This document discusses several pediatric neurological disorders including hydrocephalus, spina bifida, and bacterial meningitis. Hydrocephalus is an abnormal buildup of cerebrospinal fluid in the brain ventricles which can cause increased intracranial pressure. It is usually treated with surgical insertion of a shunt system to drain fluid from the brain. Spina bifida is a birth defect involving incomplete closing of the spinal column which can range from mild to severe. Bacterial meningitis is a medical emergency caused by bacterial infection of the meninges and cerebrospinal fluid, with symptoms including fever, irritability, and neck stiffness.

1. Neurological Disorders
Introduction
Pediatric neurological disorders can include cerebral
palsy, hydrocephalus, spina bifida, bacterial meningitis.

2. 1- Hydrocephalus
Hydrocephalus:
also known as "water on the brain," is a medical condition in which there is an
abnormal accumulation of cerebrospinal fluid (CSF) in the ventricles, or cavities of
the brain. It can lead to developmental, physical, and intellectual impairments
This may cause increased intracranial pressure inside the skull and progressive
enlargement of the head, convulsion, double of vision, and mental disability.

3. Pathology for Hydrocephalus
Hydrocephalus is usually due to blockage of cerebrospinal fluid (CSF) outflow in
the ventricles or in the subarachnoid space over the brain.
Hydrocephalus can be caused by impaired cerebrospinal fluid (CSF) flow,
reabsorption, or excessive CSF production.

4. Causes of Hydrocephalus
1- A blockage develops that prevents CSF from flowing normally
2- There is a decrease in the ability of blood vessels to absorb it your
3- Brain produces an excess amount of it
High risk factors:
1- Birth defect in which the spinal column doesn’t close
2- Genetic abnormality
3- Certain infections that occur during pregnancy, such as rubella

6. Classification of Hydrocephalus
1- Communicating.
2- Non-communicating (obstructive).
Both forms can be either congenital or acquired.
1- Communicating:
2- Communicating hydrocephalus, also known as non-obstructive hydrocephalus, is caused by impaired
cerebrospinal fluid reabsorption in the absence of any CSF-flow obstruction between the ventricles and
subarachnoid space.
2-Non-communicating:
Non-communicating hydrocephalus, or obstructive hydrocephalus, is caused by a CSF-flow obstruction
ultimately preventing CSF from flowing into the subarachnoid space (either due to external compression or
intraventricular mass lesions).

7. Signs and Symptoms
1- Increased intracranial pressure may be manifested by:
Headaches (initially in the morning)- Forceful vomiting , poor feeding , bulging fontanel .
Nausea - coma.(Tense, bulging fontanel Separated cranial sutures Macewen (cracked-pot) sign)
2-Eyes that appear to gaze downward.
3- Irritability - Seizures - Sleepiness
4- low muscle tone and strength
5- Slow reflexes and Drowsiness
6- Head circumference that is larger than normal for their age
Treatment
- Aimed to prevent brain damage
1- Hydrocephalus treatment is surgical
2- Most shunts drain
3- A shunt system can also be placed in the lumbar space of the spine and have the CSF redirected to the
peritoneal cavity (Lumbar-peritoneal shunt).

8. Shunt System
A shunt system consists of the shunt, a catheter, and a valve. One end of the
catheter is placed within a ventricle inside the brain. The other end of the
catheter is commonly placed within the abdominal cavity, where the CSF can
drain and be absorbed. A valve located along the catheter maintains one-way
flow and regulates the rate of CSF flow. A shunt implant is typically permanent
and has to be monitored regularly.

9. Shunt Complications
✓Shunt malfunction.
✓ Shunt failure.
✓ Shunt infection

10. 2- Spina Bifida
Spina- Bifida :
A developmental neurological congenital disorder's
caused by the incomplete closing of the embryonic
neural tube.
.

11. Types of Spina Bifida
1- Spina Bifida occulta:
one of the most common forms of spina bifida. In occulta,the outerpart of some of the vertebrae
are not completelyclosed. Its not risk
2- Meningocele:.
Meningocele covering spinal cord meninges pass back through opening in the spinal cord and form
cyst (meninges to herniate into the spinal cord)
3- Myelomeningocele:
unfused portion spinal cord to protrudethrough an opening. The meningeal membranes that cover the
spinal cord also protrudethrough the opening, forming a sac enclosingthe spinal elements, such as
meninges, cerebrospinal fluid, and parts of the spinal cord and nerve roots. that is the most serious type

12. Types of Spina Bifida

16. Diagnosis
These conditions can be diagnosed in utero on the basis
of elevated levels of alpha-fetoprotein, after amniocentesis,
and by ultrasound imaging

17. Incidence:
The incidence of spina bifida can be decreased by up to 75%
when daily folic acid supplements are taken prior to
conception.
Signs and symptoms:
Children with spina bifida often have hydrocephalus, which
consists of excessive accumulation of cerebrospinal fluid in the
ventricles of the brain.

18. Prevention
There is no single cause of spina bifida nor any known way to prevent it
entirely.
However, dietary supplementation with folic acid has been shown to be
helpful in preventing spina bifida. Sources of folic acid include whole
grains, fortified breakfast cereals, dried beans, leaf vegetables and fruits.
Recommended amount of folic acid for women of childbearing age and
women planning to become pregnant is at least 0.4 mg/day of folic acid
from at least three months before conception, and continued for the first
12 weeks of pregnancy.

19. Intracranial Infections
Meningitis
✓ Meningitis, an inflammation of the meninges & CSF, can be caused by
either bacterial or viral agents.
✓ Bacterial meningitis is more virulent than viral meningitis and is sometimes
rare and fatal.
✓ Suspected bacterial meningitis is a medical emergency
✓ Infants are at greatest risk for bacterial meningitis.

20. Pathophysiology and Etiology
Meningitis occur secondary to other infection such as otitis media, or sinusitis, pharyngitis,
pneumonia; brain trauma; or a neurosurgical procedure.
Organisms causing meningitis include:
✓ Streptococcus pneumonia (pneumococcus) in children the most common cause of
meningitis in children 3 months to 11 years old
✓ Group B Streptococcus.
✓ Haemophilus influenza type b
✓ Neisseria meningitides the most common cause of meningitis in children 11 year to
17 years old

21. Mode of Transmission
✓Usually mode of transmission (Middle ear or nasopharyngeal)
✓Fractures of the skull
✓lumbar punctures
✓Shunts
✓Most frequent in children <24mths & most often in winter

22. Clinical Manifestations
Progressively over 2-3 days of URI before meningitis starts
✓ Irritability - Vomiting - Lack of appetite - Seizures
✓ High-pitched cry
✓ Lethargy and irritability
✓ Jaundice (infants)
✓ Headache
✓ Photophobia
✓ Tenseness of the fontanels
✓ Nuchal rigidity: (resistance to neck flexion)
✓ Positive Kernig's sign: the child is inability to extend leg when thigh is flexed anteriorly at hip
✓ Positive Brudzinski's sign: flexion of the extremities occurring with deliberate flexion of the
child's neck
✓ Opisthotonis: involuntary arching of back
✓ Petechiae
✓ Febrile illness.

23. Clinical Manifestations cont
Classic picturein children between 3 months and 2 years old
• Fever
• Poor feeding
• Vomiting
• Marked irritability Frequent seizures (often accompanied by a high-pitched cry)
• Bulging fontanel
• Nuchal rigidity possible
• Brudzinski and Kernig signs not helpful in diagnosis
• Difficult to elicit and evaluate in this age group
• Subdural empyema (H. influenzae infection)

24. Clinical Manifestations cont
Neonates Specific Signs Child well at birth but within a few days begins to look and behave
poorly
• Refuses feedings Poor sucking ability
• Vomiting or diarrhea Poor tone
• Lack of movement Weak cry
• Full, tense, and bulging fontanel may appear late in course of illness
• Neck usually supple
• Nonspecific Signs That May Be Present Hypothermia or fever (depending on the infant's maturity)
Jaundice Irritability
• Drowsiness Seizures
• Respiratory irregularities or apnea
• Cyanosis Weight loss

25. Diagnostic Evaluation
1- Diagnosis is usually established through lumbar puncture and examination of
cerebral spinal fluids (CSF). Characterized by
➢Cloudy color.
➢Elevated CSF pressure.
➢Increased white blood cell (WBC) count.
➢Low glucose level
➢Elevated protein level.

26. Complications
1- Acute seizures, cerebral edema & increased intra cranial pressure (ICP) &
shock.
2- Long term sensor neural hearing loss, hydrocephalus, blindness, learning
disabilities & developmental delays.

27. Therapeutic Management
• Isolation precautions
• Initiation of antimicrobial therapy
• Maintenance of hydration
• Maintenance of ventilation
• Reduction of increased ICP
• Management of systemic shock
• Control of seizures
• Control of temperature
• Treatment of complications

28. Therapeutic Management cont
1- Administration for hospital & isolation
2- I.V. administration of the appropriate antibiotics to promote rapid destruction
of the bacteria such as 4th generation cephalosporins, ampicillin, gentamic and
vancomycin
3- Analgesics to treat pain of meningeal irritation
4- Supportive management of the comatose child or the child with seizures.
5- Appropriate prophylactic treatment provided for contacts when indicated.

29. Prognosis
• Less than 10% of cases of bacterial meningitis are fatal