Disease Types of the Signs and Diagnostic Management

Disease Symptoms tests

*Hydroceph Communicati Rapid head - daily Surgical

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

-Always support
head and neck

- Avoid
overstimulation

-Small frequent
feedings

Occulta:
Spina Bifida Surgical Closure:
Occulta
 - not visible Skin dimples Pre operation:
externally;
Spina affects L5 and Port wine Myelograph Prone position
Bifida S1 angiomatous y with sterile
Spina Bifida levi dressing
- neural Prenatal moistened with
midline tube Cystica Dark tufts of Detection; NSS
defect - external sac hair ultrasound,
involving like protrusion increased Change dressing
failure of Soft SQ AFP chronic every 24 hours
Subtypes S.B lipomas
osseous Cystica: villus
spine to sampling Hips slightly
Meningocele Cystica: flexed and legs
close;
affects L5 - affects Below L2: MRI abducted
and S1 meninges and CT Scan No diapers
CSF Flaccid
Myolemening partial Post operation:
ocele paralysis
Prone position
- affects Incontinence
meninges, CSF Side lying
Rectal
and nerves
prolapsed Orthopedic:

Below L3: Prevent joint

contraction
Hydrocephal
us Correct
deformities
If with
thoracic Prevent effects
lesions: of motor and
kyphosis and sensory deficits
scoliosis
Prevent skin
breakdown

Genitourinary:
neurologic
bladder
dysfunction

- antibiotic
therapy

-clean
intermittent
catheterization

Vesicostomy

Augmentation
enterocystoplast
y

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