neurological problems & neurological disorder

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