Craniosynostosis is the premature fusion of skull sutures, restricting skull growth in some areas and enhancing it in others. The main types are:
- Scaphocephaly from sagittal suture fusion, causing a long narrow head.
- Trigonocephaly from metopic suture fusion, pushing the forehead forward in a triangular shape.
- Plagiocephaly from unilateral coronal or lambdoid fusion, causing an asymmetric "skewed" head shape.
- Brachycephaly from bilateral coronal fusion, restricting forward and backward growth for a short wide head.
- Oxycephaly from coronal plus other suture fusion,
all about brain tumors. clinical presentation of brain tumors also CT scan MRI of different tumors available to interpret the tumors of brain and spinal cord.
Hydrocephalus
introduction
Hydrocephalus, also known years ago as “water on the brain”, is a condition where the circulation system of the body’s cerebrospinal fluid (CSF) is not functioning properly. The CSF accumulates in the brain and causes intracranial pressure. A shunt is usually placed to equalize the flow of CSF, which requires surgery. The diagnosis and surgery can be very frightening for the parents as well as the child
definition
Hydrocephalus is a condition characterized by an excess of cerebrospinal fluid (CSF) within the ventricular and subarachnoid spaces of the cranial cavity
INCIDENCE
It is found in 1-3 of every 1000 born children in world wide
Classification
Non communicating. In the non communicating type of congenital hydrocephalus, an obstruction occurs in the free circulation of CSF.
Communicating. In the communicating type of hydrocephalus, no obstruction of the free flow of the CSF exists between the ventricles and the spinal theca; rather, the condition is caused by defective absorption of CSF, thus causing increased pressure on the brain or spinal cord.
CAUSES
Obstruction. The most common problem is a partial obstruction of the normal flow of CSF, either from one ventricle to another or from the ventricles to other spaces around the brain.
Poor absorption. Less common is a problem with the mechanisms that enable the blood vessels to absorb CSF; this is often related to inflammation of brain tissues from disease or injury.
Overproduction. Rarely, the mechanisms for producing CSF create more than normal and more quickly than it can be absorbed.
PATHOPHYSIOLOGY
CLINICAL MANIFESTATION
Poor feeding. The infant with hydrocephalus has trouble in feeding due to the difficulty of his condition.
Large head. An excessively large head at birth is suggestive of hydrocephalus.
Bulging of the anterior fontanelles. The anterior fontanelle becomes tense and bulging, the skull enlarges in all diameters, and the scalp becomes shiny and its veins dilate.
Setting sun sign. If pressure continues to increase without intervention, the eyes appear to be pushed downward slightly with the sclera visible above the iris- the so-called setting sun sign.
High-pitched cry. The intracranial pressure may increase and the infant’s cry could become high-pitched.
Irritability. Irritability is also caused by an increase in the intracranial pressure.
Projectile vomiting. An increase in the intracranial pressure can cause projectile vomiting
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conclusions
all about brain tumors. clinical presentation of brain tumors also CT scan MRI of different tumors available to interpret the tumors of brain and spinal cord.
Hydrocephalus
introduction
Hydrocephalus, also known years ago as “water on the brain”, is a condition where the circulation system of the body’s cerebrospinal fluid (CSF) is not functioning properly. The CSF accumulates in the brain and causes intracranial pressure. A shunt is usually placed to equalize the flow of CSF, which requires surgery. The diagnosis and surgery can be very frightening for the parents as well as the child
definition
Hydrocephalus is a condition characterized by an excess of cerebrospinal fluid (CSF) within the ventricular and subarachnoid spaces of the cranial cavity
INCIDENCE
It is found in 1-3 of every 1000 born children in world wide
Classification
Non communicating. In the non communicating type of congenital hydrocephalus, an obstruction occurs in the free circulation of CSF.
Communicating. In the communicating type of hydrocephalus, no obstruction of the free flow of the CSF exists between the ventricles and the spinal theca; rather, the condition is caused by defective absorption of CSF, thus causing increased pressure on the brain or spinal cord.
CAUSES
Obstruction. The most common problem is a partial obstruction of the normal flow of CSF, either from one ventricle to another or from the ventricles to other spaces around the brain.
Poor absorption. Less common is a problem with the mechanisms that enable the blood vessels to absorb CSF; this is often related to inflammation of brain tissues from disease or injury.
Overproduction. Rarely, the mechanisms for producing CSF create more than normal and more quickly than it can be absorbed.
PATHOPHYSIOLOGY
CLINICAL MANIFESTATION
Poor feeding. The infant with hydrocephalus has trouble in feeding due to the difficulty of his condition.
Large head. An excessively large head at birth is suggestive of hydrocephalus.
Bulging of the anterior fontanelles. The anterior fontanelle becomes tense and bulging, the skull enlarges in all diameters, and the scalp becomes shiny and its veins dilate.
Setting sun sign. If pressure continues to increase without intervention, the eyes appear to be pushed downward slightly with the sclera visible above the iris- the so-called setting sun sign.
High-pitched cry. The intracranial pressure may increase and the infant’s cry could become high-pitched.
Irritability. Irritability is also caused by an increase in the intracranial pressure.
Projectile vomiting. An increase in the intracranial pressure can cause projectile vomiting
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conclusions
Encephaloceles are rare birth defects associated with skull defects characterized by partial lacking of bone fusion leaving a gap through which a portion of the brain sticks out (protrudes).
Hydrocephalous is a serious disease of the central nervous system which has both congenital and aquired subtypes. the congenital variety affects the children and is a considerable burden especially is the developing countries. I tleads to long term morbidity and high rates of mortality
Management of hypoxic ischemic encephalopathy (HIE) by Sunil Kumar Dahasunil kumar daha
Please find the power point on Management of hypoxic ischemic encephalopathy (HIE) . I tried to present it on understandable way and all the contents are reviewed by experts and from very reliable references. Thank you
Encephaloceles are rare birth defects associated with skull defects characterized by partial lacking of bone fusion leaving a gap through which a portion of the brain sticks out (protrudes).
Hydrocephalous is a serious disease of the central nervous system which has both congenital and aquired subtypes. the congenital variety affects the children and is a considerable burden especially is the developing countries. I tleads to long term morbidity and high rates of mortality
Management of hypoxic ischemic encephalopathy (HIE) by Sunil Kumar Dahasunil kumar daha
Please find the power point on Management of hypoxic ischemic encephalopathy (HIE) . I tried to present it on understandable way and all the contents are reviewed by experts and from very reliable references. Thank you
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdfJim Jacob Roy
Cardiac conduction defects can occur due to various causes.
Atrioventricular conduction blocks ( AV blocks ) are classified into 3 types.
This document describes the acute management of AV block.
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
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2. Hydrocephalus
Hydrocephalus is a condition characterized by an excess of cerebrospinal fluid (CSF)
within the ventricular and subarachnoid spaces of the cranial cavity .
Normally a delicate balance exists between the rate of formation and absorption of
CSF: the entire volume is absorbed and replaced every 12 to 24 hours. In
hydrocephalus, this balance is disturbed.
Hydrocephalus may be recognized at birth, or it may not be evident until after a few
weeks or months of life
3.
4.
5. CSF ( cerebro spinal fluid )
It is a clear, colorless body fluid found in the brain and spinal cord.
It is produced by the specialized ependymal cells in the choroid plexuses of the
ventricles of the brain, and absorbed in the arachnoid granulations .
About 20 ml of CSF is secreted in an hour .
About 500mL is generated every day
8. Functions of CSF
CSF acts as a cushion or buffer for the brain, providing basic
mechanical and immunological protection to the brain inside the skull.
Serves a vital function in cerebral autoregulation of cerebral blood
flow .
Carry nutrient to the brain and spinal cord and remove waste
substances .
9. Etiology
Congenital hydrocephalus
Intrauterine infections: Rubella, cytomegalovirus, toxoplasmosis, intracranial
bleeds, intraventricular haemorrhage .
Congenital malformations: Aqueduct stenosis, Dandy-Walker syndrome
(posterior fossa cyst continuous with fourth ventricle), Arnold-Chiari syndrome
(portions of cerebellum and brainstem herniating into cervical spinal canal, blocking
the flow of CSF to the posterior fossa) ,Midline tumors obstructing CSF flow .
11. Classification
Communicating hydrocephalus - There is no blockage in the CSF pathway but
reabsorption may be affected. Excess CSF may be produced in papilloma of choroid
plexus.
Obstructive or non communicating hydrocephalus - The block is at any level in the
ventricular system, commonly at the level of aqueduct or foramen of Luschka and
Magendie . This blockage causes increased pressure on the brain or spinal cord .
12. Clinical Manifestations
Enlarging head size
Delayed closure of fontanel and sutures .
Associated symptoms include headache, nausea, vomiting, personality
and behavior disturbances such as irritability, head banging, apathy
and drowsiness .
Scalp veins become prominent and dilated.
Papilledema, pyramidal tract signs and cranial nerve palsies may occur
13. Cont.…..
Sun set sign
Macewen sign
Distortion of the brainstem may lead to bradycardia,
systemic hypertension and altered respiration rate .
15. Management
Medical Management : only in mild cases
• Acetazolamide at a dose of 25-100 mg/kg/day
diminishes CSF production in mild, slowly
progressive hydrocephalus .
• Oral glycerol has also been used for similar
purpose
16. Surgical Management
Ventriculoperitonial(VP)shunt :
A catheter is inserted into the ventricle with
tubing tunnelled subcutaneously down the
thorax and then further tunnelled into the
peritoneal cavity where the CSF is absorbed.
VP shunt drains excess CSF and decreases
the pressure in brain .
17. Shunt systems
It has three components:
(1) a ventricular catheter
(2) a one way valve
(3) a distal catheter
The ventricular catheter is a straight piece of
tubing, closed on the proximal end and usually
with multiple holes for the entry of CSF along
the proximal two centimeters of the tube
18. Complications of VP shunt
Infection
Blockage
Symptoms of shunt malfunction or infection include headache, fever, drowsiness
, convulsions, increased head circumference and bulging fontanelle .
19. ventriculoatrial (VA) Shunt
The CSF is shunted from the cerebral ventricles into the right atrium of the heart. The
CSF is then shunted directly into the blood circulation.
A silicon catheter is inserted in lateral ventricle & down through the internal jugular vein
into left atrium of the heart .
It is reserved for older children who have attained most of their somatic growth &
children with abdominal pathology. It requires repeated lengthening as child grows
20.
21. Ventriculopleural shunt
This type of shunt drains fluid from the lateral ventricle to the pleural cavity .Drainage of the CSF
may cause hydrothorax, necessitating either removal of the shunt or a thoracentesis.
22. Third ventriculostomy
It is a surgical procedure for treatment of hydrocephalus in which an opening is
created in the floor of the third ventricle using an endoscope placed within the
ventricular system through a burr hole .
it is used for no communicating obstructive hydrocephalus
23.
24. Nursing Management
Assessment :
Obtaining accurate vital and neurologic signs is necessary before and after surgery.
Measurement of the newborn’s head is essential.
If the fontanelles are not closed, carefully observe them for any signs of bulging.
Observe, report, and document all signs of Increase ICP.
Determine the level of knowledge family members have about the condition
25. Nursing diagnosis
Ineffective cerebral Tissue Perfusion related to Increased intracranial
pressure
Assess vital signs hourly, noting for any irregularity in breathing and heart
rate and rhythm and measure the pulse pressure .
Measure the head circumference and appearance of anterior fontanelle
Elevate the head of the bed gradually about 15-45 degrees as indicated
Administer diuretics, carbonic hydrase, corticosteroids as ordered .
Assess neurological status (such as mental status, motor, and balance,
reflexes )
26. Risk for Impaired Skin Integrity related to pressure from physical immobility
Assess the general condition of the patient
keep the newborn’s head turned away from the operative site until the physician allows a
change in position .
Inspect the dressings over the shunt site immediately after the surgery, every hour for
the first 3 to 4 hours
Maintain the aseptic techniques .
Assess the pressure points frequently (sacrum. Heels, bones)
Deficient Knowledge related to the family’s understanding of the child’s condition and
home care
Encourage the parents to provide as normal lifestyle as possible
Explain how to recognize signs and symptoms of increased ICP. Subtle signs include changes in
school performance,intermittent headache, and mild behaviour changes
Encourage the child to participate in age appropriate activities as tolerated.
Encourage the parents to provide as normal lifestyle as possible.
27. Risk for Infection related to the presence of a shunt.
Monitor the signs & symptoms of infection
Follow aseptic technique for performing any procedure to the patient to prevent the
chances of infection
Administer antibiotics as prescribed.
Provide drain care , catheter care to the patient .
Anxiety related to the family caregiver’s fear of the surgical outcome
Explain to the family the condition and the surgical procedure .
Encourage them to express their anxieties and ask questions
Provide feedback to the family in their understandable terms .
Clear thee doubts of the family
Provide counselling
29. Definition
spina bifida is a failure of the posterior laminae of the vertebrae to close;
this leaves an opening through which the spinal meninges and spinal cord
may protrude .
It is a neural tube defect
Due to deficiency of folic acid and zinc .
30. Etiology
Maternal risk factors include zinc and folate deficiency, alcohol, radiation
exposure, insulin dependent diabetes mellitus (IDDM), and use of valproate and
carbamazepine during pregnancy .
Family history - Previous NTD affected pregnancy increses risk that a woman
will have another NTD-affected pregnancy
Obesity
Genetic Factors - genetic condition such as Patau's syndrome, Edwards'
syndrome or Down's syndrome.
Race/ethnicity (NTDs are more common among white women than black
women, and more common among Hispanic women than non-Hispanic women
32. Spina Bifida Occulta
Occult means hidden
The outer part of some of the vertebrae is not completely closed.
The splits in the vertebrae are so small that the spinal cord does not protrude.
The skin at the site of the lesion may be normal, or it may have some hair growing
from it; there may be a dimple in the skin, or a birthmark.
33.
34. Spina bifida cystica
Meningocele: A posterior meningocele is the least common form of spina bifida.
In this form, a single developmental defect allows the meninges to herniate between
the vertebrae.
As the nervous system remains undamaged, individuals with meningocele are
unlikely to suffer long-term health problems
No nerve roots are involved, so no paralysis or sensory loss below the lesion appears
The sac may rupture or perforate, introducing infection into the spinal fluid and
causing meningitis
35.
36. Myelomeningocele
The most severe of all forms of Spina Bifida.
The spinal cord and dura mater protrudes from the opening in the spine. Because
the spinal cord leaves the protective bone tube of the spine and grows in the sack,
damage to the nerves occur at this point.
In some cases, the skin covering the area will be absent requiring surgical closure
Complete paralysis involves the lower trunk and legs, as well as bowel and bladder
sphincters
37.
38.
39. Clinical Manifestations
Physical problems :
Leg weakness and paralysis
Orthopedic abnormalities (i.e., club foot, hip dislocation, scoliosis)
Bladder and bowel control problems, including incontinence, urinary tract infections, and
poor kidney function
Pressure sores and skin irritations
Abnormal eye movement
40. Cont.…
Neurological problems :
The Arnold Chiari II malformation
Hydrocephalus also occurs because the displaced cerebellum interferes with the
normal flow of cerebrospinal fluid, causing an excess of the fluid to accumulate
Academic problem :
Individuals with spina bifida may struggle academically, especially in the subjects of
mathematics and reading
41. Diagnostic Evaluation
AFP level - An elevated AFP level in the maternal serum or amniotic fluid indicates the
probability of central nervous system abnormalities .
Fetal ultrasound - Open spina bifida can usually be detected during pregnancy by fetal
ultrasound.
Genetic counseling and genetic testing – Amniocentesis ( performed at 14 and 16
weeks gestation.)
(MRI), ultrasonography, computed tomography (CT), and myelography
42. Prevention
Primary prevention includes preconception folate supplementation to all
prospective mothers
Counseling of family with a previous child with NTD is essential
Folate supplementation reduces recurrence risk by 70%. Zinc and vitamin A
supplementation is also advised .
Dose for primary prevention is 0.4 mg per day. A mother who has previously
delivered a child with NTD should receive 4 mg per day of folic acid in subsequent
pregnancies
43. Surgical Management
Surgery includes closure of the defect and a VP shunt (if associated with
hydrocephalus). Early closure prevents neurological deterioration.
Open lesions draining CSF should be closed within 24 hr. Closed lesions should
be operated within 48 hr.
44. Lorber's criteria for selective surgery : Surgery is not recommended if
there is severe
paraplegia at or below L3 level
kyphosis or scoliosis
gross hydrocephalus, associated gross congenital anomalies
intracerebral birth injuries and neonatal ventriculitis before closure of back
.
45. Nursing Management
Risk for Infection related to vulnerability of the myelomeningocele sac
Risk for Injury related to neuromuscular impairment
Compromised Family Coping related to the perceived loss of the perfect newborn
Deficient Knowledge of the family caregivers related to the complexities of caring for a
newborn with serious neurologic and musculoskeletal defect
47. Definition
Craniosynostosis is the premature fusion of one or more cranial sutures, either major (e.g.
metopic, coronal, sagittal, and lambdoid) or minor (frontonasal, temporosquamosal, and
frontosphenoidal ) .
Virchow's law dictates that, when premature suture closure occurs, growth of the skull typically
is restricted perpendicularly to the fused suture and enhanced in a plane parallel to it, thus trying
to provide space for the fast-growing brain
The resulting skull deformity is termed as scaphocephaly, plagiocephaly or trigonocephaly based
on the suture involved.
48.
49. Scaphocephaly
Premature sagittal suture closure restricts growth in a perpendicular plane, thus the head will
not grow sideways and will remain narrow .
Compensatory growth occurs forward at the coronal suture and backward at the lambdoid
suture giving respectively a prominent forehead, called frontal bossing, and a prominent back
portion of the head, called coning .
When viewed from sideways the resulting shape of the head will look a bit like a boat
50.
51. Trigonocephaly
Results from the premature closure of the metopic suture.
Compensatory growth occurs at both the coronal sutures, thereby pushing the forehead
forwards .
Trigonocephaly is also a Greek-derived word, which can be translated as triangular-
shaped head
52.
53. Plagiocephaly
Plagiocephaly can be subclassified as anterior plagiocephaly or posterior plagiocephaly
Anterior plagiocephaly : is a clinical description of unilateral coronal synostosis. Children born with
unilateral coronal synostosis develop due to compensatory mechanisms a skew head .
The sagittal suture 'divides' the coronal suture in two halves; unilateral meaning that either the
right side or the left side to the sagittal suture is fused
54. Posterior plagiocephaly : Unilateral lambdoid synostosis is also called posterior
plagiocephaly, indicating that this gives, just like unilateral coronal synostosis, a 'skew
head'. The difference is that this time, the deformity mostly shows at the occiput.
55. Brachycephaly
Brachycephaly, or a 'short head', is the result of a closure of both the coronal sutures.
child's head with a restriction of growth in the forward direction and in the backward
direction , recessed frontal bones and a flattened occiput.
Compensatory growth will occur sideways, due to the sagittal suture, and upwards, due to
the lambdoid sutures
56.
57. Oxycephaly
The premature closure of the coronal suture plus any other suture, like the lambdoid suture .
Also known as turricephaly and high-head syndrome/ Tower head .
58.
59. Other craniosynostosis types and their
signs
Apert syndrome : An abnormal skull shape, small upper jaw, and fusion of the fingers and toes.
Crouzon syndrome : A craniofacial birth abnormalities with bilateral coronal suture fusion.
Anterior and posterior of skull shortness, flat cheek bones and a flat nose are their features.
Pfeiffer syndrome : Abnormalities of the skull, hands, and feet wide-set, bulging eyes, an
underdeveloped upper jaw, beaked nose.
Saethre–Chotzen syndrome : Short or broad head. the eyes may be spaced wide apart and have
palpebral ptosis (droopy eyelids), and fingers may be abnormally short and webbed .
60. Etiology
Biomechanical factors : fetal head constraint during pregnancy
Environmental factors : maternal smoking and the maternal exposure to amine-containing
drugs.
Hormonal factors : Hyperthyroid induced craniosynostosis is a hormone mediated premature
closure
61. Clinical Manifestations
Craniosynostosis causes a change in the normal shape of the head. Depends on type of suture
involved
Elevated ICP
If left untreated, some children may then develop learning disabilities or problems with their
eyesight.
Slow or no growth of the head as your baby grows
63. Management
Helmet therapy - Cranial remolding helmets are usually made of a hard outer
shell with a foam lining. Gentle, persistent pressures are applied to capture the
natural growth of a baby’s head while inhibiting growth in the prominent areas and
allowing for growth in the flat regions .
child is diagnosed with deformational plagiocephaly, brachycephaly or
scaphocephaly and is less than 12 months old, cranial remolding may be prescribed
to correct the shape of the baby’s head .
The average treatment with a helmet is usually three month
64.
65. Surgical Management
Real-time Stereotactic-Endoscopic Craniectomy:
Minimally invasive technique can be used to treat patients with unicoronal, bicoronal and metopic
synostosis .
It is reserved only for young infants (less than 3 months of age)
A small camera (endoscope) is used that is registered to the patient's radiologic images (CT) to
ensure precise removal of the pathologic suture and release of the other bones to permit normal
bone growth .
66. Endoscopic Strip Sagittal Craniectomy
An endoscopic strip sagittal craniectomy is also minimally invasive and is used with
younger infants with sagittal craniosynostosis.
Small incisions are made in the front and back of the head.
A strip of bone encasing the fused suture approximately two inches wide is removed
under endoscopic guidance
67. Standard Craniosynostosis Surgery
Strip Sagittal Craniectomy -- This technique is used for children who are not candidates for
endoscopic procedures.
An incision is made over the top of the head from ear to ear and the scalp is moved forward. A
strip of bone encasing the fused suture approximately two inches wide is removed from behind
the "soft spot" to the back of the head .
Frontal-Orbital Advancement (FOA) -- This procedure is recommended for older infants with
severe metopic synostosis or coronal synostosis.
An incision is made over the top of the scalp from ear to ear.
The bone of the skull is removed from above the eyes to behind the forehead. The bone is
reformed and then replaced.
68. Frontal-Occipital Reversal (FOR) -- This procedure is advised for children 6 months of
age or older who have fusion of the sagittal suture or have multiple sutures that are fused .
An incision is made over the top of the scalp from ear to ear.
The scalp is drawn back and the skull bone is removed from above the eyes to the back of
the head
The bone is divided into several pieces, which are reshaped and then replaced over the
crown of the head. Tiny plates and screws are used to fix the bones into proper position.
69. Nursing Management
Pre operative care :
Provide counselling to the parents.
Prepare patient for surgery .
Check for informed consent
Arrange for blood products .
Encourage mothers for breastfeeding before and after surgery
70. Post operative care :
After surgery for craniosynostosis, patients return to the pediatric
intensive care unit for monitoring of hemodynamic status and
level of consciousness.
Monitor vitals of the patient
Keep head end elevated
Monitor for signs of hypovolemia as there is increased risk of
bleeding
Monitor laboratory values for haematocrit , platelets .
Monitor intake and output
Monitor output of the subgleal drain