- The nervous system is made up of the central nervous system and the peripheral nervous system (NS).
- It is made up of nerves that send signals to and receive signals from the CNS.
- The PNS is divided into the somatic nervous system and the autonomic nervous system
REQUIREMENT FOR THE EVALUATION OF INFANT WITH SUSPECTED NEUROLOGICAL DISORDERS
- Carefully elicited history
- Accurate assessment and interpretation of physical signs.
- Working knowledge of the expected rate of growth and development of the child & the accepted range of deviation from the norm.
Should include adequate information regarding
- Child’s prior health
- Acquisition or loss of developmental milestones
- Family history.
- Social and physical environment
Such considerations may modify the child’s response to illness or provide clues to inciting factors.
INTRAUTERINE DEVELOPMENT OF NERVOUS SYSTEM
- Nervous system develops from ectoderm
- Primary neural plate forms
- It divides into neural tube
- Neural tube later gives rise to:
- spinal cord
- neural crest cells (pons, PNS, meninges melanocytes, adrenal medulla)
10 TH – 18TH WEEK
- Most intensive dividing of nervous cells takes place
- Critical period of formatting of CNS
- Any injury sustained during this period is likely to impair brain growth. (infections, metabolic, toxic, vascular disorders)
AGE PECULIARITIES OF NS
- The brain is the most morphologically developed organ @ birth bout its functional abilities are immature.
|Newborn||1/9th of body weight|
|End of 1st year||Doubles 1/11th – 1/12th body weight|
|5 years||1/13 – 1/14th body weight|
|Adult||1/40th body weight|
- The brain tissue is characterized by rich vascularization, but the back-flow of blood is weak
- This courses easy development of brain elema a collection of toxic substances.
- Neurocytes need as much as in 22x more oxygen than any Somatic cell
- That is why lots of diseases in infancy lead to development of hypoxic excephalophetty
|Newborn||30 – 40 ml|
|12 Months||40 – 60 ml|
|Adolescence||Up to is 150 ml|
- The adult person has got 16 million of neurocytes
|At birth||25 % of the amount of all undifférenticated cells in the brain|
|6th month||66% of the amount of all undifférenticated cells in the brain|
|1 year||90-95% of the amount of all undifférenticated cells in the brain|
|18 months||100% of neurocytes are similar to those of adults|
- * Proper nutrition, development, caring for the child & absence of diseases are so important during this period.
NEUROLOGIC EVALUATION IN CHILDREN
- History taking,
- Chief complaints
- Present illness
- Family history
- Past history
- Physical examination
- Neurological examination
- Mental status
- Stance and Locomotion
- Motor System
- Sensory System
- Cerebellar System
- CONGENITAL DEFECTS OF THE NS next lesson
- Erb Palsy
- Cerebral Palsy
- Febrile sei aures
- Seizure disorder
- Tic disorders
- The most common bacterial infection of the central nervous system in childhood.
- The most common causes of meningitis are bacterial pathogens
- Group B Streptococci
- Gram -ve enteric bacilli (klebsiella, enterobacter)
- E. coli
- Listeria monocytogenes
- Neisseria meningitidis
- Strep. pneumonia
- Viral agents
- Tuberculosis & Spirochetes pathogens.
- Colonizations or infection of the upper respiratory tract with the bacteria responsible former meningitis occurs @ some time or another in the majority of otherwise normal infants & children
- Symptoms are either mild or inapparent.
- In a few, infection leads to blood invasion
- Children fail to clear the bloodstream of these organisms and disease takes root.
Signs and Symptoms
- Beyond newborn period highest attacks occur between 3-8 months.
- Incidence remains high till 4yrs of age
- Infants under 1 month show
- Unusual cry
- Poor feeding
- High fever
- Signs of meningeal irritation (absent)
- Infants older than 4 months produce
- Stiff neck
- Increased interstitial pressure
- In older children
- Muscle & back pain
- Stiff neck
- Lumbar puncture & examination of CSF
- Blood Cultures
- Cultures of nose of throat
CENTRAL NERVOUS SYSTEM DISORDERS
- These remain a significant source of childhood morbidity a mortality especially in infants & children & 3 yrs in whom immunologic defense mechanisms are less developed & clinical signs more pronounced.