invasion of the geniculate ganglion and CN VIII nerve ganglia by the herpes zoster virus. This produces severe ear pain, hearing loss that may be permanent or recover partially, vertigo lasting days to weeks, and transient or permanent facial nerve palsy with loss of taste in the front two-thirds of the tongue. Investigation shows increased lymphocytes and protein in cerebrospinal fluid. Treatment involves prompt corticosteroid therapy, acyclovir for 10 days to shorten the clinical course, codeine for pain relief, and diazepam to suppress vertigo.
The document discusses bronchiectasis, a chronic lung condition characterized by permanent dilatation of the bronchi. It causes include congenital disorders, past infections, and idiopathic cases. Common symptoms are persistent cough, copious sputum, and intermittent coughing of blood. Investigations include sputum culture, chest x-ray, and high-resolution CT scan of the chest. Management involves airway clearance techniques, antibiotics, bronchodilators, and sometimes surgery for severe cases.
Introduction to GI Medicine.... By Shapi.pdfShapi. MD
Dr. Chongo Shapi provides an overview of common gastrointestinal conditions and definitions. These include leucoplakia, aphthous ulcers, candidiasis, cheilitis, and glossitis. Investigative procedures for gastrointestinal issues like sigmoidoscopy, colonoscopy, upper endoscopy, duodenal biopsy, and liver biopsy are also outlined. Risks, preparations, and procedures for each test are described. The document aims to introduce common terms and investigations in gastrointestinal medicine.
Hypoglycemia (As in the ER)...... By Shapi.pdfShapi. MD
This document discusses hypoglycemia, including its symptoms, causes, investigation, and treatment. Hypoglycemia is defined as a plasma glucose level less than or equal to 3mmol/L and can cause brain damage or death if severe or prolonged. Symptoms include autonomic symptoms like sweating and hunger as well as neuroglycopenic symptoms like confusion and seizures. Causes in diabetics are most commonly insulin or sulfonylurea treatment, while in non-diabetics include drugs, liver failure, and rare tumors. Investigation involves documenting blood glucose and symptoms during attacks. Treatment of conscious patients involves carbohydrate intake, while unconscious patients require intravenous or intramuscular glucose or glucagon administration.
Biochemistry of Carbohydrates.. By Shapi.pdfShapi. MD
1. Carbohydrates are an essential part of biochemistry and serve important functions in the body. They include sugars, starches, and fibers.
2. Monosaccharides like glucose and fructose are the simplest forms of carbohydrates and cannot be broken down further. They undergo various reactions and participate in metabolic pathways.
3. Derangements in carbohydrate metabolism can lead to disorders like diabetes, while inherited deficiencies of enzymes cause diseases like glycogen storage disorders and galactosemia.
Anatomy of the GLUTEAL REGION........ By Shapi.pdfShapi. MD
The gluteal region contains important muscles and structures. It is bounded superiorly by the iliac crest, medially by the intergluteal cleft, and inferiorly by the gluteal fold. The main muscles are the gluteus maximus, medius, and minimus. The gluteus maximus is the largest muscle and extends the hip. The medius and minimus are important abductors of the hip. Other short rotator muscles include the piriformis, obturator internus, gemelli, and quadratus femoris. Major nerves are branches of the sacral plexus and vessels are branches of the internal iliac artery.
BioChemistry of Lipids......... By Shapi.Shapi. MD
This document discusses lipids and fatty acids. It defines lipids and outlines their structural features and classification. Lipids are classified into simple lipids, compound lipids, and derived lipids. The document discusses the biomedical importance of lipids as important dietary constituents, building materials, and as carriers of fat-soluble vitamins. It also summarizes the different types of fatty acids including saturated, unsaturated, essential fatty acids, and eicosanoids derived from polyunsaturated fatty acids.
Acute Coronary Syndromes and Angina.. By Shapi.Shapi. MD
Angina pectoris is a symptom of reversible myocardial ischemia characterized by chest pain or discomfort due to an imbalance between myocardial oxygen supply and demand. It is usually precipitated by exertion or stress and relieved by rest. The document discusses the causes, types, clinical features, investigations, and management of angina pectoris and acute coronary syndromes.
Pneumonia (Community Aqcuired and Hospital Aqcuired).. By ShapiShapi. MD
This document discusses pneumonia, including its causes, classification, symptoms, investigations, management, complications, and types. Pneumonia can be community-acquired, hospital-acquired, or occur in immunocompromised patients. Common causes include Streptococcus pneumoniae, Haemophilus influenzae, Mycoplasma pneumoniae, and Legionella pneumophila. Severity is assessed using CURB-65 scoring. Management involves antibiotics, oxygen therapy, IV fluids, and ICU care for severe cases. Complications include pleural effusions, abscesses, respiratory failure, and sepsis.
Development Urinary system by Shapi. MD.pdfShapi. MD
A well summarized presentation on the Basics in the science of the Human Anatomy that'll effectively deliver information in an incredibly remarkable way to the reader.
DEVELOPMENT OF RESPIRATORY SYSTEM by Shapi. MD.pdfShapi. MD
A well summarized presentation on the Basics in the science of the Human Anatomy that'll effectively deliver information in an incredibly remarkable way to the reader.
A well summarized presentation on the Basics in the science of the Human Anatomy that'll effectively deliver information in an incredibly remarkable way to the reader.
Bilaminar and trilaminar discs formation.pdfShapi. MD
The document discusses embryology, specifically the formation of the bilaminar and trilaminar germ discs. It describes how during the second week of development, the blastocyst differentiates into trophoblast layers and the inner cell mass forms the hypoblast and epiblast. Extraembryonic mesoderm and the chorionic plate then develop. In the third week, gastrulation occurs as the epiblast differentiates into the three germ layers - ectoderm, mesoderm, and endoderm - from which all tissues and organs develop. Diagrams are included showing notochord formation.
Gametogenesis and Pre-ebryonic life by Shapi. MDpdfShapi. MD
A well summarized presentation on the Basics in the science of the Human Anatomy that'll effectively deliver information in an incredibly remarkable way to the reader.
NOTOCHORD, NEURULATION AND NTDs by Shapi. MD.pdfShapi. MD
The document discusses embryology and neural tube defects. It includes diagrams of notochord formation and neurulation. Neural tube defects discussed include myelomeningocele, meningocele, spina bifida occulta, and hydrocephalus. The document was authored by Dr. Chongo Shapi, a medical doctor, and contains 15 pages with diagrams related to embryology and neural tube development.
A review of the growth of the Israel Genealogy Research Association Database Collection for the last 12 months. Our collection is now passed the 3 million mark and still growing. See which archives have contributed the most. See the different types of records we have, and which years have had records added. You can also see what we have for the future.
This presentation includes basic of PCOS their pathology and treatment and also Ayurveda correlation of PCOS and Ayurvedic line of treatment mentioned in classics.
Walmart Business+ and Spark Good for Nonprofits.pdfTechSoup
"Learn about all the ways Walmart supports nonprofit organizations.
You will hear from Liz Willett, the Head of Nonprofits, and hear about what Walmart is doing to help nonprofits, including Walmart Business and Spark Good. Walmart Business+ is a new offer for nonprofits that offers discounts and also streamlines nonprofits order and expense tracking, saving time and money.
The webinar may also give some examples on how nonprofits can best leverage Walmart Business+.
The event will cover the following::
Walmart Business + (https://business.walmart.com/plus) is a new shopping experience for nonprofits, schools, and local business customers that connects an exclusive online shopping experience to stores. Benefits include free delivery and shipping, a 'Spend Analytics” feature, special discounts, deals and tax-exempt shopping.
Special TechSoup offer for a free 180 days membership, and up to $150 in discounts on eligible orders.
Spark Good (walmart.com/sparkgood) is a charitable platform that enables nonprofits to receive donations directly from customers and associates.
Answers about how you can do more with Walmart!"
This slide is special for master students (MIBS & MIFB) in UUM. Also useful for readers who are interested in the topic of contemporary Islamic banking.
How to Make a Field Mandatory in Odoo 17Celine George
In Odoo, making a field required can be done through both Python code and XML views. When you set the required attribute to True in Python code, it makes the field required across all views where it's used. Conversely, when you set the required attribute in XML views, it makes the field required only in the context of that particular view.
A workshop hosted by the South African Journal of Science aimed at postgraduate students and early career researchers with little or no experience in writing and publishing journal articles.
Chapter wise All Notes of First year Basic Civil Engineering.pptxDenish Jangid
Chapter wise All Notes of First year Basic Civil Engineering
Syllabus
Chapter-1
Introduction to objective, scope and outcome the subject
Chapter 2
Introduction: Scope and Specialization of Civil Engineering, Role of civil Engineer in Society, Impact of infrastructural development on economy of country.
Chapter 3
Surveying: Object Principles & Types of Surveying; Site Plans, Plans & Maps; Scales & Unit of different Measurements.
Linear Measurements: Instruments used. Linear Measurement by Tape, Ranging out Survey Lines and overcoming Obstructions; Measurements on sloping ground; Tape corrections, conventional symbols. Angular Measurements: Instruments used; Introduction to Compass Surveying, Bearings and Longitude & Latitude of a Line, Introduction to total station.
Levelling: Instrument used Object of levelling, Methods of levelling in brief, and Contour maps.
Chapter 4
Buildings: Selection of site for Buildings, Layout of Building Plan, Types of buildings, Plinth area, carpet area, floor space index, Introduction to building byelaws, concept of sun light & ventilation. Components of Buildings & their functions, Basic concept of R.C.C., Introduction to types of foundation
Chapter 5
Transportation: Introduction to Transportation Engineering; Traffic and Road Safety: Types and Characteristics of Various Modes of Transportation; Various Road Traffic Signs, Causes of Accidents and Road Safety Measures.
Chapter 6
Environmental Engineering: Environmental Pollution, Environmental Acts and Regulations, Functional Concepts of Ecology, Basics of Species, Biodiversity, Ecosystem, Hydrological Cycle; Chemical Cycles: Carbon, Nitrogen & Phosphorus; Energy Flow in Ecosystems.
Water Pollution: Water Quality standards, Introduction to Treatment & Disposal of Waste Water. Reuse and Saving of Water, Rain Water Harvesting. Solid Waste Management: Classification of Solid Waste, Collection, Transportation and Disposal of Solid. Recycling of Solid Waste: Energy Recovery, Sanitary Landfill, On-Site Sanitation. Air & Noise Pollution: Primary and Secondary air pollutants, Harmful effects of Air Pollution, Control of Air Pollution. . Noise Pollution Harmful Effects of noise pollution, control of noise pollution, Global warming & Climate Change, Ozone depletion, Greenhouse effect
Text Books:
1. Palancharmy, Basic Civil Engineering, McGraw Hill publishers.
2. Satheesh Gopi, Basic Civil Engineering, Pearson Publishers.
3. Ketki Rangwala Dalal, Essentials of Civil Engineering, Charotar Publishing House.
4. BCP, Surveying volume 1
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How to Setup Warehouse & Location in Odoo 17 InventoryCeline George
In this slide, we'll explore how to set up warehouses and locations in Odoo 17 Inventory. This will help us manage our stock effectively, track inventory levels, and streamline warehouse operations.
How to Setup Warehouse & Location in Odoo 17 Inventory
Cerebral Palsy (CP).pdf
1. PAEDIATRICS AND CHILD HEALTH
• Paediatrics and Child Health
• Cerebral Palsy (CP)
Dr. Chongo Shapi (BSc.HB, MBChB)
- Medical Doctor
3/20/2022 Dr. Chongo Shapi, BSc.HB, MBChB, CUZ. 1
2. Definition
• Cerebral = cerebrum, Palsy = disorder of
movement
• Is a diagnostic umbrella term used to describe a
group of motor syndromes (posture, movement
and coordination) which is caused by a NON-
PROGRESSIVE “insult” to the motor control centres
of an immature brain (developing brain) usually
prenatally
3/20/2022 Dr. Chongo Shapi, BSc.HB, MBChB, CUZ. 2
3. • It is associated with:
1. Epilepsy
2. Abnormalities in:
a. Speech
b. Vision
c. Hearing
d. Swallowing (oromotor dysfunction = OMD),
hence FTT
e. Behaviour
f. Mental retardation
3/20/2022
Dr. Chongo Shapi, BSc.HB, MBChB, CUZ.
.
3
4. • Although historically considered a static
encephalopathy (loosely “brain paralysis”), this term
is not entirely accurate
• This is because of the recognition that the neurologic
features of CP often change or progress over time
• Many children and adults with CP function at a high
educational and vocational level
• These have no sign of the type of cognitive dysfunction
that is generally implied by the term encephalopathy
• CP is the leading cause of childhood disability affecting
function and development
3/20/2022
Dr. Chongo Shapi, BSc.HB, MBChB, CUZ.
.
4
5. • CP is restricted to lesions of the brain only (CNS)
• Diseases specific to the peripheral nerves of the
spinal cord or to muscles although causing early
motor abnormalities, are not considered cerebral
palsy:
1. Peripheral nerves of the spinal cord e.g. spinal
muscular atrophy, myelomeningocele
2. Muscles e.g. muscular dystrophies
3/20/2022 Dr. Chongo Shapi, BSc.HB, MBChB, CUZ. 5
6. • The brain lesions of CP occur from the fetal or
neonatal period to up to the age of 3 years
• Insults to the brain after age 3 years may manifest
clinically as similar or identical to CP
• By definition, these lesions are not CP
• Despite the lesion to the developing brain
occurring before age 3 years, the diagnosis of CP
may not be made until after that time
3/20/2022 Dr. Chongo Shapi, BSc.HB, MBChB, CUZ. 6
7. • Some authorities advocate not making a
definitive diagnosis in selected cases until age 5
years or later
• This approach allows the clinical picture to be
clear and potentially allows exclusion of
progressive diseases
• In addition, some children have been diagnosed
with CP at an early age, only to have the
symptoms resolve later
3/20/2022
Dr. Chongo Shapi, BSc.HB, MBChB, CUZ.
.
7
8. Aetiology of CP
• The causes are broad:
1. Developmental e.g. prematurity
2. Ischemic causes e.g. birth asphyxia
3. Infections (TORCHES)
4. Genetic causes
5. Metabolic causes
6. Other acquired aetiologies that produce a common
group of neurologic phenotypes
NB: Prematurity usually causes the spastic diplegic type
while birth asphyxia usually causes the athetoid type
3/20/2022 Dr. Chongo Shapi, BSc.HB, MBChB, CUZ. 8
9. Classification of CP
• Classification is according to resting tone and what
limbs are involved (called topographic
predominance)
• Is a combination of both anatomy and physiology:
1. Spastic (pyramidal) : 80%
- Damage is to the pyramidal tract (UMNL)
- Hence, there are UMNL signs
- Subtypes: (diplegia, hemiplegia, quadriplegia and
monoplegia)
3/20/2022 Dr. Chongo Shapi, BSc.HB, MBChB, CUZ. 9
10. Subtypes of spastic CP:
a. Diplegia: 30-40%
- Bilateral spasticity of the legs greater than in the arms
b. Hemiplegia: 20-30%
- Ipsilateral spasticity of both upper and lower limbs
- Upper extremity more than lower extremity
- E.g. right side involved with right arm more than right leg
c. Quadriplegia : 10-15%
- Marked motor impairment of all extremities
d. Monoplegia
- Rare
- Involvement is noted in 1 limb, either an arm or a leg
- If a patient has monoplegia, an effort should be made to rule
out causes other than CP
3/20/2022 Dr. Chongo Shapi, BSc.HB, MBChB, CUZ. 10
11. Classification of CP
2. Extrapyramidal (Athetoid, dyskinetic) : 10-15%
- Damage is to the basal ganglia
- Abnormal movements (athetosis, chorea,
bradykinesia/akinesia)
- Hypotonia and
- No UMNL signs
3. Ataxic/Hypotonic: < 5%
- Damage is to the cerebellum
- Truncal and extremity hypotonia with
- Hyperreflexia and persistent primitive reflexes
4. Mixed
- No single specific tonal quality predominating
- Typically characterized by a mixture of spastic and dyskinetic
components
3/20/2022 Dr. Chongo Shapi, BSc.HB, MBChB, CUZ. 11
13. Risk factors for CP
1. Prenatal
- Pre-eclampsia
- Congenital malformations in the
fetus
- Polyhydramnios
- Maternal seizure disorder
- Male sex of fetus
- APH
- IUGR
- Multiple gestation
2. Perinatal
- Prematurity
- Birth asphyxia
- Chorioamnionitis
- Nonvertex and face presentation
of the fetus
3. Postnatal
- Infections (eg, meningitis,
encephalitis)
- Intracranial hemorrhage (eg,
due to prematurity, vascular
malformations, or trauma)
- Periventricular leukomalacia (in
premature infants)
- Hypoxia-ischemia (eg, from
meconium aspiration)
- Persistent fetal circulation
- Kernicterus
3/20/2022 Dr. Chongo Shapi, BSc.HB, MBChB, CUZ. 13
14. Clinical Manifestations
• Presentation is usually after failing to meet expected
growth motor developmental milestones or failing to
suppress obligatory primitive reflexes in the first year of life
• Abnormal muscle tone is the most frequently observed
symptom
• CP frequently manifests as early hypotonia for the first 6
months to 1 year of life, followed by spasticity
• The longer the period of hypotonia before hypertonia, the
greater the likelihood that the hypertonia will be more
severe
• Asymmetric crawling or failure to crawl
• Growth disturbance especially with FTT
• Review other systems to evaluate for multiple
complications that can occur with CP
3/20/2022 Dr. Chongo Shapi, BSc.HB, MBChB, CUZ. 14
15. Clinical Manifestations
Spastic diplegia
• Bilateral spasticity of the legs greater than in the
arms
• 1st often noted when an affected infant begins to
crawl
• Child uses the arms in a normal reciprocal fashion but
tends to drag the legs behind more as a rudder
(commando crawl) rather than using the normal four-
limbed crawling movement
• If the spasticity is severe, application of a diaper is
difficult because of the excessive adduction of the
hips
• Child may be unable to sit if there is paraspinal muscle
involvement
3/20/2022 Dr. Chongo Shapi, BSc.HB, MBChB, CUZ. 15
16. Clinical Manifestations
• Neurologic examination reveals UMNL signs
• If child is suspended by the axillae, a scissoring
posture of the lower extremities is maintained
• Walking is significantly delayed, feet held in a
position of equinovarus, and the child walks on
tiptoe
• Severe spastic diplegia is characterized by:
- Disuse atrophy
- Impaired growth of the lower extremities
- Disproportionate growth with normal
development of the upper torso
3/20/2022 Dr. Chongo Shapi, BSc.HB, MBChB, CUZ. 16
17. Clinical Manifestations
• Prognosis for normal intellectual development is
excellent for these patients
• Likelihood of seizures is minimal
• The most common neuropathologic finding is PVL
• This is in particular in the area where fibers
innervating the legs course through the internal
capsule
• MRI is very useful for evaluating the severity of
white matter injury and for excluding other brain
lesions
3/20/2022 Dr. Chongo Shapi, BSc.HB, MBChB, CUZ. 17
18. Clinical Manifestations
Spastic hemiplegia:
• Definite hand preference before age 1 year is a
red flag for possible hemiplegia
• The arm is often more involved than the leg and
difficulty in hand manipulation is obvious by 1 yr
of age
• Walking is usually delayed until 18–24 mo, and a
circumductive gait is apparent
• Examination of the extremities may show growth
arrest, particularly in the hand and thumbnail
3/20/2022 Dr. Chongo Shapi, BSc.HB, MBChB, CUZ. 18
19. Clinical Manifestations
• This is especially if the contralateral parietal lobe
is abnormal because extremity growth is
influenced by this area of the brain
• Spasticity is apparent in the affected extremities,
particularly the ankle, causing an equinovarus
deformity of the foot
• An affected child often walks on tiptoe because
of the increased tone
• Affected upper extremity assumes a dystonic
posture when the child runs
3/20/2022 Dr. Chongo Shapi, BSc.HB, MBChB, CUZ. 19
20. Clinical Manifestations
• UMNL signs may be present:
- Babinski sign
- Increased deep tendon reflexes
- Ankle clonus
- Weakness of the hand and foot dorsiflexors
• About 1/3rd of patients with spastic hemiplegia
have a seizure disorder
• This usually develops in the 1st year or 2
• About 25% have cognitive abnormalities including
mental retardation
3/20/2022 Dr. Chongo Shapi, BSc.HB, MBChB, CUZ. 20
21. Clinical Manifestations
• CT scan or MRI may show an atrophic cerebral
hemisphere with a dilated lateral ventricle
contralateral to the side of the affected extremities
• MRI is far more sensitive than CT for most lesions
seen with CP
• CT scan may be useful for detecting calcifications
associated with TORCHES infections
• Focal cerebral infarction (stroke) secondary to
intrauterine or perinatal thromboembolism is a vital
cause of hemiplegic CP
• The thromboembolism is related to thrombophilic
disorders, especially anticardiolipin antibodies
3/20/2022 Dr. Chongo Shapi, BSc.HB, MBChB, CUZ. 21
22. Clinical Manifestations
Spastic quadriplegia
• Is the most severe form of CP because of:
1. Marked motor impairment of all extremities and
2. High association with mental retardation and
seizures
3. Swallowing difficulties due to supranuclear bulbar
palsies, leading to aspiration pneumonia
4. Developmental disabilities
5. Speech and visual abnormalities
• The most common lesions seen on MRI scanning are
severe PVL and multicystic cortical encephalomalacia
3/20/2022 Dr. Chongo Shapi, BSc.HB, MBChB, CUZ. 22
23. • Neurologic examination shows UMNL signs
• Flexion contractures of the knees and elbows are
often present by late childhood
• Associated developmental disabilities, including
speech and visual abnormalities, are particularly
prevalent in this group of children
• Children with spastic quadriparesis often have
evidence of athetosis and may be classified as
having mixed CP
3/20/2022 Dr. Chongo Shapi, BSc.HB, MBChB, CUZ. 23
24. Clinical Manifestations
Athetoid or Choreoathetoid or Extrapyramidal CP
• Referred to in Europe as dyskinetic CP
• Characteristically hypotonic with poor head
control and marked head lag
• Develop increased variable tone with rigidity and
dystonia over several years
• Feeding may be difficult
• Tongue thrust and drooling may be prominent
• Speech is typically affected because the
oropharyngeal muscles are involved
3/20/2022 Dr. Chongo Shapi, BSc.HB, MBChB, CUZ. 24
25. Clinical Manifestations
• Absent of speech or sentences are slurred
• Deafness is common
• UMNL signs are not present
• Seizures are uncommon
• Intellect is preserved in many patients
• Extrapyramidal CP is the type most likely to be
associated with:
1. Birth asphyxia
2. Kernicterus
3. Metabolic genetic disorders e.g. mitochondrial
genetic disorders and glutaric aciduria
3/20/2022 Dr. Chongo Shapi, BSc.HB, MBChB, CUZ. 25
26. Clinical Manifestations
• Extrapyramidal CP secondary to birth asphyxia is
associated with bilaterally symmetric lesions in the
posterior putamen and ventrolateral thalamus
• The lesions appear to correlate the neuropathologic
lesion called status marmoratus in the basal ganglia
• MRI scan shows lesions in the globus pallidus
bilaterally
3/20/2022 Dr. Chongo Shapi, BSc.HB, MBChB, CUZ. 26
27. Complications of CP
MSS
Orthopaedic complications:
- Contractures leading to talipes equinovarus
- Hip dislocation
- Osteoporosis in wheelchair-bound patients or those with
ambulatory dysfunction
- Scoliosis
Integumentary
- Decubitus ulcers and sores
Respiratory system
- Aspiration pneumonia because of OMD
- Chronic lung disease/bronchopulmonary dysplasia
- Bronchiolitis/asthma
3/20/2022 Dr. Chongo Shapi, BSc.HB, MBChB, CUZ. 27
28. Complications of CP
GIT/Nutritional
- FTT (malnutrition) due to feeding and swallowing
difficulties secondary to OMD
- Patients may require a gastrostomy tube (G-tube)
or a jejunostomy tube (J-tube) to augment
nutrition
- Obesity less common than FTT
- Gastroesophageal reflux
- Constipation
3/20/2022 Dr. Chongo Shapi, BSc.HB, MBChB, CUZ. 28
29. Complications of CP
GIT/Nutritional
- Dental problems: dental caries, enamel
dysgenesis, malocclusion, and gingival
hyperplasia
- Increased incidence of dental problems is often
secondary to the use of medications, especially
drugs administered to premature infants and
antiepileptic agents
3/20/2022 Dr. Chongo Shapi, BSc.HB, MBChB, CUZ. 29
30. Complications of CP
Nervous system
- Epilepsy (15-60%), more in spastic quadriplegia
- Speech abnormalities
- Deafness (particularly in patients who had
kernicterus)
- Visual-field abnormalities due to cortical injury
- Strabismus
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31. Nervous system
- Cognitive/psychologic/behavioral:
• Mental retardation (30-50%), most common with
spastic quadriplegia
• Attention-deficit/hyperactivity disorder (ADHD)
• Learning disabilities which has an impact on
academic performance and self-esteem
• Increased prevalence of depression
• Increased prevalence of progressive development
disorder or autism associated with concurrent
diagnosis of cerebral palsy
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32. Diagnosis of CP
• The diagnosis of cerebral palsy is generally made
based on the clinical picture
• A thorough history and physical examination
should preclude a progressive disorder of the CNS
• This include degenerative diseases, metabolic
disorders, spinal cord tumour, or muscular
dystrophy
• However, some authors propose that the diagnosis
should be deferred until the child is age 2 years or
older
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33. Diagnosis of CP
• Rule out anomalies at the base of the skull or
cervical spinal cord in patients with little
involvement of the arms or cranial nerves
• MRI or CT scans of the brain/spinal cord are
indicated to determine the location and extent of
structural lesions or associated congenital
malformations
• Audiometry and ophthalmological (visual acuity)
tests
• Genotyping should be considered in patients with
congenital malformations (chromosomes) or
evidence of metabolic disorders
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34. Differential diagnosis
• Inherited metabolic disorders
• Hereditary spastic paraplegia
• Rett syndrome
• Metabolic myopathies
• Metabolic neuropathy
• Movement disorders in individuals with
developmental disabilities
• Traumatic peripheral nerve lesions
• Tumors of the conus and cauda equina
• Vascular malformations of the spinal cord
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35. Investigations
• Neuroimaging
- Cranial USS, CT, MRI: intracranial haemorrhage, HIE,
PVL, hydrocephalus
- EEG (seizure disorder)
- Electromyography (EMG) and nerve conduction
studies
• Laboratory (not definitive)
- TFTs to rule out hypothyroidism: TSH, T4, T3
- Lactate and pyruvate: metabolic abnormalities
- Chromosomal analysis (Genotyping)
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36. Treatment
Must be individualized based on the child's clinical
presentation and requires a multidisciplinary
approach:
Physiatrists Orthopaedic surgeons
Neurosurgeons Ophthalmologists
Gastroenterologists Geneticists
Nutritionist Pulmonologists
Occupational therapists Speech pathologists
Social workers Educators
Developmental psychologists
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37. Treatment
• Patients need to be rehabilitated
• Rehabilitation is a comprehensive intervention
strategy designed to facilitate adaptation to and
participation in an increasing number and variety
of settings in a particular society and culture
• Neurologists and physiatrists play significant roles
in the management of anti-spasticity medications
• The paediatrician’s responsibility is to closely
supervise and manage the multiple medical
complications associated with cerebral palsy
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38. Treatment
Physiatrist/Physiotherapists/Rehabilitation therapists
• Consulted for the evaluation and management of the
rehabilitation program
• Help with many aspects of care including spasticity
management
• May also administer IM botulinum toxin type A
Orthopaedic surgeons
• Correct any structural deformities
• Surgical management of hip dislocation, scoliosis, and
spasticity (eg, tenotomy, a tendon-lengthening
procedure)
• May also administer intramuscular botulinum toxin
type A
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39. Treatment
Neurosurgeons
• Treat hydrocephalus, a tethered spinal cord, or spasticity
• Perform the dorsal rhizotomy procedure
Neurologists
• Help with differential diagnosis and with ruling out other
neurologic disorders
• Treatment of seizures
Geneticists
• May help with the differential diagnosis and with ruling out
other disorders
• To evaluate for an underlying genetic syndrome, particularly in
the setting of dysmorphic features, multiple organ
abnormalities, or a family history of a similar neurologic
syndrome
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40. Treatment
Gastroenterologist, nutritionist, and
feeding/swallowing team
• Manage feeding and swallowing difficulties and
GORD
• Assesses nutritional status so that child does not
suffer from growth failure or nutritional
deficiencies
Pulmonologists
• Manage chronic pulmonary disease due to
bronchopulmonary dysplasia and frequent or
recurrent aspiration
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41. Treatment
Learning disability team
• Identifies specific learning disabilities, monitor cognitive
progression, and guide services through early intervention
and school
• Guide speech and language treatment and the use of
communicative devices
Others:
Ophthalmologists/ENT/dentists/endocrinologists
• Ophthalmologist: visual deficits
• ENT: hearing difficulties
• Dentists: dental checks up
• Endocrinologist: precocious puberty or treatment of
osteoporosis
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42. Medications in CP
• Antispasmodics/muscle
relaxants
- Bolinum toxin type A (Botox)
- Baclofen
- Benzodiazepines e.g. diazepam
- Dantrolene sodium
- Alpha 2- Adrenergic agonists
e.g. Tizanidine
• Anticholinergics (decrease
secretions and also tremors)
- Trihexyphenidyl (Atane)
• Anticonvulsants
- Phenobarbitone
- Levetiracetam
- Valproic acid
• Dopamine prodrugs
- Levodopa/carbidopa
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43. Neurosurgery and Orthopaedic Surgery
• Intrathecal baclofen pump insertion
• Selective dorsal rhizotomy
• Stereotactic basal ganglia
• Orthopaedic surgical intervention
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44. Selective dorsal rhizotomy
• Is a neurosurgical treatment that may be beneficial
in both the short term and long term to treat
velocity-dependent spasticity
• This procedure includes a laminectomy and then
surgical ablation of 70-90% of the dorsal or
sensory nerve roots
• Selective dorsal rhizotomy decreases spasticity by
decreasing reflexive motoneuron activation, which
is thought to result from the lack of descending
fiber input
• This surgery has come to be performed less
frequently since the advent of the baclofen pump
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45. Selective dorsal rhizotomy
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A: After laminectomy, the dura is opened and the dorsal spinal rootlets are exposed.
The rootlets are stimulated so that abnormal rootlet activity can be identified
B: A proportion of rootlets are transected