No associated symptoms
- Not aggravated by routine physical activity
- Not associated with nausea or vomiting
- Bilateral and non-pulsating
- Family history of tension headaches
This document summarizes the medical history and examination findings of a 16-year-old male patient presenting with occipital headache, neck pain, loss of pain and temperature sensation in the left upper limb, and laxity of the left shoulder joint. Examination revealed loss of sensation from C3 to T2 on the left side and absent biceps and supinator reflexes on the left. MRI showed Arnold-Chiari malformation type 1 with syringomyelia involving the cervical and thoracic spinal cord. The patient was diagnosed with syringomyelia related to Arnold-Chiari malformation.
ALS is a neurodegenerative disease that affects motor neurons in the brain and spinal cord. It causes progressive muscle weakness and atrophy. There is currently no cure, and the average survival time is 3-5 years from symptom onset. Riluzole is the only approved treatment shown to modestly prolong survival. Supportive care focuses on managing symptoms like spasticity, secretions, and respiratory failure to prolong function and quality of life. The ice bucket challenge raised significant funds for ALS research. Diagnosis requires ruling out other causes and demonstrating both upper and lower motor neuron signs that progress over time.
Cerebellar dysfunction can cause ataxia, a lack of muscle coordination. The cerebellum controls fine movements and posture. Damage to the cerebellum disrupts these functions. Ataxia affects walking, limb movements, speech, and eye movements. It is diagnosed through clinical exams like finger-nose and Romberg tests. The causes include lesions, tumors, or injuries to the cerebellum. While incurable, treatment focuses on easing symptoms to improve quality of life.
This short document promotes creating presentations using Haiku Deck, a tool for making slideshows. It encourages the reader to get started making their own Haiku Deck presentation and sharing it on SlideShare. In just one sentence, it pitches the idea of using Haiku Deck to easily create engaging slideshow presentations.
A 64-year-old male presented with neck pain after falling down stairs while intoxicated. Imaging showed posterior interspinous ligament edema and fluid in the C1-C2 articulations, consistent with traumatic atlantoaxial rotatory subluxation (Fielding Type III). The patient underwent traction and reduction followed by C1-C3 fusion. Atlantoaxial rotatory subluxation occurs when forced rotation combines with lateral tilt, placing stress on ligaments like the transverse ligament. It can be caused by trauma, infection, arthritis or other conditions. Imaging helps identify ligament disruption and bone displacement. Surgical fusion is often needed for stabilization.
Ataxia is a medical condition which results in the lack of muscle coordination that usually affects voluntary movements such as walking, eye movements, speech, and the patient’s ability to swallow.
This document provides an overview of spinal cord injuries, including:
1. It discusses the anatomy, common causes, and demographics of spinal cord injuries. The most common causes are motor vehicle accidents, falls, violence, and sports injuries. Men ages 16-30 are most commonly affected.
2. It defines different types of spinal cord injuries such as complete vs incomplete, primary vs secondary, and describes various spinal cord syndromes like central cord syndrome, anterior cord syndrome, and Brown-Sequard syndrome.
3. It outlines the initial management of spinal cord injury patients in the emergency department, including immobilization, monitoring, imaging, and use of methylprednisolone within 8 hours of injury.
This document provides an overview of the approach to evaluating and diagnosing ataxia. It defines ataxia and describes how it can be caused by lesions in the cerebellum, posterior column, or vestibular system. It then discusses the clinical features, investigations, and treatment of various causes of ataxia, including cerebellar lesions, hereditary ataxias like Friedreich's ataxia and ataxia telangiectasia, metabolic disorders, and more. The document emphasizes taking a thorough history and examination to identify features that can help determine the underlying cause of ataxia in each patient.
This document summarizes the medical history and examination findings of a 16-year-old male patient presenting with occipital headache, neck pain, loss of pain and temperature sensation in the left upper limb, and laxity of the left shoulder joint. Examination revealed loss of sensation from C3 to T2 on the left side and absent biceps and supinator reflexes on the left. MRI showed Arnold-Chiari malformation type 1 with syringomyelia involving the cervical and thoracic spinal cord. The patient was diagnosed with syringomyelia related to Arnold-Chiari malformation.
ALS is a neurodegenerative disease that affects motor neurons in the brain and spinal cord. It causes progressive muscle weakness and atrophy. There is currently no cure, and the average survival time is 3-5 years from symptom onset. Riluzole is the only approved treatment shown to modestly prolong survival. Supportive care focuses on managing symptoms like spasticity, secretions, and respiratory failure to prolong function and quality of life. The ice bucket challenge raised significant funds for ALS research. Diagnosis requires ruling out other causes and demonstrating both upper and lower motor neuron signs that progress over time.
Cerebellar dysfunction can cause ataxia, a lack of muscle coordination. The cerebellum controls fine movements and posture. Damage to the cerebellum disrupts these functions. Ataxia affects walking, limb movements, speech, and eye movements. It is diagnosed through clinical exams like finger-nose and Romberg tests. The causes include lesions, tumors, or injuries to the cerebellum. While incurable, treatment focuses on easing symptoms to improve quality of life.
This short document promotes creating presentations using Haiku Deck, a tool for making slideshows. It encourages the reader to get started making their own Haiku Deck presentation and sharing it on SlideShare. In just one sentence, it pitches the idea of using Haiku Deck to easily create engaging slideshow presentations.
A 64-year-old male presented with neck pain after falling down stairs while intoxicated. Imaging showed posterior interspinous ligament edema and fluid in the C1-C2 articulations, consistent with traumatic atlantoaxial rotatory subluxation (Fielding Type III). The patient underwent traction and reduction followed by C1-C3 fusion. Atlantoaxial rotatory subluxation occurs when forced rotation combines with lateral tilt, placing stress on ligaments like the transverse ligament. It can be caused by trauma, infection, arthritis or other conditions. Imaging helps identify ligament disruption and bone displacement. Surgical fusion is often needed for stabilization.
Ataxia is a medical condition which results in the lack of muscle coordination that usually affects voluntary movements such as walking, eye movements, speech, and the patient’s ability to swallow.
This document provides an overview of spinal cord injuries, including:
1. It discusses the anatomy, common causes, and demographics of spinal cord injuries. The most common causes are motor vehicle accidents, falls, violence, and sports injuries. Men ages 16-30 are most commonly affected.
2. It defines different types of spinal cord injuries such as complete vs incomplete, primary vs secondary, and describes various spinal cord syndromes like central cord syndrome, anterior cord syndrome, and Brown-Sequard syndrome.
3. It outlines the initial management of spinal cord injury patients in the emergency department, including immobilization, monitoring, imaging, and use of methylprednisolone within 8 hours of injury.
This document provides an overview of the approach to evaluating and diagnosing ataxia. It defines ataxia and describes how it can be caused by lesions in the cerebellum, posterior column, or vestibular system. It then discusses the clinical features, investigations, and treatment of various causes of ataxia, including cerebellar lesions, hereditary ataxias like Friedreich's ataxia and ataxia telangiectasia, metabolic disorders, and more. The document emphasizes taking a thorough history and examination to identify features that can help determine the underlying cause of ataxia in each patient.
Whiplash is an injury to the neck caused by sudden acceleration-deceleration movements like those seen in car accidents. It can cause neck pain and stiffness as well as headaches. While imaging may appear normal, whiplash can still cause soft tissue damage to neck muscles, ligaments, and discs. Symptoms can last over a year in many cases. Treatment focuses on pain relief, muscle relaxation, and in severe cases surgery may be needed. Prognosis is often worse for those with multiple injuries, females, and older individuals.
Spinal shock is the immediate temporary loss of total power, sensation and reflexes below the level of a spinal cord injury. It occurs in four phases as the spinal cord recovers. Phase 1 is complete areflexia lasting 1-3 days due to loss of descending facilitation. Phase 2 sees initial reflex return from denervation supersensitivity. Phases 3-4 involve hyperreflexia and spasticity as the cord grows new synapses. Spinal shock is managed by immobilization, monitoring, and high-dose methylprednisolone to prevent secondary injury if given within 3 hours of the initial trauma.
This document provides information about myoclonus, which are sudden, shock-like contractions of muscles. It describes different types of myoclonus including focal, cortical, brainstem, spinal, peripheral, multifocal, generalized, essential, and childhood myoclonic epilepsies. Diagnostic tests like EMG and EEG are discussed. Various causes and treatment options are also mentioned.
Peripheral neuropathy is inflammation and degeneration of the peripheral or cranial nerves, impairing conductivity. There are several types including mononeuropathy affecting a single nerve, mononeuropathy multiplex affecting multiple nerves, and polyneuropathy affecting many nerves. Polyneuropathy can have many causes including diabetes, hereditary factors, infections, toxins and metabolic disorders. Symptoms of polyneuropathy include motor weakness, sensory loss like numbness and tingling, and autonomic dysfunction affecting sweating and temperature control. Specific types like diabetic neuropathy and Guillain-Barre syndrome are also discussed. Testing includes nerve conduction studies and electromyography to diagnose peripheral neuropathies.
The document discusses cerebellar ataxia, a disorder caused by damage to the cerebellum that controls coordination. It causes loss of coordination, balance problems, and slurred speech. The cerebellum coordinates muscle movement and is located in the hindbrain. Causes include viruses, alcohol, tumors, and toxins. Symptoms are diagnosed through neurological exams, imaging scans, and lab tests. Treatment focuses on physical therapy, assistive devices, and treating any underlying causes to ease symptoms and improve quality of life. Prevention involves vaccinations to reduce risk of viral infections that can lead to cerebellar ataxia.
This document provides an overview of cerebral palsy, including its definition, classification, clinical assessment, goals of management, and treatment approaches. Cerebral palsy is a non-progressive brain disorder resulting from injury to the developing brain, with an incidence of 2-5 per 1000 live births. It is classified based on type of motor dysfunction and pattern of limb involvement. Physical examination aims to determine muscle strength, tone, and degree of deformity. Management goals target communication, daily living skills, mobility, and focus on the individual's needs as an adult. Treatment includes physical therapy, orthotics, spasticity management, and orthopedic surgery.
The document provides guidance on evaluating patients presenting with suspected muscle disease. It outlines the key goals of determining the site of lesion, cause, and available treatments. Symptoms like weakness, fatigue, myalgia and their patterns are discussed to help determine underlying conditions. The temporal evolution, including acute vs chronic onset and progression, helps differentiate between genetic, inflammatory and metabolic myopathies. Considering symptom precipitants and distributions can provide clues to diagnose specific myopathies based on pattern recognition of proximal, distal or other muscle group involvement.
Cervical disc prolapse occurs when a cervical disc herniates and compresses the nerve root. The cervical spine has 7 vertebrae and 6 intervertebral discs that act as shock absorbers and allow motion. A disc is composed of an inner nucleus pulposus surrounded by the outer annulus fibrosus. Common sites of prolapse are C5-C6 and C6-C7. Clinical features include neck pain radiating to the arm. Imaging like MRI or CT is used to confirm prolapse. Treatment involves rest, medications, traction and surgery like anterior cervical discectomy if non-operative measures fail.
The occipital lobe is the visual processing center of the brain containing most of the visual cortex. It contains the primary visual cortex (V1) and several extrastriate areas involved in more complex visual tasks. Lesions can cause visual field defects, cortical blindness, visual agnosias or hallucinations depending on the location and extent of damage. Balint's syndrome and simultanagnosia involve bilateral lesions disrupting global visual perception while preserving local details.
This document provides an overview of spinal cord injury (SCI) management. It describes a case of a 47-year-old male who suffered a cervical spine injury in a motor vehicle accident 4 months ago and is now presenting with paraplegia and paraparesis. The document then outlines key topics related to SCI, including anatomy, causes, types, pathophysiology, clinical syndromes, diagnosis, neurological assessment classification, and management. Tables and diagrams are provided to illustrate spinal cord anatomy and tracts, dermatomes, myotomes, and the American Spinal Injury Association classification system.
The document discusses various syndromes of the spinal cord including complete and incomplete cord syndromes. It describes Brown-Sequard syndrome, central cord syndrome, anterior cord syndrome, posterior cord syndrome, and conus medullaris syndrome. Complete cord transection results in paralysis, sensory loss, and autonomic dysfunction below the level of injury. Incomplete syndromes can cause varying degrees of motor weakness, sensory loss, and autonomic dysfunction depending on the areas of the spinal cord affected. Specific vascular, inflammatory, and traumatic causes are discussed for each syndrome.
The hereditary motor sensory neuropathieszahid mehmood
A 14-year-old girl presented with progressive weakness and deformities in her legs and hands since age 4. Examination found claw hands, foot drop, diminished sensation, and absent reflexes. She was diagnosed with Charcot-Marie-Tooth disease, a genetic disorder causing peripheral nerve damage. It results in muscle wasting and weakness over time. While most common in adults, it can begin in childhood. There is currently no cure, but treatment focuses on managing symptoms like foot drop and providing ankle support.
The pyramidal tract (corticospinal tract) originates from motor areas of the cerebral cortex and descends through the brainstem and spinal cord. It crosses to the opposite side and terminates on internuncial neurons which connect to motor neurons in the anterior horn of the spinal cord. The extrapyramidal tracts include the rubrospinal, vestibulospinal, reticulospinal, and tectospinal tracts and are involved in motor control and coordination. Damage to upper motor neurons in the pyramidal tract causes different paralysis than damage to lower motor neurons in the spinal cord.
Charcot-Marie-Tooth disease (CMT) is a group of inherited neurological disorders that damage the peripheral nerves, causing muscle weakness, loss of sensation in the feet and hands, and deformities. CMT is caused by genetic mutations that affect the myelin sheath or axons in the nerves. There are several types of CMT including CMT1, CMT2, CMT4 and CMTX, which are distinguished by their genetic causes and symptoms. Currently there is no cure for CMT but treatment focuses on managing symptoms through physical therapy, bracing, and surgery. Researchers are investigating potential new treatments to help prevent disability and progression of the disease.
Neck pain can have many causes, but is generally due to soft tissue injuries or abnormalities of the cervical spine structures. The cervical spine is comprised of 7 vertebrae, intervertebral discs, and supporting ligaments and muscles. Common causes of neck pain include muscle strains, disc injuries such as herniations or protrusions, arthritis, and fractures or dislocations. Symptoms vary depending on the underlying cause but often include neck pain and tenderness as well as reduced range of motion. Treatment involves physical therapy, medications, and sometimes surgery or injections depending on the severity and nature of the condition causing neck pain.
Paraplegia is defined as impairment of motor function in the lower extremities, with or without sensory involvement, and is usually caused by involvement of the spinal cord, nerves supplying the lower limbs, or muscles directly. It is classified as spastic or flaccid depending on the affected part of the nervous system and resulting muscle tone. Common causes include spinal cord injuries, infections, tumors, and vascular disorders. A thorough history, neurological examination, and imaging tests are used to diagnose the condition and determine the specific cause and level of spinal involvement.
PARKINSONS DISEASE MEDICAL TREATMENT AND PHYSIOTHERAPY MANAGEMENT Srinitha Busam
This presentation contains brief description about parkinsons disease , its medical management and physiotherapy management ( aims of rehabilitation and exercise training for parkinsons disease patient)
Current concepts in management of metastatic brain tumourLiew Boon Seng
1) Brain metastases occur in 25% of cancer patients and are most commonly diagnosed from lung cancer, breast cancer, and melanoma. Surgery is the preferred treatment for single, accessible brain metastases while radiosurgery and whole brain radiation therapy are options for multiple metastases.
2) Surgical resection provides the best chance of survival and neurological function for carefully selected patients with single brain metastases. Factors such as the patient's overall health, tumor size and location, and control of the primary cancer help determine treatment.
3) While whole brain radiation can effectively treat multiple brain metastases, it carries risks of neurocognitive side effects. Combined treatment with surgery or radiosurgery followed by whole brain radiation may improve outcomes
This document outlines guidelines for the insertion and management of external ventricular drains (EVDs). EVDs are used to temporarily drain cerebrospinal fluid from the brain ventricles to relieve pressure. The document describes the indications for EVD placement, types of EVD systems, insertion procedure, and guidelines for drain positioning, monitoring drainage amounts and characteristics, obtaining samples, administering medications, and removing the drain. Key steps include accurately positioning the drain system based on the patient's ventricle height, monitoring hourly drainage amounts and qualities, and following aseptic technique for procedures involving the drain port.
Whiplash is an injury to the neck caused by sudden acceleration-deceleration movements like those seen in car accidents. It can cause neck pain and stiffness as well as headaches. While imaging may appear normal, whiplash can still cause soft tissue damage to neck muscles, ligaments, and discs. Symptoms can last over a year in many cases. Treatment focuses on pain relief, muscle relaxation, and in severe cases surgery may be needed. Prognosis is often worse for those with multiple injuries, females, and older individuals.
Spinal shock is the immediate temporary loss of total power, sensation and reflexes below the level of a spinal cord injury. It occurs in four phases as the spinal cord recovers. Phase 1 is complete areflexia lasting 1-3 days due to loss of descending facilitation. Phase 2 sees initial reflex return from denervation supersensitivity. Phases 3-4 involve hyperreflexia and spasticity as the cord grows new synapses. Spinal shock is managed by immobilization, monitoring, and high-dose methylprednisolone to prevent secondary injury if given within 3 hours of the initial trauma.
This document provides information about myoclonus, which are sudden, shock-like contractions of muscles. It describes different types of myoclonus including focal, cortical, brainstem, spinal, peripheral, multifocal, generalized, essential, and childhood myoclonic epilepsies. Diagnostic tests like EMG and EEG are discussed. Various causes and treatment options are also mentioned.
Peripheral neuropathy is inflammation and degeneration of the peripheral or cranial nerves, impairing conductivity. There are several types including mononeuropathy affecting a single nerve, mononeuropathy multiplex affecting multiple nerves, and polyneuropathy affecting many nerves. Polyneuropathy can have many causes including diabetes, hereditary factors, infections, toxins and metabolic disorders. Symptoms of polyneuropathy include motor weakness, sensory loss like numbness and tingling, and autonomic dysfunction affecting sweating and temperature control. Specific types like diabetic neuropathy and Guillain-Barre syndrome are also discussed. Testing includes nerve conduction studies and electromyography to diagnose peripheral neuropathies.
The document discusses cerebellar ataxia, a disorder caused by damage to the cerebellum that controls coordination. It causes loss of coordination, balance problems, and slurred speech. The cerebellum coordinates muscle movement and is located in the hindbrain. Causes include viruses, alcohol, tumors, and toxins. Symptoms are diagnosed through neurological exams, imaging scans, and lab tests. Treatment focuses on physical therapy, assistive devices, and treating any underlying causes to ease symptoms and improve quality of life. Prevention involves vaccinations to reduce risk of viral infections that can lead to cerebellar ataxia.
This document provides an overview of cerebral palsy, including its definition, classification, clinical assessment, goals of management, and treatment approaches. Cerebral palsy is a non-progressive brain disorder resulting from injury to the developing brain, with an incidence of 2-5 per 1000 live births. It is classified based on type of motor dysfunction and pattern of limb involvement. Physical examination aims to determine muscle strength, tone, and degree of deformity. Management goals target communication, daily living skills, mobility, and focus on the individual's needs as an adult. Treatment includes physical therapy, orthotics, spasticity management, and orthopedic surgery.
The document provides guidance on evaluating patients presenting with suspected muscle disease. It outlines the key goals of determining the site of lesion, cause, and available treatments. Symptoms like weakness, fatigue, myalgia and their patterns are discussed to help determine underlying conditions. The temporal evolution, including acute vs chronic onset and progression, helps differentiate between genetic, inflammatory and metabolic myopathies. Considering symptom precipitants and distributions can provide clues to diagnose specific myopathies based on pattern recognition of proximal, distal or other muscle group involvement.
Cervical disc prolapse occurs when a cervical disc herniates and compresses the nerve root. The cervical spine has 7 vertebrae and 6 intervertebral discs that act as shock absorbers and allow motion. A disc is composed of an inner nucleus pulposus surrounded by the outer annulus fibrosus. Common sites of prolapse are C5-C6 and C6-C7. Clinical features include neck pain radiating to the arm. Imaging like MRI or CT is used to confirm prolapse. Treatment involves rest, medications, traction and surgery like anterior cervical discectomy if non-operative measures fail.
The occipital lobe is the visual processing center of the brain containing most of the visual cortex. It contains the primary visual cortex (V1) and several extrastriate areas involved in more complex visual tasks. Lesions can cause visual field defects, cortical blindness, visual agnosias or hallucinations depending on the location and extent of damage. Balint's syndrome and simultanagnosia involve bilateral lesions disrupting global visual perception while preserving local details.
This document provides an overview of spinal cord injury (SCI) management. It describes a case of a 47-year-old male who suffered a cervical spine injury in a motor vehicle accident 4 months ago and is now presenting with paraplegia and paraparesis. The document then outlines key topics related to SCI, including anatomy, causes, types, pathophysiology, clinical syndromes, diagnosis, neurological assessment classification, and management. Tables and diagrams are provided to illustrate spinal cord anatomy and tracts, dermatomes, myotomes, and the American Spinal Injury Association classification system.
The document discusses various syndromes of the spinal cord including complete and incomplete cord syndromes. It describes Brown-Sequard syndrome, central cord syndrome, anterior cord syndrome, posterior cord syndrome, and conus medullaris syndrome. Complete cord transection results in paralysis, sensory loss, and autonomic dysfunction below the level of injury. Incomplete syndromes can cause varying degrees of motor weakness, sensory loss, and autonomic dysfunction depending on the areas of the spinal cord affected. Specific vascular, inflammatory, and traumatic causes are discussed for each syndrome.
The hereditary motor sensory neuropathieszahid mehmood
A 14-year-old girl presented with progressive weakness and deformities in her legs and hands since age 4. Examination found claw hands, foot drop, diminished sensation, and absent reflexes. She was diagnosed with Charcot-Marie-Tooth disease, a genetic disorder causing peripheral nerve damage. It results in muscle wasting and weakness over time. While most common in adults, it can begin in childhood. There is currently no cure, but treatment focuses on managing symptoms like foot drop and providing ankle support.
The pyramidal tract (corticospinal tract) originates from motor areas of the cerebral cortex and descends through the brainstem and spinal cord. It crosses to the opposite side and terminates on internuncial neurons which connect to motor neurons in the anterior horn of the spinal cord. The extrapyramidal tracts include the rubrospinal, vestibulospinal, reticulospinal, and tectospinal tracts and are involved in motor control and coordination. Damage to upper motor neurons in the pyramidal tract causes different paralysis than damage to lower motor neurons in the spinal cord.
Charcot-Marie-Tooth disease (CMT) is a group of inherited neurological disorders that damage the peripheral nerves, causing muscle weakness, loss of sensation in the feet and hands, and deformities. CMT is caused by genetic mutations that affect the myelin sheath or axons in the nerves. There are several types of CMT including CMT1, CMT2, CMT4 and CMTX, which are distinguished by their genetic causes and symptoms. Currently there is no cure for CMT but treatment focuses on managing symptoms through physical therapy, bracing, and surgery. Researchers are investigating potential new treatments to help prevent disability and progression of the disease.
Neck pain can have many causes, but is generally due to soft tissue injuries or abnormalities of the cervical spine structures. The cervical spine is comprised of 7 vertebrae, intervertebral discs, and supporting ligaments and muscles. Common causes of neck pain include muscle strains, disc injuries such as herniations or protrusions, arthritis, and fractures or dislocations. Symptoms vary depending on the underlying cause but often include neck pain and tenderness as well as reduced range of motion. Treatment involves physical therapy, medications, and sometimes surgery or injections depending on the severity and nature of the condition causing neck pain.
Paraplegia is defined as impairment of motor function in the lower extremities, with or without sensory involvement, and is usually caused by involvement of the spinal cord, nerves supplying the lower limbs, or muscles directly. It is classified as spastic or flaccid depending on the affected part of the nervous system and resulting muscle tone. Common causes include spinal cord injuries, infections, tumors, and vascular disorders. A thorough history, neurological examination, and imaging tests are used to diagnose the condition and determine the specific cause and level of spinal involvement.
PARKINSONS DISEASE MEDICAL TREATMENT AND PHYSIOTHERAPY MANAGEMENT Srinitha Busam
This presentation contains brief description about parkinsons disease , its medical management and physiotherapy management ( aims of rehabilitation and exercise training for parkinsons disease patient)
Current concepts in management of metastatic brain tumourLiew Boon Seng
1) Brain metastases occur in 25% of cancer patients and are most commonly diagnosed from lung cancer, breast cancer, and melanoma. Surgery is the preferred treatment for single, accessible brain metastases while radiosurgery and whole brain radiation therapy are options for multiple metastases.
2) Surgical resection provides the best chance of survival and neurological function for carefully selected patients with single brain metastases. Factors such as the patient's overall health, tumor size and location, and control of the primary cancer help determine treatment.
3) While whole brain radiation can effectively treat multiple brain metastases, it carries risks of neurocognitive side effects. Combined treatment with surgery or radiosurgery followed by whole brain radiation may improve outcomes
This document outlines guidelines for the insertion and management of external ventricular drains (EVDs). EVDs are used to temporarily drain cerebrospinal fluid from the brain ventricles to relieve pressure. The document describes the indications for EVD placement, types of EVD systems, insertion procedure, and guidelines for drain positioning, monitoring drainage amounts and characteristics, obtaining samples, administering medications, and removing the drain. Key steps include accurately positioning the drain system based on the patient's ventricle height, monitoring hourly drainage amounts and qualities, and following aseptic technique for procedures involving the drain port.
Three key points about space occupying lesions of the brain:
1. Space occupying lesions include neoplasms like meningiomas and gliomas, infections like abscesses, and vascular lesions like aneurysms and hemorrhages.
2. Signs and symptoms vary depending on the location and size of the lesion but can include headaches, seizures, nausea/vomiting, and neurological deficits.
3. Neuroimaging with CT or MRI is important for diagnosis and helps characterize lesions, while lumbar puncture and blood tests help evaluate for other potential causes like infections.
The document provides an overview of brain anatomy and physiology for nurses. It describes the three main parts of the brain - the hindbrain, midbrain, and forebrain. It details the lobes of the cerebrum including the frontal, parietal, occipital, and temporal lobes. It discusses the composition of the brain including neurons, glial cells, cerebrospinal fluid, and blood vessels. Key structures like the ventricles, basal ganglia, and brainstem are also outlined. The document aims to educate nurses on the basic structure and function of the human brain.
Bedside Ultrasound in Neurosurgery Part 3/3Liew Boon Seng
Ultrasound can be used to assess intracranial dural arteriovenous fistulas (DAVF) and carotid cavernous fistulas (CCF). For DAVF, ultrasound shows increased velocities in feeding arteries and decreased resistance indices, allowing assessment before and after treatment. For CCF, ultrasound reveals abnormal mosaic flow in the cavernous sinus and engorged veins with reversed flow. It can monitor hemodynamic changes and treatment response in a noninvasive manner. Ultrasound is also useful for assessing cerebral veins and sinuses, and can diagnose temporal arteritis by identifying hypoechoic wall thickening and stenoses in temporal arteries.
This document discusses classifications and surgical methods for treating spinal injuries. It covers injuries of the cervical, thoracolumbar, and lumbar spine. For the cervical spine, it describes techniques for fractures of C1-C2 including traction, fusion, and screw fixation. For the thoracolumbar spine, it recommends a posterior approach using pedicle screws and plates or rods, and only using anterior fusion for large defects. It stresses the importance of careful technique and handling to avoid neurological complications.
Bedside Ultrasound in Neurosurgery Part 1/3Liew Boon Seng
This document provides an overview of ultrasound training in neurosurgery. It introduces various applications of ultrasound in neurosurgery such as fetal neurosonograms, cranial ultrasonography of newborns, assessing ventricular shunt patency, spinal ultrasound in infants, and transcranial insonation of blood vessels. It also summarizes techniques for different types of Doppler imaging and discusses pathologies that can be detected using ultrasound like intraventricular hemorrhage.
This document discusses hydrocephalus, including:
- Hydrocephalus is an abnormal buildup of cerebrospinal fluid in the brain, which can increase pressure and cause neurological symptoms.
- There are two main types - obstructive, caused by blockages in the flow of cerebrospinal fluid, and communicating, caused by issues with absorption of fluid.
- Common causes of obstructive hydrocephalus include aqueductal stenosis, tumors, cysts, and hemorrhages. Communicating hydrocephalus can result from subarachnoid hemorrhages.
- Normal pressure hydrocephalus is a type of communicating hydrocephalus where patients experience gait, memory, and
Bedside Ultrasound in Neurosurgery Part 2/3Liew Boon Seng
This document provides information from an ultrasound training course on various techniques for imaging intracranial vessels through different acoustic windows of the skull. It discusses techniques such as transorbital, temporal, and foramen magnum windows. It also covers topics like diagnosing intracranial occlusions and stenoses, grading carotid artery stenosis, diagnosing carotid dissections, assessing collateral flow, and evaluating bypass graft patency. The document discusses the use of transcranial Doppler in patients after decompressive craniectomy. It also reviews perfusion imaging with ultrasound contrast and experimental evidence for sonothrombolysis.
Applied Surgical Anatomy of the Brain and Spinal CordLiew Boon Seng
The document summarizes key anatomy related to the spinal cord and scalp. It describes the layers of the scalp from superficial to deep. It then discusses the skull vault and base, identifying several surface landmarks. It details the anatomy of the spinal cord, including its length, weight, segments, internal configuration of grey and white matter, and surrounding meninges. Finally, it lists the objectives which are to identify brain and spinal cord anatomy and relate it to surgical procedures and surface markings.
Neurological Conditions and Diseases (At birth)Liew Boon Seng
This document discusses various neurological conditions and diseases that can cause macrocephaly in infants and children. It describes conditions present at birth such as caput succedaneum, subgaleal hemorrhage, cephalohematoma, osteopetrosis, subdural hematomas, benign enlargement of the subarachnoid space, megalencephaly, vein of Galen aneurysm, and hydrocephalus. Hydrocephalus and its causes, clinical presentation, assessment, treatments including shunts, and complications are discussed in detail. Posthemorrhagic hydrocephalus as a consequence of intraventricular hemorrhage is also outlined.
CSF Shunt Infection: Diagnosis and TreatmentLiew Boon Seng
Ventricular shunt infection is a common complication of CSF shunting with an incidence rate of 8.5-15%. Risk factors include young age, prior revisions, and prolonged surgery time. Early infections are usually caused by skin flora like Staphylococcus epidermidis. Diagnosis involves CSF analysis showing pleocytosis and low glucose, along with culture of infected hardware. Treatment consists of removing the infected shunt and replacing it with a new shunt after the CSF is sterile, while administering intravenous antibiotics for 10-14 days. Prognosis depends on the organism, underlying pathology, and adequacy of treatment to prevent complications like cerebritis, abscesses, or recurrent infections.
This document discusses various medical and surgical management strategies for different types of hydrocephalus and associated conditions. It covers:
1) Medical management of hydrocephalus using diuretics and steroids to decrease CSF production.
2) The history of surgical drainage methods for hydrocephalus dating back to Hippocrates. Modern methods include ventriculostomies, shunt placements in various cavities, and endoscopic procedures.
3) Complications associated with different surgical procedures and how newer endoscopic techniques are improving outcomes compared to traditional shunting.
4) Specific guidelines for treating different causes of hydrocephalus like TB meningitis, hematocephalus, and congenital cases
Cranial surgery involves procedures to access and treat conditions within the skull and brain. The main types discussed are burr holes, craniotomies, and craniectomies. Craniotomies provide larger access than burr holes and are used for procedures like tumor removal, hemorrhage evacuation, and repairing vascular structures. Craniectomies involve removing a piece of skull that is later reconstructed. Additional topics covered include cranial procedures for vascular conditions like aneurysms, skull base surgery, and treating tumors, infections, hydrocephalus and more. Precise techniques and equipment are needed to perform surgeries near vital structures in the brain.
This document provides an overview of various vascular lesions of the brain. It discusses arteriovenous malformations (AVMs), dural arteriovenous fistulas, carotid-cavernous fistulas, cavernomas, capillary telangiectasias, venous angiomas, aneurysms, and other conditions. For each type of lesion, it describes characteristics, imaging appearance, clinical presentation, and treatment options. Magnetic resonance imaging and cerebral angiography are important diagnostic tools. Treatment may involve surgery, endovascular procedures, or radiosurgery depending on the specific lesion.
Neuropsychiatric manifestations of head injurySantanu Ghosh
This document summarizes a presentation on neuropsychiatric aspects of head injury. It begins with an introduction discussing the prevalence of head injuries. It then covers the history of understanding head injuries, comparative diagnostic classifications, epidemiology, types and pathophysiology of head injuries including acute and chronic behavioral consequences. The presentation also discusses clinical features such as cognitive impairment, personality changes, mood disorders, anxiety, aggression and psychosis. It concludes with discussing prognosis and predictors of outcome following head injury.
This document provides information on different types of seizures including their definition, classification, causes, symptoms and treatment. It discusses conditions like epilepsy, febrile seizures, absence seizures, myoclonic epilepsy and status epilepticus. Seizures are classified as acute non-recurrent, chronic recurrent or according to their localization as generalized or partial seizures involving different areas of the brain. Treatment involves identifying and managing the underlying cause as well as use of anticonvulsant medications depending on the seizure type.
This document discusses various types of seizures that can occur in children. It describes how seizures may be localized to one part of the body or widespread. Seizures in newborns and toddlers can present differently. Characteristics of seizures include abrupt onset, brief duration, altered mental status and postictal state. Causes of seizures in children include infections, developmental problems, head trauma and unknown causes. The most common type is febrile seizures associated with fever. Other causes, treatments, and types like tonic, clonic, absence and myoclonic seizures are outlined as well. Status epilepticus and its management are also discussed.
Seizure disorder is one of the important topic in children and adult also. here i explained the seizure disorder in pediatrics, include all most content for nurses level
This document discusses several topics related to neurology. It begins by describing upper and lower motor neuron lesions, including that pronator sign is an early sign of upper motor neuron lesion. It then discusses different types of headaches like tension-type headache and migraine, providing details on their symptoms. Raised intracranial pressure and space-occupying lesions as secondary causes of headache are also mentioned. Management strategies for various conditions like tension headaches, migraines, seizures and more are outlined. Neural tube defects, febrile seizures, and Duchenne muscular dystrophy are also summarized.
- Stephen, a previously healthy 4-year-old boy, presented with unsteady gait and difficulty walking. On examination, he had low muscle tone, mild dysmetria, and wide-based gait.
- Acute ataxia can be caused by dysfunction of the cerebellum, sensory pathways, or a combination. Common causes are acute cerebellar ataxia, toxic exposure, and Guillain-Barré syndrome. Life-threatening causes include tumors, hemorrhage, stroke, and infection.
- Further examination and testing is needed to determine the underlying cause and rule out serious conditions in Stephen's case of acute ataxia.
This document provides a review of pediatric neurology topics including headache, seizures, epilepsy, peripheral nervous system disorders, brain malformations, ataxia, and neurocutaneous syndromes. It discusses the epidemiology, classification, clinical presentation, evaluation, and treatment of various childhood conditions such as migraine, tension headache, febrile seizures, infantile spasms, and more. Neuroimaging findings are presented for secondary headaches and conditions like brain tumors, hemorrhage, stroke, hydrocephalus, and arterial malformations.
This document discusses seizures in children, including febrile seizures. It defines seizures and different types, like generalized seizures and focal seizures. It covers the epidemiology, causes, clinical presentation and diagnosis of seizures. Complications, both acute and chronic, are outlined. Investigations and management approaches are also summarized. The document focuses in particular on febrile seizures, their definition, causes, types, evaluation and treatment in children presenting with fever and seizures.
Headache is a common symptom in children and adolescents, with up to 75% experiencing a significant headache by age 15. Headaches can be primary, such as migraines or tension-type headaches, or secondary to other conditions such as viral infections. A thorough history and physical exam are usually sufficient for diagnosis, though imaging may be required if symptoms suggest increased intracranial pressure. Treatment involves acute medication to stop attacks as well as preventive medication and lifestyle modifications if headaches are frequent or disabling.
Epilepsy is a chronic neurological condition characterized by recurrent, unprovoked seizures. Seizures occur due to excessive firing of neurons in the brain. Epilepsy has many potential causes including genetic factors, brain injury, infections, tumors, or developmental problems. Evaluation involves an EEG and neuroimaging to classify seizure type and identify underlying causes. Treatment focuses on medication or other options like the ketogenic diet, vagus nerve stimulation, or epilepsy surgery to control seizures. Children with uncontrolled epilepsy may experience social or academic challenges at school.
The document discusses several pediatric neurological emergencies including seizures, meningitis, stroke, traumatic brain injuries, and increased intracranial pressure. It provides details on assessing and initially stabilizing patients, distinguishing different seizure types, approaches to febrile and afebrile seizures, signs of meningitis, evaluating increased intracranial pressure, and causes and features of disorders like hypotonia. Investigations and differential diagnoses for various conditions are also outlined.
Pediatric headache by dr. milind bapatMilind Bapat
Headaches are common in children, affecting 39% by age 6 and 75% by age 15. Migraines, the most common type of primary headache in children, can cause school absences and impair academic performance. Evaluation of childhood headaches should consider secondary causes from infections, injuries, or intracranial pathology. For primary headaches like migraines, treatment involves acute abortive medications and lifestyle changes to prevent triggers as well as prophylactic medications if headaches are frequent or severe.
- Febrile seizures are seizures associated with fever but without evidence of infection in the brain. They typically occur in children between 6 months and 5 years old.
- Simple febrile seizures are brief (<15 minutes) and occur once per fever episode while complex febrile seizures are longer or occur multiple times.
- Most febrile seizures are benign and have an excellent prognosis without neurological deficits or increased risk of developing epilepsy later in life, especially for those with simple febrile seizures and no other risk factors. Recurrence occurs in about 30-50% of children within 1-2 years.
1. Seizure in children can be focal, generalized, or unknown onset based on brain involvement. Focal seizures involve one hemisphere while generalized seizures involve both.
2. Epilepsy is defined as two or more unprovoked seizures more than 24 hours apart. Around 3-10% of children experience seizures by age 16 with half starting in childhood.
3. Evaluation of a first seizure involves assessing for underlying causes, determining seizure type and focus, and considering imaging and EEG based on risk factors for recurrence. Status epilepticus is a medical emergency requiring airway management and treatment of underlying causes.
Febrile seizures are non-epileptic seizures triggered by fever between ages 6 months to 5 years. They are generally brief and self-limiting, resolving within 15 minutes. Febrile seizures are classified as simple or complex depending on duration and recurrence. While frightening, febrile seizures typically cause no long term issues and have a low risk of developing epilepsy. Proper management involves antipyretics, observation, and reassurance of parents on typical prognosis.
This document discusses epilepsy in children, including types, clinical presentation, investigations, management, and complications. It provides an overview of seizure types and classifications, the etiology and syndromes of epilepsy in children, how epilepsy presents clinically and is evaluated, and guidelines for treatment and counseling to control seizures and prevent complications. Key aspects covered include acute seizure management, anti-epileptic medications, status epilepticus, and the potential neurological and developmental impacts of uncontrolled epilepsy.
Epilepsy is a chronic neurological disorder characterized by recurrent seizures resulting from abnormal electrical discharges in the brain. Seizures can be generalized, affecting both sides of the brain, or partial, affecting one area. Epilepsy is diagnosed when a person has two or more unprovoked seizures more than 24 hours apart. While the specific cause is unknown in many cases, potential contributing factors include genetic predisposition, head injuries, brain tumors, infections, and developmental disorders. Treatment involves anticonvulsant medications to prevent seizures.
Dr. Dilraj Singh Sokhi gave a presentation on epilepsy to trainees. He discussed causes like infections, head trauma, and neurocysticercosis. Seizures are classified as focal or generalized. Diagnosis involves a detailed history and physical exam. Treatment involves lifestyle management, medication like phenobarbital or phenytoin, and gradual dose adjustments. The goal is complete seizure control with as few side effects as possible.
Similar to Neurological Conditions and Diseases (During Development) (20)
LAND USE LAND COVER AND NDVI OF MIRZAPUR DISTRICT, UPRAHUL
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Changes in vegetation cover refer to variations in the distribution, composition, and overall
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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
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.
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2. Neurological conditions and
diseases
Part I
– At birth (Congenital, acquired)
Macrocephaly
Microcephaly
Spine defect
Other developmental defect
Birth trauma/HIE
Part II
– During development (Congenital, acquired)
Meningitis
Seizure
Headache
Stroke/Vascular
Neoplasm/Tumour
Trauma
Coma
4. During development (Congenital,
acquired)
– Meningitis
– Seizure
– Headache
– Stroke/Vascular
– Neoplasm/Tumour
– Trauma
– Coma
5. Meningitis
Inflammation of the meninges
Most common infection of the CNS
Most cases (70%) occur in children <5 years old
May be secondary to other localized or systemic infections
(e.g., otitis media).
Two primary classifications
– Viral
– Bacterial
– Others: fungi and (rarely) parasites
Morbidity is also high.
About 30% of survivors have some sequelae of their
disease
However, these complications can be reduced if meningitis
is treated early.
6. Assessment
Viral meningitis
– Infants and toddlers
Irritability, lethargy, vomiting
Change in appetite
– Older children
Usually preceded by a nonspecific febrile
illness
Headache, malaise, muscle aches, nausea/
vomiting, photophobia, nuchal/spinal rigidity
7. Assessment
Bacterial meningitis
– Infants and toddlers
Poor feeding/suck, vomiting, high-pitched
cry, bulging fontanel, fever or hypothermia,
poor muscle tone
– Children and adolescents
Abrupt onset
Fever, chills, headache, nuchal rigidity,
vomiting, changes in LOC, photophobia,
extreme irritability
8. Assessment
In children <1 month old:
– group B Streptococcus, Escherichia coli
In children 4-12 weeks old:
– E. coli, Hemophilus influenzae type B,
Streptococcus pneumoniae, group B
Streptococcus, Neisseria meningitidis
(meningococcal)
In children 3 months to 18 years old:
– Streptococcus pneumoniae (most common
cause), N. meningitidis, H. influenza type B
(rare)
– Mycobacterium tuberculosis
9. Assessment
PHYSICAL EXAM
- Temperature- elevated
- Tachycardia or bradycardia with increased intracranial
pressure
- Blood pressure normal (low if septic shock has occurred)
- Child in moderate-to-acute distress
- Flushed
- Level of consciousness variable
- Possible enlargement of the cervical nodes
- Focal neurologic signs:
- photophobia
- nuchal rigidity (in children >12 months old)
- positive Brudzinski's sign ( in children >12 months)
- positive Kernig's sign (in children >12 months )
12. Lumbar puncture
Patients at greatest risk for meningitis
– under 18 months of age
– seizure in the ED
– focal or prolonged seizure
– seen a physician within the past 48 hours
Other indications
– concern about follow-up
– prior treatment with antibiotics
The American Academy of Pediatrics
“strongly consider” in infants under 12
months of age with a first febrile seizure
13. Management: Nursing Interventions
Place child in isolation until 24 hours of antibiotic
therapy has completed
Administer antibiotics (7-14 days)
Fever control
Monitor for signs of ICP
Monitor for fluid overload
Viral meningitis is treated symptomatically
14. Prevention and Control
Meningitis Caused by Hemophilus influenzae
– A vaccine is now routinely given to infants as
part of the usual childhood immunizations.
15. During development (Congenital,
acquired)
– Meningitis
– Seizure
– Headache
– Stroke/Vascular
– Neoplasm/Tumour
– Trauma
– Coma
16. Seizure
Febrile seizure
Epilepsy - two or more seizures not
provoked by a specific event such as fever,
trauma, infection, or chemical change
Neonatal seizures
Status epilepticus
17. Febrile seizure
Definition: Convulsions occurring in association
with fever in children between 3 months and 6
years of age, in whom there is no evidence of
intracranial pathology or metabolic derangement.
- No signs or history of underlying seizure disorder
- Often familial
- Uncomplicated and benign if seizure is of short
duration (<15 minutes), only 1 in 24 hours, and
normal CNS exam after seizure
- Involves tonic-clonic movements, bilaterally
- Associated with temperature >38°C
18. Epidemiology
Age 3mo – 5yrs
Peak age 9-20 months
2-5% children will have before age 5
25-40% will have family history
80 – 97% simple
3 - 20% complex
19. Management
Control fever
– take off clothing and tepid sponging.
– antipyretic e.g. syrup or rectal Paracetamol 15
mg/kg 6 hourly.
– antipyretic is indicated for parent’s comfort,
but has not been shown to reduce the
recurrence rate of febrile convulsion.
20. Epilepsy
Definition: a neurological condition
characterised by recurrent unprovoked
epileptic seizures
ILAE Classification of seizure types:
– generalized
LOC
tonic, clonic, tonic-clonic, myoclonic, atonic, absence
– partial – focal onset
simple partial – no LOC
complex partial – LOC
partial secondarily generalized
– unclassified
23. Neonatal seizure
brief and subtle
– eye blinking
– mouth/tongue movements
– “bicycling” motion to limbs
typically seizure’s can’t be provoked/ consoled
autonomic changes
EEG less predictable
24. Neonatal seizure
Etiology
– hypoxic-ischemic encephalopathy
Presents within first day
– congenital CNS anomalies
– intracranial hemorrhage
– electrolyte abnormalities – hypoglycemia and
hypocalcemia
– infections
– drug withdrawal
– pyrodoxine deficiency
25. Status Epilepticus
Definition
– Seizure lasting >30 mins
– sequential seizures without regain LOC >30min
Mortality in pediatric status epilepticus 4%
Morbidity may be as high as 30%
26. Treatment
Correct underlying pathology, if any
Antipyretics ineffective in febrile seizure
Anti-epileptic choice often trial and error
no anti-epileptic 100% effective
febrile seizure – diazepam, phenobarbital, valproic acid
– Currently AAP does not recommend
neonatal - phenobarbital
generalized TC – phenytoin, phenobarbital, carbamazepine,
valproic acid, primidone
absence – ethosuximide, valproic acid
new anti-epileptics – felbamate, gabapentin, lamotrigine,
topiramate, tiagabine, vigabatrine
in consultation with neurologist
27. Neuroimaging
Neuroimaging (preferably MRI) is indicated for
any child with
– epilepsy occurring in the first year of life,
except febrile seizures
– partial epilepsy except benign rolandic epilepsy
– developmental delay or regression
28. EEG
EEG is important to support the:
– clinical diagnosis of epileptic seizures,
– Classify the epileptic syndrome,
– selection of anti-epileptic drug and prognosis
– helps in localization of seizure foci in
intractable epilepsy
Consider in:
– persistent altered mental status (?non
convulsive status epilepticus)
– paralyzed patients
– pharmacologic coma
29. Disposition
can be discharged home if
– single seizure
– stable, returning to baseline neuro
status
– no underlying condition/cause requiring
treatment in hospital
– arranged follow-up
30. During development (Congenital,
acquired)
– Meningitis
– Seizure
– Headache
– Stroke/Vascular
– Neoplasm/Tumour
– Trauma
– Coma
31. Headaches
Occurs in 20% of school-age children. Onset may
occur at any age
The most common causes of headache in
children:
- benign vascular headaches (leading to
migraine)
- muscle contraction (leading to tension
headaches)
35. Organic –Traction
Result of an abnormality in the brain or skull
- Headaches increase rapidly in frequency and
severity
- Headache is worst upon awakening in the
morning, diminishes during the day
- Headache wakens child from sleep
- Aggravated by coughing or valsalva maneuver
- May be relieved by vomiting
- Associated symptoms: focal neurological findings;
altered gait; changes in behavior, personality,
cognition or learning ability
36. Migraine
- Headache -pulsatile (throbbing)
- Headaches are periodic, separated by symptom-
free intervals
- Associated with at least three of the following
symptoms: abdominal pain and nausea or
vomiting, aura (motor, sensory, visual), family
history of migraine
- Unilateral or bilateral
- Headache relieved by sleep
37. Tension Headache
- Band-like tightness or pressure in the
bifrontal, occipital or posterior cervical
regions
- Seen at any age
- Lasting for days or weeks but not
disrupting regular activities
- Not associated with a prodrome
- Associated symptoms: tight neck muscles,
sore scalp, nausea, vomiting and aura are
uncommon
39. TMJ Dysfunction
- Temporal headache
- Associated symptoms: local jaw discomfort,
malocclusion (crossbite), decreased range of
motion of mouth, click with jaw movement,
bruxism (grinding of teeth)
40. Chronic Sinusitis
- Frontal headache
- Tenderness to percussion over the frontal,
maxillary or nasal sinuses
- Associated symptoms: prolonged rhinorrhea and
congestion, chronic cough and postnasal drip,
anorexia, low-grade fever, malaise
- It is unusual for children <10 years old to have
recurrent headaches secondary to chronic
sinusitis
41. Chronic Progressive Headache
least common presentation
classically based on historical and physical
– sudden severe headache
– rapid increase over days - weeks
– suggestive of increased ICP
severe nocturnal headache (wakes or upon
waking), changes in pain with position,
coughing
– pseudotumor cerebri
– space occupying lesion
– following head trauma
Imaging
– CT
– MRI preferred in non-urgent indication
42. During development (Congenital,
acquired)
– Meningitis
– Seizure
– Headache
– Stroke/Vascular
– Neoplasm/Tumour
– Trauma
– Coma
44. Arteriovenous malformations
Cerebral arteriovenous
malformations occur in about 1 in
100, 000 of the population
They are the most common
cerebrovascular lesions in children.
AVMs are congenital lesions which
occur as a result of a malfunction
in the normal separation of arteries
and veins during embryonic
development.
AVMs in the CNS are more common
above the tentorium, particularly
around the middle cerebral artery.
45. Arteriovenous malformations
The majority of AVMs are asymptomatic.
Often these malformations are only discovered
incidentally, usually during treatment for an
unrelated disorder.
AVMs that are symptomatic usually present in
young adulthood; the average age of
presentation in children is about 10 years of age.
46. Arteriovenous malformations
Generalized symptoms include seizures and
headaches, additionally, children with an AVMs
may present with a range of specific focal
neurological signs depending on the location of
the lesion, such as
– muscle weakness or hemiplegia,
– loss of coordination,
– visual disturbances,
– abnormal sensations or
– alterations in cognitive functioning.
Approximately 50 to 80 per cent of AVMs present
with signs and symptoms of raised intracranial
pressure as a result of intracranial haemorrhage
48. Cerebrovascular Accident (stroke)
Defined as a clinical syndrome characterized by focal
neurological deficits caused by a sudden disruption of the
blood supply to the brain, lasting more than 24 hours
Stroke is much less common in children than in adults.
The estimated incidence of stroke in children is
approximately 3 in every 100,000 children
Stroke in children is more likely to occur in the presence of
underlying diseases, such as metabolic disorders,
haematological disorders (particularly sickle cell anaemia),
congenital cardiac disease and moyamoya disease
49. Cerebrovascular Accident (stroke)
General care of a child who has had a stroke includes
maintaining normal temperature, ensuring adequate
oxygenation and consideration of aspirin in ischaemic
stroke
In the case of moyamoya disease improvements to cerebral
blood flow, as a result of intracranial internal carotid
occlusion, can be made by performing vasoreconstructive
surgery (bypass surgery).
The outcome following stroke in children is variable but
survival is thought to be better than in adults
The survival rate following stroke in children has been
estimated to be about 85 per cent
50. During development (Congenital,
acquired)
– Meningitis
– Seizure
– Headache
– Stroke/Vascular
– Neoplasm/Tumour
– Trauma
– Coma
51. Childhood Malignancies
Cancer is the most common cause of disease
related deaths in children 1-19 years
Incidence has increased slowly, but mortality
rates have declined significantly
53. Brain Tumours: Diagnosis and Mx
Comprehensive history and complete PE
Careful CNS exam
Rule out other causes -
infection/trauma/metabolic
CT head and/or MRI
Referral to neurosurgery
54. During development (Congenital,
acquired)
– Meningitis
– Seizure
– Headache
– Stroke/Vascular
– Neoplasm/Tumour
– Trauma
– Coma
55. Head Injuries
HISTORY-Ascertain the following:
- Mechanism of injury
- Time of injury
- Loss of consciousness (a brief seizure at the time of
injury) may not be clinically significant
- Loss of memory , amnesia
- Irritability
- Visual disturbance
- Disorientation
- Abnormal gait
- Lethargy, pallor or agitation may indicate severe injury
- Vomiting
- Symptoms of increased intracranial pressure (vomiting,
headache, irritability)
57. Head Injuries
Signs of Skull Fracture
- Hemotympanum
- Periorbital or post-auricular ecchymosis
- Cerebrospinal fluid otorrhea or rhinorrhea
- Depressed fracture or penetrating injury
- Palpate scalp for hematomas and contusions,
underlying depressions, which may signify
depressed skull fracture
58. Head Injuries
Neurologic Examination
- Pediatric Glasgow coma scale
- Papilloedema
- Pupillary light reflexes
- Cranial nerve examination
- Movement of extremities
- Abnormal posture (decorticate or decerebrate)
- Muscle flaccidity, spasticity
- Plantar responses
60. Management Mild Injury
Children with mild intracranial injury may be
discharged home
An instruction sheet should be given to the
parents or caregiver concerning observation and
precautions
61. Table 15-3: Instructions to Parents or Caregivers for
Observation at Home of Children with Head Trauma
Bring child back to clinic immediately if any of the
following signs and symptoms appear within the first
72 hours after discharge:
Any unusual behavior
Disorientation as to name and place
Inability to wake child from sleep
Increasing headache
Seizures
Unsteadiness on feet
Unusual drowsiness and sleepiness
Vomiting more than two or three times
62. Moderate To Severe Injury
- ABC’s first priority
- C-spine control
- Suture scalp lacerations, as major blood loss can
occur
- Start IV therapy with normal saline to keep vein
open (unless the child is in shock from other
injuries)
- Restrict fluids to 60% of normal intake (except in
cases of shock)
- Oxygen
- Elevate head of bed by 30° to 45°
- Place head and neck in midline position
63. Moderate To Severe Injury
- Minimize stimuli (e.g., suctioning and movement)
- To control increased intracranial pressure: above
measures
plus establish controlled hyperventilation
- CT scan of head
- C-spine x-ray
- Diuretics if intracranial pressure is increased (and
there is documented deterioration) despite
measures outlined above:mannitol, 0.5-1 g/kg IV
- Monitor ABCs, vital signs, pulse oximetry, level of
consciousness (with serial pediatric Glasgow
coma scores), intake and output
65. During development (Congenital,
acquired)
– Meningitis
– Seizure
– Headache
– Stroke/Vascular
– Neoplasm/Tumour
– Trauma
– Coma
66. Pediatric Coma
Most common pattern in children is diffuse
impairment of cerebral hemispheres
Less commonly results from brainstem
dysfunction
Differential Dx of causes:
– Trauma
– Insulin/hypoglycemia/inborn errors of
metabolism/intususception
– Psychiatric
– Seizures, stroke, shock, shunt malfunction
– Alcohol abuse
– Electrolytes, encephalopathy, endocrinopathy
– Infection
– Overdose/ingestion
– Uremia
67. Pediatric Coma-Initial
Approach
Primary Survey
- ABC;s - C-spine precautions
- Pediatric Glasgow Coma Scale
- Vital signs including rectal temperature
- Check for signs of obvious trauma
- Check for S&S of raided ICP
- Hypoglycemia- give glucose 0.5 g/kg( D50W, 1-2
ml/kg IV empirically - chemstrip sugar low
- Narcan empirically 0.1 mg/kg if pupils
small/pinpoint
68. Pediatric Coma-Initial
Approach
Secondary survey
- History - known underlying cause, acute fever,
trauma, ingestion, PMH, Medications, allergies,
last meal
- General CPX including CNS exam
- Look for evidence of infection, intoxication,
traumatic and metabolic causes
- Fontanelle, neck stiffness, neck bruits,
fundi( retinal hemorrhages), oculomotor
movements
- Breathing patterns
- Motor responses ( focalizing/lateralizing signs)
69. Pediatric Coma-Initial
Approach
Investigations - depends on potential etiology
and clinical condition
– Blood work may include:
- CBC, cultures, glucose, electrolytes, BUN, creatinine,
Calcium, magnesium, LFT’s, ammonium, blood clotting
screen, ABG
– Diagnostic Imaging
- CT of head essential if focal causes suspected e.g trauma
not if diffuse cause e.g infection
- CRX, C-spine XR, Flat plate of Abdomen, limb XR
- Urinalysis, C&S, latex agglutination
- LP- CSF analysis
- ECG
- EEG
Further management directed at underlying cause
Serial Glasgow coma scale assessments
Maintain homeostasis with Oxygen, IV fluids, electrolytes,
nutrition
70. During development (Congenital,
acquired)
– Meningitis
– Seizure
– Headache
– Stroke/Vascular
– Neoplasm/Tumour
– Trauma
– Coma