module_12_assignment_doc1.doc - .Module 12 Assignment 1...

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.Module 12 Assignment 1. Differentiate between the clinical findings commonly associated with congenital hydrocephalus that occurs in infancy and those commonly associated with hydrocephalus that occurs in older children. Congenital hydrocephalus is characterized by an increased volume of CSF. The increase in volume may be caused by blockage within the ventricular system. The reduced re asbsorption causes ventricular enlargement and an increased ICP When hydrocephalus develops before fusion on the skull the skull has the capacity to accommodate the increased fluid. Clinical manifestations include, rapid growing head, fontanels enlarged and the eyes assume a starring expression. The infant may have difficulty holding their head up and their skin on the skull may appear shiny with visible veins. The clinical manifestations of hydrocephalus in the older child is the child’s mental status deterioration rapidly. They complain of declining memory and cognitive function, and unsteady gait with a history of falling downs, and urinary incontinences 2. Two individuals come to the emergency room with head injuries. One, 25 years of age, has just been in a motor vehicle accident (MVA) and has a temporal lobe injury. The other, 65 years of age, has increasing confusion following a fall that happened earlier in the week. How could you clinically differentiate between the individual with the extramural hematoma and the individual with the subdural hematoma? Which one of these individuals requires priority surgical treatment? The 25 year old is suffering with an extramural hematoma. It is usually the result of a skull fracture and an artery is the main source of bleeding in 85% of the cases. He would most likely experience loss of consciousness at the time of injury, followed by a lucid period that lasts from a few hours to a few days. As the hematoma accumulates the individual may experience headache, vomiting, drowsiness, confusion, seizures. They can also have papillary dilatation and contralateral hemiperesis. The 65 year old would likely be diagnosed with a subdural hematoma. These are often located on top of the skull. On CT they appear as a high density mass. The surgical intervention that would take priority would be the 25 year old because he is at a higher risk of brain stem herniation and death 3. Ms. Evans has a flexion injury with resultant incomplete spinal cord transaction at level C4-5. What symptoms would you expect Ms. Evans to have 1 month after her injury? Read Answer: She would have Brown-Squared syndrome with (1) ipsilateral paralysis below C4-5 with return of Babinski reflexes and ankle and knee reflexes; (2) ipsilateral loss of touch, pressure, vibration, and proprioception with possible paresthesia below the level of transection; and (3) contralateral loss of pain and temperature. She may
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experience autonomic hyperreflexia (dysreflexia). She may also have some reappearance of defecation and urination reflexes.
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  • Spring '16
  • Steven Ripley

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