Topic 6 The Child with Cerebral Dysfunction

• What are early signs of increased ICP?

  Headache, vomiting, irritability, fatigue.
• What are manifestations of increased ICP in infants?

  Irritability with poor feeding, high pitched cry, fontanels bulging, cranial sutures separated, setting sun eyes, distended scalp veins.
• What are late signs of increasing ICP?

  Bradycardia, decreased motor and sensory responses, alterations to pupil size, decreased consciousness.
• What is the earliest indicator of changes in neurological status?

  Levels of consciousness.
• What GCS score is considered a coma?

  GCS score of 8 or less.
• What is the highest GCS score?

  15.
• How frequently should increased ICP be assessed for?

  Every 15 minutes to every 2 hours.
• How often is temperature assessed in a patient with increased ICP?

  Every 2 - 4 hours.
• How can imaging help diagnose increased ICP?

  Rule out fractures and evaluate suture lines.
• What is contraindicated for care of an unconscious child?

  Suctioning and percussion.
• What are the three major causes of brain damage in childhood?

  • Falls
  • Motor vehicle injuries
  • Being struck by or striking an object
• What is a linear skull fracture?

  Single line that does not cross suture lines.
• What is a comminuted skull fracture?

  Multiple linear fractures.
• What is a depressed skull fracture?

  Fracture with several irregular fragments.
• What is a basilar skull fracture?

  Fracture involving bones at the base of the skull.
• What is an epidural hemorrhage?

  Bleeding between the skull and dura.
• What is a subdural hemorrhage?

  Bleeding between the dura and the arachnoid membrane.
• What is a clinical picture of epidural hemorrhage?

  Momentary unconsciousness followed by a normal period, followed with lethargy and coma due to blood accumulation and compression of the brain.
• What are signs of subdural hemorrhage?

  Bleeding across cranial sutures, irritability, vomiting, increased head circumference, bulging fontanels, lethargy, coma, seizures.
• How long does it take for cerebral edema to peak?

  24 - 72 hours after injury.
• What medication can be given for headaches after head trauma?

  Acetaminophen.
• What is Reye's Syndrome?

  Metabolic encephalopathy that causes cerebral edema and fatty changes in the liver.
• When does Reye's syndrome usually occur?

  After common viral illnesses like influenza or varicella.
• What medications can lead to the development of Reye's syndrome?

  Aspirin and Ibuprofen and Pepto Bismol.
• What is the definitive way to diagnose Reye's?

  Liver biopsy.
• What is considered epilepsy?

  Two unprovoked seizures occurring more than 24 hours apart or one unprovoked seizure and a possibility of further seizures.
• What is hydrocephalus?

  Hydrocephalus is a condition characterized by an accumulation of cerebrospinal fluid in the brain, leading to increased pressure and enlargement of the head.
• How is hydrocephalus diagnosed antenatally?

  Ultrasound and MRI.
• How is hydrocephalus diagnosed in infancy?

  Head circumference and neurological signs.
• How are older children diagnosed with hydrocephalus?

  CT and MRI.
• What is the period of greatest risk for shunt infection?

  1 - 3 months after shunt placement.