Neurological disorder
Neurological disorder
The nervous system is usually divided into Central Nervous System and the Peripheral Nervous System, the CNS consist of the brain and spinal cord while the PNS is made up of the sense organs that sends information to the brain and efferent nerves that sends information out to the body for a particular response, Extra CNS has been found to have a very huge influence in the child’s cognitive development, that is why in most cases health provides are tasked with the challenge of screening and identifying health problems or even when is the proper time to refer the child to a specialist.
2
The nervous system is divide into the CNS and PNS
CNS has a very huge influence in child’s development
Health providers have a challenge of identifying and screening neurologic problems
Neurologic Disorder
Neurologic disorder is where a disease affects the CNS and PNS, it usually has a very huge neurologic implication in case that occurs since the central neurons will have uncontrolled firing i.e. seizure, the CNS will be unable to respond or process stimuli as well as PNS being unable to receive or respond to stimuli. This things usually occur when the nervous system of an individual is damaged hence preventing neurotransmitters to work properly as expected of them.
3
They are diseases that affect the CNS and the PNS
They usually lead to neurologic implication
The brain could start experiencing seizures
PNS may be unable to receive or respond to stimuli
Main Objectives
Describe the Pathophysiology of the neurologic system and pediatric differences
Choose the appropriate assessment guidelines and tools to examine infants and children with altered level of consciousness and other neurologic conditions
Assessment of the Nervous System
History
Onset
Pain and/or headache
Sensory deficits
Injury
Reflexive responses
Behavioral changes
Motor/balance changes
Medical history
Prenatal
Birth history/neonatal course
Injuries/infections
Assessment of the Nervous System
Medical history
Cardiovascular/respiratory disorders
Environmental exposure to toxins
Metabolic disorders
Past neurologic diseases/tests
Drug ingestion
Urinary tract disease
Physical growth
Family disease history
Similar symptoms/pedigree
Consanguinity
Migraine history
Intellectual functioning of family members
Assessment of the Nervous System
Developmental history
Achievement plateau/loss of skills
Functional health
Effects of symptoms on all areas of health promotion and safety
Social context
Family composition, school, community
Review all systems plus:
Allergies, immunizations, hearing, vision, dental, skin, behavior, nutrition,
Medications; recreational drugs
Physical Examination
Growth parameters
Skin abnormalities
Anomalies
Cardiovascular system
Musculoskeletal system
Hearing/vision
Tanner stage
Hepatomegaly/splenomegaly
Physical Examination
Specifics of the neurological examination
Behavior and mental status
Cranial nerve function
Motor examination
Sensory examination
Reflexes
Cranium examination
Autonomic nervous system
Meningeal signs
Physical Examination
Diagnostic studies
CT/MRI
Laboratory studies for systemic disease, infection, inflammation
Lumbar puncture
Electroencephalogram
US in infants
Polysomnography, electromyography, nerve conduction, evoked responses, cerebral arteriography
Early detection and how to suspect
We can suspect a child has neurological disorder if where he comes from is exposed to toxins such as lead
If there one of his family members has in the past experienced a long history of neurological disorder
It can be detected if a child experiences sensory deficit such as numbness or loss of pain sensation
Neurological disorder is usually suspected in a child if where he comes from the surrounding environment is exposed to toxins such as lead, which is something that must be put in consideration when examining the neurological condition of a child. We can also suspect them to have such conditions if one of their family members had experienced such condition in the past, to detect if a child might have a neurological disorder we might decide to take a look at the sensory deficit he or she is experiencing and whether or not it may be as a result of neurological condition.
11
Age/gender and risk factor
The gender mostly affected by this condition are the male species
They are children whose age run from 3yrs and below
Risk factor is environmental exposure to toxins such as lead
Trauma is also another risk factor
The male are the gender are mostly affected by neurological disorder since they are more exposed to the things which can lead to such conditions such as drug exposure. Children who are two years and below are the ones which this study is focused on and how neurological disorder can affect their neurodevelopment process. When a person is exposed to toxins such as lead his chances of getting neurological disorder is usually very high, likewise when he or she likes experiencing trauma and that may lead in having a negative long-term effect on his brain-functioning.
12
Genetics and most common diseases
Neurodegenerative disorder
White matter diseases
Rett syndrome
Multiple sclerosis
Nondegenerative Disorders
Benign paroxysmal vertigo
Cerebral palsy
Bell palsy
Epilepsy and seizure disorders
Febrile seizures
Brachial palsy
Guillain-Barre syndrome
Headaches
13
Genetics and most common diseases
Central Nervous System Infection
Head Injury
Disturbances of Head Growth
Macrocephaly
Microcephaly
Craniosynostosis
The Hypotonic Infant
Reye Syndrome
Tethered Cord
Arnold-Chiari Malformation
Myelomeningocele
Myasthenia Gravis
Central Nervous System Infection: Bacteria, viruses, fungi, spirochetes, protozoa, parasites can cause
14
Epilepsy
Seizure disorder of brain; characterized by recurring and excessive discharge from neurons
Repeated, unpredictable seizures
One in 20 children will have a seizure by age 18
45,000 children develop epilepsy each year
Seizure Disorders
Causes: Traumatic brain injury (TBI)
Infection
Congenital brain defects
Metabolism disorders (such as phenylketonuria)
Brain tumor
Abnormal blood vessels (brain)
Toxic ingestion
Anoxic or hypoxic events Hypoglycemia
Fever
Classification of Seizures
Partial
Simple partial: no loss of consciousness
Complex partial: affect level of consciousness
Symptoms depend on what area of the brain is involved
Often presents as a staring episode or slight twitching of eyes and drooling
Classification of Seizures
Generalized
Tonic-clonic (grand mal)
Tonic – stiff
Clonic – jerking
Sudden loss of muscle tone
Eye blinking, alter awareness, mouth, or facial
Epilepsy and seizure disorders physical examination
Focal abnormalities/weakness
Seizure activity during exam
Hypertension
Systemic disease
Cardiovascular disorder
Neurocutaneous disease
Signs of head trauma
Transillumination of skull in infants
Epilepsy and seizure disorders diagnostic studies
CBC, LFTs
Metabolic screen later in workup
Blood glucose
Urine/serum toxicology
Lumbar puncture if <6 months
EG
MRI in some cases
CT if marked cognitive, motor, neurologic dysfunction
Polysomnography
Differential diagnosis
Breath-holding, inattentive staring, benign shudders, tantrums
Cyclic vomiting, benign paroxysmal vertigo, syncope, migraines, cardiovascular are symptoms
GERD, night terrors, nonepileptic seizures
Metabolic problems, tumors or CNS problems
Management
Referral – to neurologist for diagnosis and initiation of treatment
PCP can monitor stable children
Drug monitoring
Antiepileptic medication withdrawal
Gradual withdrawal after 2 years without seizures
Ketogenic diet
Surgery
Counseling
Safety
Swimming, driving, sports
Immunizations
Pertussis vaccine on individualized basis
Febrile Seizures
Age
Most common between 6 months and 5 years
Concurrent illness with rapid fever rise
Diagnostic studies
Lumbar puncture
Blood glucose
CBC, calcium, electrolytes, urinalysis optional
EEG if neurological signs present
MRI for complex febrile seizures
Differential diagnosis
Sepsis, meningitis, metabolic/toxic encephalopathies
Hypoglycemia, anoxia, trauma, tumor, hemorrhage
Febrile seizure Management
Protect airway, breathing, circulation
Time duration of seizure
Reduce fever with APAP or ibuprofen
Anticonvulsants only if complex, if neurological signs present
Prophylaxis not recommended
Education about febrile seizures
Disturbances of Head Growth
Macrocephaly
Head circumference >2 SD above mean
Hydrocephaly, megalencephaly, subdural hematoma, tumor, skull thickening
Microcephaly
Head circumference 2 SD below mean
Normal shape; may have overlapping sutures
Delayed development, neurological problems
Craniosynostosis
Congenital – early closure/absence of one or more sutures
Syndromic – accounts for 25% of cases
Growth along open sutures produces deformity
Secondary synostosis – outside forces put pressure growing cranium – plagiocephaly
Physical examination – cranial symmetry for first year, symmetry of neck rotation
Neural Tube Defects
Abnormalities of brain, spine, or spinal column; present at birth
Failure of the osseous spine to close around the spinal column
Spina bifida: most common type
Spina bifida occulta
Meningocele
Meningomyelocele
Spina Bifida Clinical Manifestations
Vary depending on the level of the lesion and defect
Motor, sensory, reflex and sphincter abnormalities
Lower extremity weakness Ambulation difficulties
Flaccid paralysis of legs- absent sensation and reflexes, or spasticity Bowel and bladder control issues
Hydrocephalus
Learning, attention, memory, and reasoning problems
Spina Bifida: Diagnostic Tests
Prenatal detection
Ultrasound
Alpha-fetoprotein
Following Birth:
NB assessment
Ultrasound
CT scan/ MRI
X-ray of spine
X-ray of skull
Spina Bifida Extensive interdisciplinary treatment
Antibiotics, sac closure (neonatal neurosurgery), and ventriculoperitoneal shunt placement
Monitoring of head size (hydrocephalus), evaluation of sphincters, and institution of bowel and bladder regimen
Dietary fiber, stool softeners, suppositories
Clean intermittent catheterization
Physical therapy, occupational therapy, speech therapy
Braces, assistive devices, weight-bearing exercises
Calcium, vitamin D, high-fiber diet
Myelomeningocele
Posterior neural tube and vertebral column not closed
Protrusion of both spinal cord and meninges
Spina bifida cystica – myelomeningocele
Spina bifida occulta – no herniation; open column
Clinical findings
Poor intake of folic acid in pregnancy
Saclike cyst containing meninges/spinal fluid
Flaccid paralysis of lower extremities
Absence of DTRs; lack of pain/touch response
Constant urinary dribbling
Management and complications
Serial cranial US to monitor for hydrocephaly
Surgical resection/closure of structures at birth
Multidisciplinary supportive management
Genitourinary management
Prognosis
Normal intelligence in 70%
Functional mobility depends on level/degree
Prevention
Folic acid supplementation for all females of childbearing age
31
Arnold-Chiari Malformation
Type I – downward elongation of caudal end of cerebellar vermis into foramen magnum
Type II – herniation can lead to brainstem and upper cervical cord compression and necrosis
Diagnosis by MRI
Never attempt LP in child with Arnold-Chiari malformation
Cerebral Palsy
Nonreversible disorders
Chronic, nonprogressive
May have disturbances in sensation, perception, cognition, communication, behavior
Epilepsy, musculoskeletal problems may be present
Three major types:
Spastic – muscle stiffening and tightness
Athetoid – involuntary, purposeless muscle movement
Ataxic – affects balance and coordination
1.5 – 2 cases per 1000 live births
Most common motor disability in children
Clinical Manifestations Infants
Problems with sucking and swallowing
A weak or shrill cry
Extreme irritability and crying
Jittery (easily startled)
Unusual positions (either very relaxed and floppy or very stiff)
Delay in reaching motor skills milestones (such as sitting up alone or crawling)
Delays in speech development or difficulty speaking
Clinical Manifestations Children
Abnormal motor development
Persistent primitive infantile reflexes Increased or decreased muscle tone
Hypertonia, rigidity, muscles stiff
Keeps legs extended or crossed
Rigid and unbending
Exaggerated deep tendon reflexes
Opisthotonus
Abnormal increased muscle development in arms & legs Hypotonia, muscles floppy
Smaller muscles in affected arms & legs Diminished reflexes
Clinical Manifestations Children
Abnormal posture
Difficulty walking, such as walking on toes, a crouched gait, a scissors-like gait with knees crossing or a wide-based unsteady gait
Persistent fetal position (>5 months)
Abnormal voluntary movements
Tremors or involuntary movements
Slow, writhing movements (athetosis)
Difficulty with precise motions (hand movements)
Lack of muscle coordination (ataxia)
Abnormal sensations Abnormal touch or pain perceptions
Seizures
Cerebral palsy– physical examination
Dermatologic signs of syndromes
Orthopedic exam – scoliosis, fractures, dislocations
Neurologic exam – DTR, tone, atrophy, fasciculations, reflexes, asymmetric movements, head size
Vision/hearing
Development – gross/fine motor, language, personal-social skills
Feeding
Diet, height, weight, BMI
Diagnostic studies – imaging studies, chromosomal and metabolic studies, lumbar puncture if sepsis suspected
Differential diagnosis – central vs peripheral; other conditions causing motor involvement
Central Nervous System Infection
Bacteria, viruses, fungi, spirochetes, protozoa, parasites can cause
Clinical findings – history
URI or GI symptoms with fever
Increasing lethargy/irritability
Recent head injury/surgery
Immunodeficiency disease
Central Nervous System Infection
Clinical findings – physical examination
Systemic signs – fever, malaise
CNS signs – headache, stiff neck/spine, N/V, changes in mental status
Kernig/Brudzinski signs
Bulging fontanelle/papilledema
Cranial nerve palsies
Findings differ by age
Diagnostic studies – blood cultures, CBC, UA, chemistry, lumber puncture
Cerebral Palsy Management
Referral of suspected cases
Family education/support/financial resources
Nutrition, elimination
Dentistry/drooling
Respiratory
Skin
Movement/mobility
Medications
Communication
Vision
Osteopenia
Pain
Special education
Other treatments
Head Injury
Traumatic brain injury (TBI)
Mild to severe tissue damage
Acceleration-deceleration or rotational forces
Long-term sequelae more common in children
Open trauma – more focal injuries
Closed trauma – multifocal/diffuse
Secondary effects: hypoxia, ischemia, hypotension, hemorrhage
physical examination
Vital signs
Thorough physical examination
Careful neurologic examination
Signs of CNS involvement
Glasgow Coma Scale to assess mental status
Periorbital hemorrhage, “Battle sign”
Head Injury
diagnostic studies
Severity dictates need for studies
CT for any of the following:
Penetrating trauma
Altered level of consciousness
Amnesia about injury
Focal neurological signs/deficit
Depressed skull fracture/basilar injury
Seizures
Persistent vomiting
History of coagulopathy
Differential diagnosis
Differentiating minor from extensive injury important
Management
Minor closed head injury; no loss of consciousness
Observation in clinic, ED, home
Understanding of signs to watch
Minor closed head injury
brief loss of consciousness Observation in clinic, ED, home
Understanding of signs to watch
CT scanning accepted
Hospitalization if reliable home monitoring not possible
Moderate head injury; worrisome symptoms
Admission, prolonged observation in ED
Hospitalize for the following:
Changing vital signs
Seizures
Altered mental status/slurred speech
Prolonged unconsciousness/persistent memory defect
Depressed or basilar skull fractures
Persistent headache
Recurrent vomiting/unexplained fever
Unexplained injury (child abuse)
Worrisome CT/MRI findings
US statics
The government has tried making investments to overcome neurological disorder
In 2011 at least 100 million Americans had been afflicted by at least one of the neurological diseases
In 2014 US spent $789 billion on the most common neurological disease
Alzheimer and other dementias had accounted for at least $243 billion out of $789 billion spent that year.
The US government has tried making a reasonable amount of investment over the year to overcome neurological disease, reports got in 2011 had indicated that at least 100 million American had once been afflicted by at least one of the neurological disease. American Neurological Association had reported that the government had spent $789 billion to be able to overcome the most common neurological diseases in 2014. Out of this money spent by ANA Alzheimer and other dementias spent about $243 billion.
44
References
Burns, C. E., Dunn, A. M., Brady, M. A., Starr, N. B., Blosser, C. G., & Maaks, D. L. G. (2012). Pediatric primary care-e-book. Elsevier Health Sciences.
Espay, A. J., Aybek, S., Carson, A., Edwards, M. J., Goldstein, L. H., Hallett, M., … & Nielsen, G. (2018). Current concepts in diagnosis and treatment of functional neurological disorders. JAMA neurology, 75(9), 1132-1141.
Kirkland, A. E., Sarlo, G. L., & Holton, K. F. (2018). The role of magnesium in neurological disorders. Nutrients, 10(6), 730.
.MsftOfcThm_Accent1_Fill { fill:#90C226; } .MsftOfcThm_Accent1_Stroke { stroke:#90C226; }
NB: We do not resell papers. Upon ordering, we do an original paper exclusively for you.
Do you need a similar assignment done from scratch? We have qualified writers to help you. We assure you an A+ quality paper that is free from plagiarism. Order now for an Amazing Discount! Use Discount Code "save15" for a 15% Discount!
Request essay helpYou can trust us for this and even for your future projects
