Disease Types of the Signs and Diagnostic tests Management

Disease Symptoms

1.)*Hydrocephalus 1.)Communicating 1.)Rapid head 1.)- daily 1.)Surgical

growth measurement Ventriculoperitoneal
- Imbalanced in - impaired CSF of cranial Shunt/ Shunting
production and absorption in “Macewen circumference Procedures -
absorption of CSF subarachnoid villi sign”
in the ventricular - EEG Position:
system Non- – crack pot
communicating sound upon -MRI Prone with head on
percussion side, supine
- Obstruction to -CT SCAN supporting head
CSF flow within the Late infancy: with pillow or towel;
ventricles side lying
Bossing sign-
frontal Increase ICP –
enlargement elevation of head of
Setting sun sign bed
– sclera visible Pre op care:
above iris
Small freq. feeding
Infancy in
general: Sheep skin or lamb
wool under the skin
Opisthotonus
Post op care:
– arching with
back -position carefully
on unprotected side

- keep child flat

General
Management:

-Always support
head and neck

- Avoid
overstimulation

-Small frequent
 feedings

2.)Spina Bifida 2.)Myelography

- neural midline 2.)Spina Bifida Prenatal 2.)Surgical Closure:

tube defect Occulta Detection;
involving failure of 2.)Occulta: ultrasound, Pre operation:
- not visible
osseous spine to Skin dimples increased AFP Prone position with
close; affects L5 externally; affects chronic villus
L5 and S1 sterile dressing
and S1 Port wine sampling moistened with NSS
angiomatous
Spina Bifida MRI
Cystica levi Change dressing
every 24 hours
Dark tufts of CT Scan
- external sac like
protrusion hair Hips slightly flexed
and legs abducted
Soft SQ
Subtypes S.B
Cystica: lipomas No diapers

Cystica: Post operation:

Meningocele

- affects meninges Below L2: Prone position

and CSF Flaccid partial Side lying
Myolemeningocel paralysis
Orthopedic:
e Incontinence
Prevent joint
- affects meninges, Rectal contraction
CSF and nerves prolapsed
Correct deformities
Below L3:
Prevent effects of
Hydrocephalus motor and sensory
deficits
If with thoracic
lesions: Prevent skin
kyphosis and breakdown
scoliosis
Genitourinary:
neurologic bladder
dysfunction

- antibiotic therapy

-clean intermittent
 catheterization

Vesicostomy

Augmentation
enterocystoplasty

Bowel control:

Regular toilet habits

To prevent
constipation:

Fiber supplement

Laxatives

Enemas

Suppositories

Avoid taking rectal

thermometer

Other
maqnagements:

Turn head to side

when feeding

Meticulous skin care

Tactile stimulation

Traumatic Injuries:

Etiology:

MVA, assault, falls, accidents, abuse

Mechanisms of Injury:

Acceleration – stagnant target is struck by a moving object

Deceleration –moving by statimary deformation

Deformation

Coup injury- occurs at the point of impact

Contrecoup injury- occurs on the opposite side

Primary injury- impact damage

Secondary injury- delayed event that follow head injury such as edema, hemorrhage

Scalp injuries:

Lacerations

Hematomas

Contusions

Abrasion

Skull injuries:

Linear skull fractures- thin lines

Depressed skull fracture- bone fragment may penetrate in to the brain tissue

Banlar skull fracture- in bones over the base of frontal, temporal lobes; allow communication
between external environments of the brain

S/s of skull fracture:

CSF or other drainage from ear or nose

Blood behind the eardrum

Raccoon eyes- periorbital ecchymosis

Battle’s sign- delayed bruise over the mastoid

Brain injury:

Concussion- no tissue damage

S/s: loss of consciousness, headache, n/v

Contusion- there is tissue damage

Cerebral: altered LOC, vomiting, seizure, headache, nausea, vertigo, increase ICP

Brain stem: immediate unresponsiveness, motor abnormalities

Abnormal reflex response

Decorticate posture

Decerebrate posture

Flaccid posture

Increased ICP: increase temperature,projectile vomiting, increase BP, decrease PR andRR

Diagnostic test: MRI, Glasglow LOC, papillary reflexes, cranial nerve testing

Management:

Cover open wound

Apply pressure except if the depressed or compound skull fracture

Debridement

Evacuation of hematoma

Surgical elevation of depressed bone fragments, suturing

Cranioplasty

Ventilator support

Regulated fluids

Drugs:

Antiseizures

H2 antsgonist- bradikinin
Analgesics and antibiotics

Increased ICP management:

Hyperventilation

Mannitol

Quiet environment

Minimal invasive procedures

Suctioning

Elevate head 30 degrees

No valsalva maneuver

Complication of head trauma:

Epidural hematoma

Subdural hematoma

Intracerebral hematoma

Brain swelling and edema

Infection

Acute hydrocephalus

ARDS

Post traumatic syndrome like headache, dizziness, irritability, insomnia

Spinal cord injury:

C!-C4 – Quadriplegia – decrease phrenic innervations to diaphragm

C5-C6- Quadriplegia and gross arm movements and diaphragmatic breathing

C6-C7- quadriplegia with intact hips; diaphragmatic breathing; loss of shoulder movement

C7-C8- quadriplegia with biceps and triceps intact

T1-T2- paraplegia with loss of leg, bowel and bladder function; intact arm function
Syndrome causing partial paralysis:

1,) Central Cord Syndrome

- Common with hyperextension – hyper flexion injuries

Cause: edemas, hemorrhage on the central area of the cord (occupied by nerve tracts to hand
and arms)

2.) Anterior Cord syndrome

- Lesions to anterior spinal cord- complete motor function loss and decrease pain sensation;
intact touch position, vibration sensation

3.) Brown- Srguard syndrome

-lateral hemisection

Epilateral motor paralysis,loss of vibrating and position sense

Contralateral loss of pain and temperature sensation

4.) Complete transaction

-immediate loss of sensation and voluntary movement below area of transaction

Spinal shock (post-traumatic areflexia)

-no autonomic reflexes, sexual responses, bladder/ bowel function, skeletal muscles

-hypotension

-7 days- 3 months

-Resolution- return to reflexes

Autunomic desreflexia

- results when multiple spinal cord and autonomic responses discharge simultaneopusly

Exaggerated sympathetic response to noxious stimulus, bladder and bowel distention, pressure
ulcers, spasm, pressure on penis, uterine contractions

S/s:

Hypertension, pounding headache, flushing, diaphoresis, blurred vision, bradycardia

Management:

Spine in neutral alignment

Log roll when turning

Use cervical collar

Maintain patent airways with adequate oxygenation

Jaw thrust technique during intubation

Mechanical ventilation

DRUG: MEhtylprednisolone- improves motor and sensory function

Surgical laminectomy:

Long term Complications:

Chronic pain

Spasticity

Neurogenic bladder

Sexual and respiratory dysfunction

Peripheral nerve injuries

Causes: bone fracture, pressure, trauma, stretching of nerves

Common: median nerve, radial nerve, ulnar nerve, axillary and sciatic nerve

Carpal tunnel syndrome

- Compression of mechanical nerve as it passes thought the carpal funnel in wrist

Increase pain and paresthesia

Unknown cause

Management:

Splinting; steroid injection; decompression

Tarsal tunnel syndrome

- lower extremity

Posterior tibial nerve is trapped

Sciatic nerve injury

- causes: ruptured intervertebral disks, osteoarthritis of lumbosacral spine, incorrect injection
technique

Cerebral Palsy

Non progressive motor function

Impaired movement and posture

Classifications:

Spastic- hypertonicity

Impaired fine and gross motor skills

Dyskinetic- abnormal involuntary movement; slow, wormlike, writhing movements

Ataxic- wide based gait: rapid

Mixed- spasticity and dyskinetic

Diagnostic exam:

Neurologic exam

Persistence of primitive reflexes, persistent neuroreflex

MRI

EEG

Hearing and Vision function test

Goal: early recognition and promotion of optimal development

Ankle or foot braces

Mobilization devices

Orthopedic surgery

Neurosurgery

Dantrolene Na+ Baclufen and Diazepam- decrease overall spasticity

Botulinum toxin A (botox) – inhibit acetylcholine release into a muscle group that decrease the
spasticity
antiepileptics