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19 Cards in this Set
- Front
- Back
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• Differentiate familial large head from hydrocephalus
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Familial large head
Head larger than 95th percentile (larger than 2 SD) -follow normal growth pattern everything is normal, mom and dad just gave you a big head! Other large heads Mostly due to hydrocephalus |
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• Differentiate obstructive and non-obstructive hydrocephalus
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Blockage of this flow anywhere within the substance of the brain (i.e. before the CSF passes through the foramina of Luschka and Magendie) results in obstructive or non-communicating hydrocephalus
Overproduction or decreased absorption at the arachnoid villi results in communicating or non-obstructive hydrocephalus. |
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Rapid increase in head size (as seen by plotting serial head circumference measurements against a normal set of curves)
Large bulging fontanel (in an upright child) |
hydrocephalus in infants
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what 2 malformations are commonly seen in Hydrocephalus in Older Children
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Foreshortened occiput (with Chiari malformation)
Prominent occiput (with Dandy-Walker malformation) |
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describe a CHIARI MALFORMATION
does it cause non-obstructive or obstructive hydrocephaly? |
Displacement of the cerebral tonsils into the cervical canal usually no sx until adolescence or adulthood. (Recurrent headaches, neck pain, urinary frequency, and progressive lower extremity spasticity. Etiology unknown.
Non-communicating or Obstructive |
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describe a Dandy Walker Malformation
does it cause non-obstructive or obstructive hydrocephaly? |
Dandy-Walker Syndrome: a cystic expansion of the 4th ventricle with failure of formation of the roof of the forth ventricle 90% have hydrocephalus. Other associated anomalies include agenesis of the posterior cerebellar vermis and of the corpus collosum.
Non-communicating or Obstructive |
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tx for hydrocephalus?
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Acetazolamide and furosemide reduce CSF production, but are not definitive solutions
V/P* shunting is palliative not curative (complicated by infection or obstruction) |
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which is more greatly affected in hydrocephalus: motor or intellect?
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Motor performance is more greatly affected than intellect because the gray matter of the brain is less affected by the hydrocephalus than the white matter (spasticity or coordination defects)
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Which of the following will you find in a child with familial macrocephaly?
Rapid increase in head growth Cracked pot sound on percussion 1st degree relative with large head History of meningitis |
1st degree relative with large head
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Which of the following is seen in an older child with untreated hydrocephalus?
Gaze disturbance Rapid increase in head size Bulging fontanelle Normal funduscopic exam |
Gaze disturbance
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Most common congenital anomaly of nervous system?
due to? |
Neural Tube Defects
FOLATE DEF |
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Anencephaly
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Failure of anterior neural tube closure with the presence of exposed rostral mass of neural tissue
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Encephalocele
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Malformation involving defective closure of a portion of the neural tube in association with a bony skull defect
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Midline defect with failure of closure of the posterior vertebral arches and laminae (typically lumbosacral)
Without protrusion of meninges or spinal cord Ordinarily asymptomatic and found incidentally on X-ray in 5 to 15% of the general population |
Spina Bifida Occulta
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define a Meningocele.
Sx? |
Midline defect in which the meninges herniate through a defect in the posterior vertebral arches, unaccompanied by neural tissue
Many patients have **gait abnormalities or loss of bladder control***, particularly during periods of rapid growth |
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define a Myelomeningocele
how do sx vary based on location? |
Midline defect of the posterior vertebral arches with herniation of meninges and neural tissue
High lesions (above T11) are associated with higher morbidity, lower intelligence, and greater disability than low lesions (below L3) Mid-sacral to mid-lumbar region: flaccid paralysis of the legs lack of touch and pain sensation clubfeet and subluxed hips Chiari II malformation with hydrocephalus (~80%) Low sacral region: bladder and bowel incontinence perineal anesthesia no motor involvement |
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A child is born with a low lumbar midline defect. MRI shows herniation of meninges through a spinal defect without neural tissue. What should you expect?
He will develop worsening spasticity in his legs He may have intermittent incontinence as he grows 80% are associated with Chiari II malformation Lack of touch and pain sensation in the legs |
correct: He may have intermittent incontinence as he grows
myelomeningiocele: 80% are associated with Chiari II malformation Lack of touch and pain sensation in the legs |
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On the boards you will be asked about the most common cause of neural tube defects. You’ll answer:
Maternal drug use TORCH infection Radiation Malnutrition B9 deficiency |
B9 deficiency
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A 5 month infant is brought to your office. At your visit a few months ago, you noted some flattening of the back of his skull. You advised repositioning. On review of yesterday’s CT scan, you note a premature fusion of bilateral lambdoid sutures. You advise the parents:
He should receive OMT He needs an MRI He should receive surgery OMT won’t be enough, he’ll need helmet therapy |
He should receive surgery
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