The brain, cerebrospinal fluid (CSF), and blood are the three intracranial compartments that determine the size of the skull during infancy. Expansion of one compartment comes at the expense of another in order to maintain volume and pressure (see Chapter 4 ). The epidural, subdural, and subarachnoid spaces may expand with blood or CSF fluid and significantly affect cranial volume and the other intracranial compartments. Less…

This chapter will review disorders causing dysfunction of the VII through XII cranial nerves. Many such disorders also disturb ocular motility and the discussion of these is in Chapter 15 . The basis for chapter assignment is by the most usual initial clinical feature. For example, the discussion of myasthenia gravis is in Chapter 15 because diplopia is a more common initial complaint than dysphagia. An…

Both congenital and acquired visual impairments in children are often associated with neurological disorders. The most common visual disorders are uncorrected refractive errors, amblyopia, strabismus, cataracts, and genetic disorders. Assessment of visual acuity The assessment of visual acuity in preverbal children relies mainly on assessing fixation and tracking as the infant or young child interacts with the environment. Clinical Assessment The pupillary light reflex is a…

The maintenance of binocular vision requires harmonious function of the visual sensory system, gaze centers, ocular motor nerves, neuromuscular junction, and ocular muscles. This chapter deals with nonparalytic strabismus, paralytic strabismus (ophthalmoplegia), gaze palsies, ptosis, and nystagmus. The discussion of visual and pupillary disorders is in Chapter 16 . Nonparalytic strabismus Strabismus, or abnormal ocular alignment, affects 3%–4% of preschool children. Many individuals have a latent…

Involuntary movements are usually associated with abnormalities of the basal ganglia and their connections and occur in several different neurological disorders. Abnormal movements can be the main or initial features of disease, or they can occur as a late manifestation. Discussion of the former type is in this chapter, and the latter in other chapters. Approach to the patient Movement disorders are difficult to describe; they…

Weakness or paralysis of a limb is usually due to pathology of the spine and the proximal portion of nerves. Monoplegia may also be the initial presentation of a hemiplegia, paraplegia, or quadriplegia. Therefore one must also consult the differential diagnosis of spinal paraplegia provided in Box 12.1 and the table and boxes in Chapter 11 referring to the differential diagnosis of cerebral hemiplegia. Approach to…

In this text, the term paraplegia denotes partial or complete weakness of both legs, and the term quadriplegia denotes partial or complete weakness of all limbs, thereby obviating need for the terms paraparesis and quadriparesis . Many conditions described fully in this chapter are abnormalities of the spinal cord. The same spinal abnormality can cause paraplegia or quadriplegia, depending on the location of the injury. Therefore…

The approach to children with hemiplegia must distinguish between acute hemiplegia, in which weakness develops within a few hours, and chronic progressive hemiplegia, in which weakness evolves over days, weeks, or months. The distinction between an acute and an insidious onset should be easy but can be problematic. In children with a slowly evolving hemiplegia, missing early weakness is possible until an obvious level of functional…

The term ataxia denotes disturbances in the fine control of posture and movement. The cerebellum and its major input systems from the frontal lobes and the posterior columns of the spinal cord provide this control. The initial and most prominent feature is usually an abnormal gait. The ataxic gait is wide-based, lurching, and staggering, and it provokes disquiet in an observer for fear that the patient…

This chapter deals primarily with sensory disturbances of the limbs and trunk. Autonomic dysfunction is often associated with sensory loss but sometimes occurs alone. Chapter 17 considers sensory disturbances of the face. Sensory symptoms Pain, dysesthesias, and loss of sensibility are the important symptoms of disturbed sensation. Peripheral neuropathy is the most common cause of disturbed sensation at any age. As a rule, hereditary neuropathies are…

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 such cramps is the repetitive firing of normal motor unit potentials. Stretching the muscle relieves the cramp. Partially denervated muscle is particularly susceptible to cramping not…

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 when considering the differential diagnosis of flaccid leg weakness without arm impairment. Cerebral disorders may cause flaccid weakness, but dementia (see Chapter 5 ) or seizures…

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 muscle. The spindle apparatus, sensing the stretch, sends an impulse through the sensory nerve to the spinal cord. This information is transmitted to the alpha motor…

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 the loss of developmental milestones previously attained. This is usually caused by a progressive disease of the nervous system. In some cases, reports of regression may…

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 mentation. The basis of referral for some children is the detection of disk edema during an eye examination. Some conditions causing increased ICP are discussed elsewhere…

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 may significantly reduce the direct and indirect cost associated with this symptom. The World Health Organization ranks migraines as one of the top 20 disabilities in…

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 semistuporous . The term encephalopathy describes a diffuse disorder of the brain in which altered states of consciousness, altered cognition or personality, and seizures may occur.…

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 diagnosing physician rarely witnesses the paroxysmal event. It is important to obtain the description of the event from the observer or a video recording and not…