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04/04/2017NEUROLOGICAL ALTERATIONS1. PEDIATRIC NEUROLOGICAL DIFFERENCESA.Brain is more vasculari.Allows intraventricular hemorrhage in preterm babiesB.Skull bones are softerC.Less developed nervous systemD.Spine is mobile, esp cervicalE.Larger head sizeii.Measure head circumference (HC) until child is 3 y/oiii.Monitor for premature closure of fontanels (craniosynostosis)F.Peripheral nerves are not completely myelinatedG.Papilledema rarely occurs in infantsH.Primitive reflexes disappear by 5 months, may recur with neurologic diseaseiv.Doll’s Eyes:1.Rotating the child’s head quickly to one side and then to the other2.Normal: Conjugate movement of eyes in the direction opposite to the head rotation3.Absence of response suggests dysfunction of brainstem or oculomotor nerve (CN III)v.Babinskivi.I.Babes cannot tell you what is wrong
2. LEVEL OF CONSCIOUSNESSA.Fully Consciousvii.Awake and alertviii.Oriented to time place, and personix.Behavior appropriate for ageB.Confused (Disoriented, Lethargic)x.Impaired decision makingC. Disorientedxi.Confusion regarding time, placexii.Decrease LOCD. Lethargicxiii.Limited spontaneous movementxiv.Sluggish speechxv.Drowsyxvi.Falling asleep quicklyE.Obtundedxvii.Arousable with stimulationF.Stuporxviii.Remaining in a deep sleepxix.Slow response to vigorous and repeated stimulationxx.Moaning responses to stimuliG. Comaxxi.No motor or verbal response or extension posturing to noxious (painful) stimuliH.Persistent vegetative statexxii.Permanently loss function of the cerebral cortexxxiii.Eyes follow objects only by reflex or when attracted to the direction of loud soundsxxiv.All four limbs are spastic but can withdraw from painful stimulixxv.Hand show reflexive grasping and groping xxvi.Face can grimacexxvii.Some food may be swallowedxxviii.May groan or cry but utter no words3. CONSCIOUSNESS TOOLS
A.Glascow Coma Scalexxix.Eye opening: 1.Spontaneous = 42.To loud voice = 33.To pain = 34.None = 1xxx.Motor response5.Obeys = 66.Localizes = 57.Withdraws (flexion) = 48.Abnormal flexion = 39.Extension = 210.None = 1xxxi.Response to auditory/visual stimuli11.Oriented = 512.Confused/disoriented = 413.Inappropriate words = 314.Incomprehensible sounds = 215.None = 1B. LOCC.Pupils: Eye movement; pupil responseD. Fontanelxxxii.Size and shape of headxxxiii.Open or closed fontanelsE.Mood (sensory responses)xxxiv.Consolability xxxv.HabituationF.Muscle tone: Posture, tone and muscle strengthG.Motility: Symmetrically movements or involuntary movementsH. Respirationsxxxvi.Prolonged apneaxxxvii.Ataxic breathingxxxviii.Paradoxic chest movementxxxix.HyperventilationI.Primitive and deep tendon reflexesJ.Cranial Nervesxl.Moro, tonic neck, and withdrawal reflexes demonstrate neurologic health in young infants
4. FLEXION AND EXTENSION POSTURINGA.Decorticate:xli.Dysfunction of the cerebral cortexxlii.Demonstrates the arms, wrists, fingers flexedand bent inward onto the chest and the legs extended and adductedB. Decerebratexliii.