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Neurological Problems & Neurological Problems & Neurological DisorderNeurological Disorder
Xuqin ChenXuqin Chen Lecturer of PediatricsLecturer of Pediatrics
Department of PediatricsDepartment of Pediatrics
Children’s Hospital of Soochow UChildren’s Hospital of Soochow Universityniversity
Section 1. Neurological Section 1. Neurological ExaminationExamination
Aims and claims1. Familiar with the general examination of neurological system.
2. Understanding the examination of the cranial nerves
3. Get hold of the motor examination,.
4. Familiar with the sensory examination.
Main contents• 1. Introduce the general examination of
neurological system.• 2. Introduce the examination of the cranial
nerves.
• 3. Emphasize the motor examination,.• 4. Introduce the sensory examination.
Topic 1. General examinationTopic 1. General examination
• Make it as a game playing to meet the children’s needs
• Carefully observe the child when playing and interacting
• Head shape and circumference• Pay attention to the relative symptoms: n
eurocutaneous stigmata, hepato-splenomegaly-------
2. What from G.E.?2. What from G.E.?
• Consciousness:
sleepy (drowsy, 嗜睡 )
unconsciousness (意识不清) lethargy ( 昏睡) coma (昏迷)
Topic 1. general examination (con.1)
Topic 1. general examination (con.2)
• Mental condition:
delirium( 谵妄) irritable ( 烦躁) obtuse ( 迟钝) depression( 忧郁)
Topic 1. general examination (con.3)
• Action and reaction:
• IQ:
• Special features:
Neurocutaneous stigmata( 神经皮肤症)
Dysmorphic feature (畸形特点)
Topic 2. The cranial nervesTopic 2. The cranial nerves• Table 32. cranial nerve assessment in infants
Nerve test Ⅰ not tested
Ⅱ blinks to bright light
Ⅲ- assess highlights on pupilsⅥ Ⅴ corneal reflexes
Ⅶ facial asymmetry
Ⅷ startles to sound;
Ⅸ- gag reflexⅩ Ⅺ not tesed
Ⅻ tongue movement
Topic 3. Motor examinationTopic 3. Motor examination• Muscle tone: posture movements• Hypotonic: frog-leg in neonates floppy ( 松软儿)• Spasticity: ( 痉挛)• Rigidity ( 僵直)
Topic 3. Motor examination(con.1)Topic 3. Motor examination(con.1)
• Power:
Power Observation
0 No power
1 Barely perceptible power
2 Movement with gravity removed
3 Movement just overcomes gravity
4 Movement against gravity and some resistance
5 Normal power
Topic 3. Motor examination(con.2Topic 3. Motor examination(con.2))
• Reflexes
• Mobility( 活动) and gait (步态) :
dystonia (肌张力障碍) athetosis (手足徐动症) chorea (舞蹈病)• Speech
Sensory examinationSensory examination• The most difficult part of neurological exa
mination:
Touch
Pain
Vibration
Temperature
Joint position
Topic 3. Motor examination(con.3)Topic 3. Motor examination(con.3)
Section 2. Infections of Section 2. Infections of the CNS the CNS
Aim and claimAim and claim• 1. Understanding the causes of meningitis, enc
ephalitis, postinfection syndrome• 2. Get hold of the clinical features of bacterial m
eningitis, encephalitis and Guilain-Barre Syndrome
• 3. Familiar with the diagnosis of meningitis and encephalitis
• 4. Understanding the complication of meningitis
Main contentsMain contents• 1. Introduce the causes of meningitis, ence
phalitis, postinfection syndrome• 2. Emphasize the clinical features of bacteri
al meningitis,encephalitis and Guilain-Barre Syndrome
• 3. Emphasize the diagnosis of meningitis and encephalitis
• 4. Introduce the complication of meningitis
Topic 1. MeningitisTopic 1. Meningitis• Pathogens of acute meningitis
Bacteria; Neisseria meningitidis
Strep. Pneumoniae Hemophilus influenzae type B
neonatal: GBS
E. coli Listeria monocytogenes
Virus: Mumos
Enterovirus Epstein-Barr virus
Topic 1. MeningitisTopic 1. Meningitis(con.1)
• Clinic features: Bulging fontanelle
Neck stiffness and photophobia
A convulsion
Meningococcal infection----non-blanching purpuric rash
Topic1. Meningitis(cont.2)Topic1. Meningitis(cont.2)
• Diagnosis:Lumbar puncture CSF examination Special LP indication for younger
children Focal neurological signs / high
intracranial pressure---treatment before LP (risk of coning)
Topic 1. Meningitis(cont.3)Topic 1. Meningitis(cont.3)
Rapid diagnostic tests include;
Countercurrent immumoelectrophoresis
Latex agglutination
PCR
Blood culture
Topic 1. Meningitis(cont.4)Topic 1. Meningitis(cont.4)
• Treatment:
Broad-spectrum iv antibiotics
third generation cephalosporin
Meningococcal sepsis---immediately benzylpenicillin
Add ampicillin under 3 years
Dexamethasone reduce neurological sequelae(except neonates) of H.Influ. And S. pneumonia
Topic 1. Meningitis(cont.5)Topic 1. Meningitis(cont.5)
• Complication:Acute : Inappropriate ADH secretion
Subdural effusion
Cerebral oedema
Convulsions
Topic 1. Meningitis(cont.6)Topic 1. Meningitis(cont.6)
• Differential diagnosis;Encephalitis:
A. Causes----herpes simplex virus1/2
Enteroviruses
Varicella
B. Clinical features---non-specific symptoms
and signs
abrupt encephalopathic illness
Topic 1. Meningitis(cont.7)Topic 1. Meningitis(cont.7)
C. Diagnosis---EEG/ MRI temporal lobe abnormalities D. Management---acyclovir for HSV supportive methods: ICU intracranial pressure monitor, mannitol and Dex. For oedemaPostinfectious syndromes---Guillain-Barre sy
ndrome
Topic 2. EncephalitisTopic 2. Encephalitis
• Causes:
Herpes simplex virus 1&2
Enterovirus
Varicella
Viral exanthems( 皮疹 ) {measles,
rubella, mumps}
Topic 2. Encephalitis (con.1)Topic 2. Encephalitis (con.1)
• Clinical features:Non-specific: Fever Headache VomitingEncephalopathic : Altered consiousness, seizure, Raised intracranial pressure
Topic 2. Encephalitis (con.2)Topic 2. Encephalitis (con.2)
• Diagnosis and management:
EEG, MRI----temporal lobe abnormality
Herpes simplex encephalitis ---acyclovir
Supportive management:
ICU intracranial pressure monitoring
Mannitol and Dex. for cerebral oedema
Thank you