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Far Eastern University

Institute of Nursing
Nicanor Reyes St., Manila

Nursing Care Management 103B


Related Learning Experience

Neurological Problems in Infants and


Pediatrics

Submitted by:
BSN 105
Group 19B
CRUZ, Dave Neilmer
CRUZ, Janelle
CUNANAN, Tristan John
DALISAY, Kenneth
DALUSONG, Eidelle Anne

Submitted to:

Ma’am Myra Sandoval, RN


Clinical Instructor
August 22, 2010
Neurological Disorders in Infants and Pediatric Patients

Cerebral Palsy

Cerebral Palsy (CP) is brain damage that occurs in an infant before, during, or soon after
birth. This simply means that there has been some injury to the brain during development which
has resulted in difficulty transmitting the necessary impulses from the brain to the muscles for
coordinated movement. This results in some degree of motor dysfunction.

Many children born prematurely will develop some movement difficulties related to early
neurological injury. These impairments emerge slowly over time and are typically not evident
during the newborn period. Most mild motor abnormalities noticeable during the first few
months of life will improve and may completely resolve with time. When motor impairment
persists, a diagnosis of cerebral palsy may be considered. About 10% of children born at birth
weights of less than 1000 grams will eventually receive a diagnosis of cerebral palsy a
permanent condition.

Diagnosing cerebral palsy in children born prematurely is often a difficult process which
requires observing the child's development over time.

For a diagnosis of CP, the following are necessary:

Movement of muscles has to be adversely affected.


The motor impairment has to be due to a neurological injury.
The injury or lesion must be static (not getting worse, but no longer resolving).
The injury has to occur while the motor system is still developing (usually before, during, or
right after birth).
The impairment in movement does not resolve with time.

Types of Cerebral Palsy

Cerebral Palsy comes in a variety of different forms and with a continuum of severity.
CP can be so mild that it is only noticeable when the individual is stressed or involved in certain
activities. It can be so severe as to limit most voluntary movement. It can take several years for
the full impact of a child's cerebral palsy to become apparent. However, children do not switch
from one form of cerebral palsy to another or from one impairment level to another, after the
condition is fully expressed. For example, a child well beyond infancy with mild cerebral palsy
effecting the legs only is not at risk to develop a different or more severe form of cerebral palsy
later in development.

Most former preemies with CP will have spastic diplegia. Spastic diplegia involves an
involuntary increase of muscle tone (tightness or stiffness) that primarily affects the limbs, with
legs and feet being much more affected than the arms and hands. Children with spastic diplegia
from injury before or around the time of birth almost always have some difficulty with their
hands, though the legs will be much more obviously affected.

Other subtypes of spastic cerebral palsy besides spastic diplegia include spastic
hemiplegic and spastic quadriplegia. The prefixes "hemi-" and "quadri-," like "di-" refer to the
location of the impairment. Children with hemiplegia have movement of the limbs on one side
of the body, but not the other. The full extent of the motor disability impairment is not realized
until fairly late with spastic hemiplegia, often as late as three years of age. Epilepsy is relatively
more common in children with hemiplegia (Russman, 1992), but these children are also very
likely to function well in general. Quadriplegia interferes with the impairment of all four limbs,
typically with the head and trunk involved as well. Quadriplegia most often occurs in children
who have had severe deprivation of oxygen to the brain because of reduced oxygen in the blood
and decreased blood flow to the brain (Eicher & Batshaw, 1993). Quadriplegia tends to be
identified earlier than other forms of cerebral palsy and can sometimes be diagnosed in the first
six months of life.

Development and Recovery

The diagnosis of CP can be very complex. One reason for the difficulty is the
simultaneous processes of development and healing (what would be called "recovery of
function" in an older patient who had previously acquired skills). An infant leaving neonatal
intensive care may have strong indications of neurologically based muscle tone abnormality, yet
the brain's remarkable ability to adapt during the recovery process is most apparent during the
early months of infancy. At the same time, however, the normal developmental process
continues - proceeding from early infancy where motor control is minimal to the sophisticated
coordination of muscle groups necessary for complex movement.

Normal newborns have little voluntary muscle control. New skills unfold in a predictable
manner as the baby grows and develops. Just as it takes time for these abilities to develop, it
takes time for it to become apparent which of them may have been affected by early injury.
(Remember, the early injury may still be resolving or healing.)

Preemies often have very low muscle tone neonatally (e.g., they are "floppy") and the
abnormally increased muscle tone (the "tightness" associated with spastic CP) is often not
apparent until after the first few months at home. Tone may appear normal during this period of
transition. The initial low tone often resolves with recovery; but, as a child with CP starts to
need voluntary movement, it becomes apparent that there is going to be difficulty with some
movements. As more muscles are called into voluntary action, further difficulties with movement
may appear.

During the first year it can be very difficult to determine at what point the infant has
maximized whatever recovery is going to be made, and at what point the emerging muscle tone
problems are indications of long-term impairment. The timing can be very different from one
child to another. For this reason, it is not unusual for a child with mild CP not to be diagnosed
until after the second year. Since CP is a permanent condition, doctors like to wait until they are
very sure that what they are seeing is not going to go away before they give a diagnosis. Usually
only the more severe cases of CP can be diagnosed within the first several months corrected age,
while milder cases tend not to be diagnosed until it becomes apparent that the muscle tone or
control problems are not going to resolve with development.

Autism

Autism is a disorder of neural development characterized by impaired social interaction


and communication, and by restricted and repetitive behavior. These signs all begin before a
child is three years old. Autism affects information processing in the brain by altering how nerve
cells and their synapses connect and organize; how this occurs is not well understood. It is one of
three recognized disorders in the autism spectrum (ASDs), the other two being Asperger
syndrome, which lacks delays in cognitive development and language, and Pervasive
Developmental Disorder-Not Otherwise Specified (commonly abbreviated as PDD-NOS), which
is diagnosed when the full set of criteria for autism or Asperger syndrome are not met.

Autism has a strong genetic basis, although the genetics of autism are complex and it is
unclear whether ASD is explained more by rare mutations, or by rare combinations of common
genetic variants.[4] In rare cases, autism is strongly associated with agents that cause birth defects.
Controversies surround other proposed environmental causes, such as heavy metals, pesticides or
childhood vaccines; the vaccine hypotheses are biologically implausible and lack convincing
scientific evidence. The prevalence of autism is about 1–2 per 1,000 people; the prevalence of
ASD is about 6 per 1,000, with about four times as many males as females. The number of
people diagnosed with autism has increased dramatically since the 1980s, partly due to changes
in diagnostic practice; the question of whether actual prevalence has increased is unresolved.

Parents usually notice signs in the first two years of their child's life. The signs usually
develop gradually, but some autistic children first develop more normally and then regress.
Although early behavioral or cognitive intervention can help autistic children gain self-care,
social, and communication skills, there is no known cure. Not many children with autism live
independently after reaching adulthood, though some become successful. An autistic culture has
developed, with some individuals seeking a cure and others believing autism should be tolerated
as a difference and not treated as a disorder.

Autism is a highly variable neurodevelopmental disorder that first appears during infancy
or childhood, and generally follows a steady course without remission. Overt symptoms
gradually begin after the age of six months, become established by age two or three years, and
tend to continue through adulthood, although often in more muted form. It is distinguished not
by a single symptom, but by a characteristic triad of symptoms: impairments in social
interaction; impairments in communication; and restricted interests and repetitive behavior.
Other aspects, such as atypical eating, are also common but are not essential for diagnosis.
Autism's individual symptoms occur in the general population and appear not to associate highly,
without a sharp line separating pathologically severe from common traits.

Brain Tumor
A brain tumor is an intracranial solid neoplasm, a tumor (defined as an abnormal growth
of cells) within the brain or the central spinal canal.

Brain tumors include all tumors inside the cranium or in the central spinal canal. They are
created by an abnormal and uncontrolled cell division, normally either in the brain itself
(neurons, glial cells (astrocytes, oligodendrocytes, ependymal cells, myelin-producing Schwann
cells), lymphatic tissue, blood vessels), in the cranial nerves, in the brain envelopes (meninges),
skull, pituitary and pineal gland, or spread from cancers primarily located in other organs
(metastatic tumors).

Any brain tumor is inherently serious and life-threatening because of its invasive and
infiltrative character in the limited space of the intracranial cavity. However, brain tumors (even
malignant ones) do not automatically cause death. Brain tumors or intracranial neoplasms can be
cancerous (malignant) or non-cancerous (benign); however, the definitions of malignant or
benign neoplasms differs from those commonly used in other types of cancerous or non-
cancerous neoplasms in the body. Its threat level depends on the combination of factors like the
type of tumor, its location, its size and its state of development. Because the brain is well
protected by the skull, the early detection of a brain tumor only occurs when diagnostic tools are
directed at the intracranial cavity. Usually detection occurs in advanced stages when the presence
of the tumor has side effects that cause unexplained symptoms.

Primary (true) brain tumors are commonly located in the posterior cranial fossa in
children and in the anterior two-thirds of the cerebral hemispheres in adults, although they can
affect any part of the brain.

Tuberous Sclerosis

Tuberous sclerosis or tuberous sclerosis complex (TSC) is a rare, multi-system genetic disease
that causes benign tumours to grow in the brain and on other vital organs such as the kidneys,
heart, eyes, lungs, and skin. A combination of symptoms may include seizures, developmental
delay, behavioral problems, skin abnormalities, lung and kidney disease. TSC is caused by
mutations on either of two genes, TSC1 and TSC2, which encode for the proteins hamartin and
tuberin respectively. These proteins act as tumour growth suppressors, agents that regulate cell
proliferation and differentiation.

The name, composed of the Latin tuber (swelling) and the Greek skleros (hard), refers to the
pathological finding of thick, firm and pale gyri, called "tubers," in the brains of patients
postmortem. These tubers were first described by Désiré-Magloire Bourneville in 1880; the
cortical manifestations may sometimes still be known by the eponym Bourneville's disease.

Multiple Sclerosis

Multiple sclerosis (abbreviated MS, also known as disseminated sclerosis or


encephalomyelitis disseminata) is an inflammatory disease in which the fatty myelin sheaths
around the axons of the brain and spinal cord are damaged, leading to demyelination and scarring
as well as a broad spectrum of signs and symptoms. Disease onset usually occurs in young
adults, and it is more common in females. It has a prevalence that ranges between 2 and 150 per
100,000. MS was first described in 1868 by Jean-Martin Charcot.

MS affects the ability of nerve cells in the brain and spinal cord to communicate with
each other. Nerve cells communicate by sending electrical signals called action potentials down
long fibers called axons, which are wrapped in an insulating substance called myelin. In MS, the
body's own immune system attacks and damages the myelin. When myelin is lost, the axons can
no longer effectively conduct signals. The name multiple sclerosis refers to scars (scleroses—
better known as plaques or lesions) in the white matter of the brain and spinal cord, which is
mainly composed of myelin. Although much is known about the mechanisms involved in the
disease process, the cause remains unknown. Theories include genetics or infections. Different
environmental risk factors have also been found.

Almost any neurological symptom can appear with the disease, and often progresses to
physical and cognitive disability. MS takes several forms, with new symptoms occurring either
in discrete attacks (relapsing forms) or slowly accumulating over time (progressive forms).
Between attacks, symptoms may go away completely, but permanent neurological problems
often occur, especially as the disease advances.

There is no known cure for MS. Treatments attempt to return function after an attack,
prevent new attacks, and prevent disability. MS medications can have adverse effects or be
poorly tolerated, and many patients pursue alternative treatments, despite the lack of supporting
scientific study. The prognosis is difficult to predict; it depends on the subtype of the disease, the
individual patient's disease characteristics, the initial symptoms and the degree of disability the
person experiences as time advances. Life expectancy of patients is nearly the same as that of the
unaffected population.

Subtypes include:

1. relapsing remitting,
2. secondary progressive,
3. primary progressive, and
4. progressive relapsing.

The relapsing-remitting subtype is characterized by unpredictable relapses followed by periods


of months to years of relative quiet (remission) with no new signs of disease activity. Deficits
suffered during attacks may either resolve or leave sequelae, the latter being more common as a
function of time.

Secondary progressive MS (sometimes called "galloping MS") describes around 65 % of those


with an initial relapsing-remitting MS, who then begin to have progressive neurologic decline
between acute attacks without any definite periods of remission.

The primary progressive subtype describes the approximately 10–15% of individuals who never
have remission after their initial MS symptoms. It is characterized by progression of disability
from onset, with no, or only occasional and minor, remissions and improvements.
Progressive relapsing MS describes those individuals who, from onset, have a steady neurologic
decline but also suffer clear superimposed attacks. This is the least common of all subtypes.[6]

Epilepsy

Epilepsy (from the Ancient Greek ἐπιληψία (epilēpsía) — "to seize") is a common chronic
neurological disorder characterized by recurrent unprovoked seizures. These seizures are
transient signs and/or symptoms of abnormal, excessive or synchronous neuronal activity in the
brain. Epilepsy is more likely to occur in young children, or people over the age of 65 years;
however, it can occur at any time. As a consequence of brain surgery, epileptic seizures may
occur in recovering patients.

Epilepsy is usually controlled, but cannot be cured with medication, although surgery may be
considered in difficult cases. However, over 30% of people with epilepsy do not have seizure
control even with the best available medications. Not all epilepsy syndromes are lifelong – some
forms are confined to particular stages of childhood. Epilepsy should not be understood as a
single disorder, but rather as syndromic with vastly divergent symptoms but all involving
episodic abnormal electrical activity in the brain.

The brain is the center that controls and regulates all voluntary and involuntary responses
in the body. It consists of nerve cells that normally communicate with each other through
electrical activity.
A seizure occurs when part(s) of the brain receives a burst of abnormal electrical signals that
temporarily interrupts normal electrical brain function.

There are several different types of seizures in children, including the following:

• focal seizures
Focal seizures take place when abnormal electrical brain function occurs in one or more
areas of one side of the brain. Focal seizures may also be called partial seizures. With
focal seizures, particularly with complex focal seizures, the child may experience an aura
before the seizure occurs. An aura is a strange feeling, either consisting of visual changes,
hearing abnormalities, or changes in the sense of smell.

Two types of partial seizures include the following:

o simple focal seizures


The seizures typically last less than one minute. The child may show different
symptoms depending upon which area of the brain is involved. If the abnormal
electrical brain function is in the occipital lobe (the back part of the brain that is
involved with vision), the child's sight may be altered. The child's muscles are
typically more commonly affected. The seizure activity is limited to an isolated
muscle group, such as fingers or to larger muscles in the arms and legs.
Consciousness is not lost in this type of seizure. The child may also experience
sweating, nausea, or become pale.
o complex focal seizures
This type of seizure commonly occurs in the temporal lobe of the brain, the area
of the brain that controls emotion and memory function. This seizure usually lasts
between one to two minutes. Consciousness is usually lost during these seizures
and a variety of behaviors can occur in the child. These behaviors may range from
gagging, lip smacking, running, screaming, crying, and/or laughing. When the
child regains consciousness, the child may complain of being tired or sleepy after
the seizure. This is called the postictal period.
• generalized seizures
Generalized seizures involve both sides of the brain. There is loss of consciousness and a
postictal state after the seizure occurs. Types of generalized seizures include the
following:
o absence seizures (also called petit mal seizures)
These seizures are characterized by a brief altered state of consciousness and
staring episodes. Typically the child's posture is maintained during the seizure.
The mouth or face may move or the eyes may blink. The seizure usually lasts no
longer than 30 seconds. When the seizure is over, the child may not recall what
just occurred and may go on with his/her activities, acting as though nothing
happened. These seizures may occur several times a day. This type of seizure is
sometimes mistaken for a learning problem or behavioral problem. Absence
seizures almost always start between ages 4 to 12 years.
o atonic (also called drop attacks)
With atonic seizures, there is a sudden loss of muscle tone and the child may fall
from a standing position or suddenly drop his/her head. During the seizure, the
child is limp and unresponsive.
o generalized tonic-clonic seizures (also called grand mal seizures)
This seizure is characterized by five distinct phases that occur in the child. The
body, arms, and legs will flex (contract), extend (straighten out), tremor (shake), a
clonic period (contraction and relaxation of the muscles), followed by the
postictal period. During the postictal period, the child may be sleepy, have
problems with vision or speech, and may have a bad headache, fatigue, or body
aches.
o myoclonic seizures
This type of seizure refers to quick movements or sudden jerking of a group of
muscles.
o These seizures tend to occur in clusters, meaning that they may occur several
times a day, or for several days in a row.
o infantile spasms
This rare type of seizure disorder occurs in infants from before six months of age.
There is a high occurrence rate of this seizure when the child is awakening, or
when they are trying to go to sleep. The infant usually has brief periods of
movement of the neck, trunk, or legs that lasts for a few seconds. Infants may
have hundreds of these seizures a day. This can be a serious problem, and can
have long-term complications.
o febrile seizures
This type of seizure is associated with fever. These seizures are more commonly
seen in children between 6 months and 5 years of age and there may be a family
history of this type of seizure. Febrile seizures that last less than 15 minutes are
called "simple," and typically do not have long-term neurological effects. Seizures
lasting more than 15 minutes are called "complex" and there may be long-term
neurological changes in the child.

A child may experience one or many seizures. While the exact cause of the seizure may not be
known, the more common seizures are caused by the following:

• in newborns and infants:


o birth trauma
o congenital (present at birth) problems
o fever /infection
o metabolic or chemical imbalances in the body
• in children, adolescents, and young adults:
o alcohol or drugs
o trauma to the head or brain injury
o infection
o congenital conditions
o genetic factors
o unknown reasons
• other possible causes of seizures may include:
o brain tumor
o neurological problems
o drug withdrawal
o medications

Clinical Manifestations
Partial Seizures may be associated with facial movements or grimaces, jerking in one part of
the body, sensory experiences of sights, smells, or sounds, tingling, an alteration in level of
consciousness
Generalized seizures may be associated with unconsciousness, uncontrolled jerking of arms
and legs, short period of apnea, salivation of frothing at the mouth tongue biting, postictal
stage. Aura may occur.

Diagnostic Tools
Medical History
Basic laboratory evaluation
Lumbar puncture, MRI, EEG

Treatment
Identification of type of seizure and reverse the cause if possible
Medications
Resective surgery
Vagus nerve stimulation
Attention-Deficit Hyperactivity Disorder (ADHD or AD/HD or ADD)

Attention-Deficit Hyperactivity Disorder (ADHD or AD/HD or ADD) is a neurobehavioral


developmental disorder. It is primarily characterized by "the co-existence of attentional problems
and hyperactivity, with each behavior occurring infrequently alone" and symptoms starting
before seven years of age.

ADHD is the most commonly studied and diagnosed psychiatric disorder in children, affecting
about 3% to 5% of children globally and diagnosed in about 2% to 16% of school aged children.
It is a chronic disorder with 30% to 50% of those individuals diagnosed in childhood continuing
to have symptoms into adulthood. Adolescents and adults with ADHD tend to develop coping
mechanisms to compensate for some or all of their impairments. 4.7 percent of American adults
are estimated to live with ADHD.

ADHD is diagnosed two to four times as frequently in boys as in girls, though studies suggest
this discrepancy may be due to subjective bias of referring teachers. ADHD management usually
involves some combination of medications, behavior modifications, lifestyle changes, and
counseling. Its symptoms can be difficult to differentiate from other disorders, increasing the
likelihood that the diagnosis of ADHD will be missed. Additionally, most clinicians have not
received formal training in the assessment and treatment of ADHD, particularly in adult patients.

ADHD and its diagnosis and treatment have been considered controversial since the 1970s. The
controversies have involved clinicians, teachers, policymakers, parents and the media. Topics
include the actuality of the disorder, its causes, and the use of stimulant medications in its
treatment. Most healthcare providers accept that ADHD is a genuine disorder with debate in the
scientific community centering mainly around how it is diagnosed and treated. The American
Medical Association concluded in 1998 that the diagnostic criteria for ADHD are based on
extensive research and, if applied appropriately, lead to the diagnosis with high reliability.

Dystonia

Dystonia is a neurological movement disorder, in which sustained muscle contractions cause


twisting and repetitive movements or abnormal postures.[1] The disorder may be hereditary or
caused by other factors such as birth-related or other physical trauma, infection, poisoning (e.g.,
lead poisoning) or reaction to pharmaceutical drugs, particularly neuroleptics.[1] Treatment is
difficult and has been limited to minimizing the symptoms of the disorder, since there is no cure
available.

Periventricular Leukomalacia (PVL)


Periventricular leukomalacia (PVL) is damage and softening of the white matter, the inner part
of the brain that transmits information between the nerve cells and the spinal cord, as well as
from one part of the brain to another.

• "periventricular" means around or near the ventricles, the spaces in the brain containing
the cerebrospinal fluid
• "leuko" means white
• "malacia" means softening

With PVL, the area of damaged brain tissue can affect the nerve cells that control motor
movements. As the baby grows, the damaged nerve cells cause the muscles to become spastic, or
tight, and resistant to movement. Babies with PVL have a higher risk of developing cerebral
palsy (a group of disorders that prevent the child from controlling their muscles normally), and
may have intellectual or learning difficulties. PVL may occur alone or in addition to
intraventricular hemorrhage (bleeding inside the brain).

It is not clear why PVL occurs. This area of the brain is very susceptible to injury, especially in
premature babies whose brain tissues are fragile. PVL may happen when the brain receives too
little oxygen. However, it is not clear when the trigger for PVL occurs - before, during, or after
birth. Most babies who develop PVL are premature, especially those born before 30 weeks
gestation. Other factors that may be associated with PVL include early rupture of membranes
(amniotic sac) and infection inside the uterus.

Intraventricular Hemorrhage

What is intraventricular hemorrhage (IVH)?

Intraventricular hemorrhage (IVH) is bleeding inside or around the ventricles, the spaces in the
brain containing the cerebral spinal fluid.

• "intraventricular" means within the ventricles


• "hemorrhage" means excessive bleeding

Intraventricular hemorrhage is most common in premature babies, especially very low


birthweight babies weighing less than 1,500 grams (3 pounds, 5 ounces).

Click Image to Enlarge


What causes intraventricular hemorrhage?

It is not clear why IVH occurs. Bleeding can occur because blood vessels in a premature baby's
brain are very fragile and immature and easily rupture. Babies with respiratory problems such as
hyaline membrane disease, or other complications of prematurity, are more likely to have IVH.
The smaller and more premature the baby, the more likely IVH will occur. Nearly all IVH occurs
within the first three days of life.

Why is intraventricular hemorrhage a concern?

Bleeding in the brain can put pressure on the nerve cells and damage them. Severe damage to
cells can lead to brain injury.

What are the different grades of intraventricular hemorrhage?

The amount of bleeding varies. IVH is often described in four grades:

• Grade 1 - bleeding occurs just in a small area of the ventricles.


• Grade 2 - bleeding also occurs inside the ventricles.
• Grade 3 - ventricles are enlarged by the blood.
• Grade 4 - bleeding into the brain tissues around the ventricles.

Grades 1 and 2 are most common, and often there are no further complications. Grades 3 and 4
are the most serious and may result in long-term brain injury to the baby. Hydrocephalus (too
much cerebral spinal fluid in the brain) may develop after severe IVH.

Spina Bifida

Spina Bifida is a congenital neural tube defect characterized by a failure of the vertebral arches
to close. This results in a cyst-like protrusion of the meninges alone (meningocele) or of the
meninges and the spinal cord (myelomeningocele) out of the vertebral column. In the case of
meningococele, the neural tissue is unexposed, and thus neural deficits are absent or minor. With
myelomeningocele, the spinal cord, in a cyst-like protrusion with its nerves, suffers injury,
inflammation, and scarring. The result is some loss in neural function, often including paralysis.
Another type of spina bifida is one in which minor irregularities in the vertebral arches exist that
are not obvious at birth. The is called spina bifida occulta(hidden). A meningocele can occur in
any area of the spine; cranial or upper cervical meningoceles are frequently associated with
hydrocephalus. A myomeningocele typically occurs in the lumber or lumbosacral area.

Causes

Although cause is unknown, a genetic predisposition may exist. Increased risk occurs with
maternal folic acid deficiency. It is recommended that all women anticipating pregnancy begin
taking folic acid supplements at least 3 months before conception.
Clinical Manifestation

Spina bifida may be asymptomatic but is associated with:


Hair growth along the spine
Midline dimple, usually in the lumbosacral area
Gait or foot abnormalities
Poor bladder control

A meningocele may be asymptomatic or associated with:


A sac-like protusion of meninges and CSF from the back
Clubbed foot
Gait disturbance
Bladder incontinence

A myelomeningocele is associated with:


Protrusion of meninges, CSF, and spinal cord
Neurologic deficits at and below the site of exposure

Diagnostic Tools
Elevated levels of a fetal protein, called alpha-fetoprotein, in maternal serum may indicate fetal
spina bifida.
Ultrasound may diagnose the condition in utero

Complications
Hydrocephalus may occur with a meningocele or myelomeningocele.

Treatment
No treatment may be required for spina bifida occulta or meningocele.
Surgical repair of the myelomeningocele and sometimes the meningocele.
If surgical repair is performed, placement of a shunt to allow CSF drainage is necessary to
prevent hydrocephalus and a subsequent increase in intracranial pressure.
Planned cesarean section before the initiation of labor can be important in reducing the
neurologic damage seen in an infant with spinal cord defect

Hydrocephalus

Hydrocephalus or water on the brain is characterized by an accumulation of CSF anywhere in the


ventricles of the brain. Hydrocephalus may result from overproduction of CSF, obstruction of
the flow of CSF within the ventricular system, or a decrease in the absorption of CSF out of the
ventricles. This can be seen with a sonogram.

Types:
A. Non-communicating Hydrocephalus
Occurs as a result of obstruction of CSF flow within the ventricular system. May occur
with a tumor as a result of a congenital irregularity in the ventricular pathways.
B. Communicating Hydrocephalus
Occurs as a result of blockage in the absorption of CSF. Causes of this type includes a
build-up of tissue (usually a neoplasm) or blood in the subarachnoid space. Head injuries
may cause this.
Effects of Hydrocephalus

Intracranial pressure increases with hydrocephalus; this can directly injure underlying nervous
tissue and compromise cerebral blood flow and the neuronal supply of oxygen and glucose.
Compensation may occur for slowly developing hydrocephalus. Rapidly developing
hydrocephalus may find compensation ineffective.

Clinical Manifestations
Enlarged head with a high-pitched cry
Acutely developing hydrocephalus causes a rapid increase in ICP and my present with severe
headache, decreased consciousness, papilledema, and vomiting
Slowly progressing hydrocephalus may present with irritability and changes in cognition or
behavior Complication may include mental retardation

Diagnostic Tools
Ultrasound may allow diagnosis in utero
After birth, diagnosis is made by clinical inspection, measurement of head circumference, and
observation of cranial suture lines

Treatment
Placement of a shunt to drain CSF in utero or after birth
Treatment of underlying cause is required

Meningitis

Meningitis is characterized by the inflammation of the meninges, the membranes lining the brain
and spinal cord. There are two types of meningitis: septic and aseptic. Septic meningitis is
caused by bacteria like meningococci, pneumococci, and Haemophilus influenza. Aseptic
meningitis is caused by viruses such as herpes simplex virus and arbovirus. It frequently occurs
from the spread of infection elsewhere in the body, for example, the sinuses, ears, or upper
respiratory tract.

Causes
Dura has been compromised(brain injury or surgery)
Systemic infection
Anatomic defects of the skull
Immunocompromise and other systemic illnesses
Otitis media or mastoiditis

Clinical Manifestations
Fever
Increased ICP (headache, decreased consciousness and vomiting)
Papilledema
Photophobia
Nuchal rigidity, Kernig’s sign, Brudzinski’s sign
Complications: Brain damage and seizures

Diagnostic Tools
CSF Profile
CT Scan, MRI

Treatment
Antibiotic Therapy
Reduction of ICP
Isolation