Fenichel's Clinical Pediatric Neurology

Cramps, Muscle Stiffness, and Exercise Intolerance

A cramp is an involuntary painful contraction of a muscle or part of a muscle. Cramps can occur in normal children during or after vigorous exercise, and after excessive loss of fluid or electrolytes. The characteristic electromyography (EMG) finding for…

Flaccid Limb Weakness in Childhood

The majority of children with flaccid limb weakness have a motor unit disorder. Flaccid leg weakness may be the initial feature of disturbances in the lumbosacral region, but other symptoms of spinal cord dysfunction are usually present. Consult Box 12.1…

The Hypotonic Infant

Tone is the resistance of muscle to stretch. Clinicians test two kinds of tone: phasic and postural. Phasic tone is a rapid contraction in response to a high-intensity stretch (deep tendon reflexes). Striking the patellar tendon briefly stretches the quadriceps…

Psychomotor Retardation and Regression

Psychomotor retardation or developmental delay refers to the slow progress in the attainment of developmental milestones. This may be caused by either static ( Box 5.1 ) or progressive ( Box 5.2 ) encephalopathies. In contrast, psychomotor regression refers to…

Increased Intracranial Pressure

The presenting complaint when dealing with increased intracranial pressure (ICP) ( Box 4.1 ) varies with age. Infants may present with a bulging fontanelle, macrocephaly, or failure to thrive. Older children often present with headache, emesis, diplopia, or change in…

Headache

Approach to headache Headache is one of the most common neurological symptoms and the source of frequent referrals to neurology. Proper diagnosis and management of headache has a positive impact on the lives of many children and their parents, and…

Altered States of Consciousness

The terms used to describe states of decreased consciousness are listed in Table 2.1 . With the exception of coma, these definitions are not standard. However, they are more precise and therefore more useful than such terms as semicomatose and…

Paroxysmal Disorders

Paroxysmal neurological disorders are characterized by the sudden onset of neurological dysfunction and stereotyped recurrence. In children, such events often clear completely. Examples of paroxysmal disorders include epilepsy, migraine, periodic paralysis, and paroxysmal movement disorders. Approach to paroxysmal disorders The…