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TL Neurologic Peds

Pediatric Neurological Disorders

Common sign in meningitis – involuntary knee flexion in when child’s head is flexed Brudzinski’s sign
Late sign of increased intracranial pressure consisting of increased systolic blood pressure, bradycardia, and irregular respirations cushing’s triad
Bleeding between the dura and cranium Epidural Hematoma
Pain or resistance when the leg is raised and knee flexed; common finding indicative of meningeal irritation Kernig’s sign
Fibrous membrane that covers brain and lines vertebral canal meninges
Stiffness of the neck or resistance to neck flexion often seen with infection of the CNS Nuchal rigidity
Client positions self hyperextending the head and neck to relieve discomfort of meningeal irritation Opisthotonus
When do the brain and spinal cord develop in the fetus? first trimester
What kind of things can affect development of the brain and spinal cord during the first trimester? Infection, substance abuse, dietary deficiency
When does the nervous system become mature? Not at birth but as the number of glial cells and dendrites increase refinement continues until about 4 years of age
List levels of consciousness in decreasing order. confusion, delirium, obtunded, stupor, coma
Define delirium. disorientation without drowsiness; hallucinations or delusions, difficulty focusing, inability to rest/sleep, physical/autonomic overactivity
Define obtunded. having diminished arousal and awareness, often as a result of intoxication, metabolic illness, infection, or neurological catastrophe
Define stupor. decreased responsiveness to environment; arousable only with vigorous or unpleasant stimuli
Define coma unarousable to painful stimuli
Define ICP pressure within the cranium or skull that surrounds the brain
What is the normal range for ICP? 4-12 mm
What three components contribute to normal ICP? the brain, cerebrospinal fluid, and blood
What happens if any one of the components of ICP increases? The other two have to compensate
What advantage does a young child have over an older one when it comes to increased ICP? their sutures have not closed so their cranium can expand to a point if there is increased pressure
What score on the Glasgow coma scale would indicate that a person has no alteration in LOC? 15
What score on the Glasgow coma scale would indicate that a person is in a coma state? 8 or below
What score on the Glasgow coma scale indicates that a person is in a deep coma? 3
What do we do if our patient does not respond to painful stimuli? report immediately
Why is it important that the neurologic examination be documented in a fashion that can be reproduced by others? This allows for comparison of the findings so that the observer can detect subtle changes in neurologic status that might not otherwise be apparent.
What do vital signs like pulse, BP and respiration tell us about altered consciousness? Information about adequacy of circulation and possible underlying cause of altered consciousness
When would autonomic activity most disturbed? In cases of deep coma or brainstem lesions
What are some possible causes of elevated temperature? most frequently infectious process or heat stroke, also ingestion of certain drugs (salicylates, alcohol, and barbiturates) or intracranial bleeding especially subarachnoid hemorrhage, involvement of the hypothalamus (temperature may increase or decrease)
What cause of coma could produce hypothermia? toxic origin
Define the Cushing reflex. increasing systolic bp (widening pulse pressure) and slowing pulse – late sign of ICP
What are some possible causes of slow, deep breathing? sedatives, after seizure, cerebral infection
What are some possible causes of slow, shallow breathing? sedatives or opioids
What are the usual causes of deep and rapid respirations? metabolic acidosis or abnormal stimulation of the respiratory center in the medulla caused by salicylate poisoning, hepatic coma, or Reye syndrome
Periodic or irregular breathing is an ominous sign of BLANK dysfunction. brainstem (especially medullary – often precedes complete apnea)
What odor does a person’s breath have when they have ketosis? fruity
What might you suspect if an unconscious person has fetid breath? Hepatic failure
Define fetid. Rank, Foul