Ebook Illustrated textbook of pediatrics (2/E): Part 2
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Ebook Illustrated textbook of pediatrics (2/E): Part 2
12Pediatric Neurology■ HISTORY TAKINGObtaining satisfactory history often provides better clue than examination or investigation for diagnosis and man Ebook Illustrated textbook of pediatrics (2/E): Part 2nagement of a neurological disease.History taking should be interactive. Doctor should cross check, whether he understood, what the patient or care giver told. Doctor should ask the patient or care giver, whether he (doctor) understood Is the same as the patient told to doctor. School-age children s Ebook Illustrated textbook of pediatrics (2/E): Part 2hould be given an opportunit)' to speak to doctor alone.History of Presenting ComplaintsChildren may present with symptoms of following neurological cEbook Illustrated textbook of pediatrics (2/E): Part 2
onditions and disorders:•Paroxysmal episodes: Seizures, migraine•Pain: Headache (migraine)•Movement disorders: Ataxia, chorea•Altered consciousness: I12Pediatric Neurology■ HISTORY TAKINGObtaining satisfactory history often provides better clue than examination or investigation for diagnosis and man Ebook Illustrated textbook of pediatrics (2/E): Part 2Loss of already achieved developmental skill (neurodegenerative disorders).However, the above neurological features should be obtained by taking history carefully. Doctor should listen carefully what the patient said and try to rationalize the history in a broader way before jumping to describe the Ebook Illustrated textbook of pediatrics (2/E): Part 2complaint as a specific pathological term. For example, if the mother complains that her child falls frequently and the doctor term it as seizure disoEbook Illustrated textbook of pediatrics (2/E): Part 2
rder, dyspraxia or ataxia, then he has closed his thinking for wide range of simple nonorganic cause of balance problem including simple problem like 12Pediatric Neurology■ HISTORY TAKINGObtaining satisfactory history often provides better clue than examination or investigation for diagnosis and man Ebook Illustrated textbook of pediatrics (2/E): Part 2as absence seizure, which should be gently discouraged.For acute onset clinical problem, it is usually better to start at the beginning of the history like asking the parents when the child was reasonably well. For very long-term problem, it may be more useful to start with present situation and fil Ebook Illustrated textbook of pediatrics (2/E): Part 2l In backward. If a child of 5-year-old with CP presents with convulsion, listen the presenting problem and then go back how it started. Currently, thEbook Illustrated textbook of pediatrics (2/E): Part 2
e child presented for the first time with convulsion. However, the child was not normal before. The problem started when he developed meningitis at I 12Pediatric Neurology■ HISTORY TAKINGObtaining satisfactory history often provides better clue than examination or investigation for diagnosis and man Ebook Illustrated textbook of pediatrics (2/E): Part 2hich the symptoms have evolved Is particularly Informative In relation to probable pathology. Slowly progressive disorders like slow growing cerebral tumor usually progress over several years while cerebrovascular events have a sudden onset.Birth History Relevant to Neurological ConditionBirth histo Ebook Illustrated textbook of pediatrics (2/E): Part 2ry is important and should be taken in detail. Preterm, very extremely low-birth weight babies are more vulnerable to develop CP and developmental disEbook Illustrated textbook of pediatrics (2/E): Part 2
orders. Ask simple questions. Was your baby born in due time (expected date of delivery) and what was his/her birth weight? If cannot remember, did he12Pediatric Neurology■ HISTORY TAKINGObtaining satisfactory history often provides better clue than examination or investigation for diagnosis and man Ebook Illustrated textbook of pediatrics (2/E): Part 2er birth, which Is relevant to birth asphyxia. which may later lead to CP. Take history whether the baby suffered from sepsis or meningitis. Ask the parents whether their baby developed severe jaundice (hyperbilirubinemia) requiring phototherapy or exchange transfusion which may be relevant to kerni Ebook Illustrated textbook of pediatrics (2/E): Part 2cterus, etc. which are relevant to later development of central nervous system (CNS) disorder. Ask the parents simply whether their baby was dischargeEbook Illustrated textbook of pediatrics (2/E): Part 2
d from hospital normally after birth, or did the baby require prolonged stay In the hospital particularly In neonatal intensive care unit requiring ve12Pediatric Neurology■ HISTORY TAKINGObtaining satisfactory history often provides better clue than examination or investigation for diagnosis and man Ebook Illustrated textbook of pediatrics (2/E): Part 2l part of neurological history taking. Ask when the child was able to sit without support, and age of learning, age of crawling and walking. Ask about speech development. Including vocalizing, babbling and speaking meaningful words. Inquire If there Is any age-matched problem with language and commu Ebook Illustrated textbook of pediatrics (2/E): Part 2nication (relevant to autism)?Can the baby respond to sound? Distinction between developmental delay (achieving developmental skills later) and develoEbook Illustrated textbook of pediatrics (2/E): Part 2
pmental regression (loss of achieved skills) can be obtained by taking careful history.Cognitive Development•Pointing at an object of his/her interest12Pediatric Neurology■ HISTORY TAKINGObtaining satisfactory history often provides better clue than examination or investigation for diagnosis and man Ebook Illustrated textbook of pediatrics (2/E): Part 2 months.•Symbolic toy test: Using representational toys (animals, dolls and cars) and function of use like showing toy aeroplane Hying or kicking small football established by 18 months. I t also assesses early language development.■ EXAMINATION OF CENTRAL NERVOUS SYSTEMTry to start examining the ch Ebook Illustrated textbook of pediatrics (2/E): Part 2ild with minimum touch, then more touch without disturbing the child and In the form of game. Details of neurological examination of neonates and younEbook Illustrated textbook of pediatrics (2/E): Part 2
g infants are mentioned later, in this chapter and also in newborn examination (See Chapter 1).442 Older children undergo the full adult neurological 12Pediatric Neurology■ HISTORY TAKINGObtaining satisfactory history often provides better clue than examination or investigation for diagnosis and man Ebook Illustrated textbook of pediatrics (2/E): Part 2ERVOUS SYSTEMIt comprises assessment of appearance, postures, gait, tone, power, reflexes, coordination and sensation.Appearance and PostureLook for muscle balk, inspection of feet (equinus posture), neurocutaneous stigmata, (depigmented spot, cafe au lalt spot, etc.) visible fasciculation and limb Ebook Illustrated textbook of pediatrics (2/E): Part 2asymmetry. Look for Involuntary Involvement (chorea, tic, etc.). Note whether stance Is broad based (cerebellar problem). Spastic children take attituEbook Illustrated textbook of pediatrics (2/E): Part 2
de of flexion.Illustrated Textbook of PediatricsGaitGait can provide clue for diagnosis of neurological conditions without touching or disturbing the 12Pediatric Neurology■ HISTORY TAKINGObtaining satisfactory history often provides better clue than examination or investigation for diagnosis and man Ebook Illustrated textbook of pediatrics (2/E): Part 2wrong. Neurological diseases typically give one of several gestalt gait appearances that enable to recognize underlying neurological condition. Remove the clothes as far as underwear, if the child Is happy.Neurological Gait GestaltSpastic hemiparesis: Equinus posture of the foot. Tendency to catch a Ebook Illustrated textbook of pediatrics (2/E): Part 2 toe on the floor either resulting in leg swing laterally during swing phase (circumducting gait) or it is compensated by hip flexion. Affected upperEbook Illustrated textbook of pediatrics (2/E): Part 2
limb is flexed at elbow (Fig. 1).Soft Neurological SignsA soft neurologic sign which include fog's test and tandem test may be defined as particular f12Pediatric Neurology■ HISTORY TAKINGObtaining satisfactory history often provides better clue than examination or investigation for diagnosis and man Ebook Illustrated textbook of pediatrics (2/E): Part 2owever, gross abnormal movement and posture, particularly if such movement and posture are asymmetric12Pediatric Neurology■ HISTORY TAKINGObtaining satisfactory history often provides better clue than examination or investigation for diagnosis and manGọi ngay
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