Algorithms in Pediatric Neurology Gouri Rao Passi
INDEX
ABCDEFGHIJKLMNOPQRSTUVWXZ
A
Absence seizures 43, 45
Absent pupillary reflexes 55
Acetylcholine 36
Achievement scores 15
Achilles tendon lengthening 38
Achondroplasia 3
Acute
disseminated encephalomyelitis 19, 53
flaccid paralysis 53
liver disease 50
muscle weakness 64, 66
onset muscle weakness 65
poliomyelitis 65, 67
Adaptive devices 36
Adductor tenotomy 38
ADEM 55, 57, 66
ADHD 14
Alcohol and phenol blocks 38
Alert and age appropriate cognitive functions 59
Alexanders disease 32
Ammonia 53
Anterior horn cell
disease 68
disorders 60
Anticonvulsants 49
Antiepileptic drugs 45
Antiepileptics 36
Antispasticity drugs 36
Aphasia and psychiatric symptoms 53
Approach to
movement disorders 48
urea cycle disorders 27
Apraxia 16
Aqueductal stenosis 4, 6
Arteriopathy 22, 23
Arthritis 50
Athetoid 35
Athetosis 49
Atonic seizure 44
Atypical febrile seizure 46
Autoimmune disorders 23, 54
B
Baby floppy 59
Baclofen 36
Benadon 40
Benign enlargement of subarachnoid space 6
Benzodiazepines 36
Blood sugar 52
Blurred vision 9
Bone marrow biopsy 32
Botulinum toxin 36, 37
Botulism 66, 67
Bradycardia 4
Brain abcess 19
Breath holding spells 42
Brisk jerks in lower limbs 4
C
Canavans
disease 32
syndrome 5
Carbamazepine 49
Carbidopa 36, 37
Carnitine deficiency 69
Central
causes of floppy baby 62
nervous system vasculitis 56
pathology 59
Cerebellar signs 30
Cerebral
edema 53
malaria 53, 55, 57
palsy 34
Cerebrohepatorenal syndrome 60
Cerebrospinal fluid 55
Child with
cerebral palsy 33
fever and encephalopathy 52
headache 7
large head 1
muscle weakness 64
school failure 12
seizures 42
stroke 19
Childhood autism rating scale 18
Chloroquine 49
Chorea 49, 50
Chronic
liver disease 50
meningitis 9
muscle weakness 68
subdural effusion 4, 6
CNS
malformations 60, 62
vasculitis 58
Cognitive decline 30
Communicating hydrocephalus in TBM 4, 6
Comprehension strategies 15
Confirmatory tests 55
Congenital
hypomyelinating neuropathy 60, 62, 63
muscular dystrophy 60, 63, 70
myasthenia 60
myopathies 62
myotonic dystrophy 60, 63
Cranial nerves 7
Creatinine deficiency 60, 63
CT
head 45
imaging of brain in acute stroke 21
D
Dandy-Walker cyst 4, 6
Deep tendon reflexes 30
Depressed deep tendon reflexes 59
Depression 35
Diabetes mellitus 52
Diazepam 36
Diplegia 35
Diptheritic polyneuropathy 66, 67
Dissection 23
Dopamine 36
Dravet's syndrome 44
Drooling 35
Duchene muscular dystrophy 64, 69, 71
Dysarthria 16
Dyslexia 13
Dysmorphic facies 59
Dystonia 49
E
Early morning vomits 4
EEG 44
Electroencephalogram 40
Emery-Dreiyfuss syndrome 68
Encephalitis 19, 53, 55, 56
Encephalopathies 49
Endocrine
disorders 69
myopathy 60
Endothelial injury 22
Energy depletion states 60
Epilepsy 34
Epileptic aphasia 17
External hydrocephalus 3
Extrapyramidal signs 53
F
Familial
dysautonomia 60, 62
megaloencephaly 3, 6
Fascioscapulohumeral syndrome 70
Fatty acid oxidation defects 60
Febrile encephalopathy 52
Fever delirium 52
First consider drugs 49
Floppy infant 59
Fluoxetine 49
Fragile X 5
Fundus 30
G
Gait abnormalities 10
Gas chromatography-mass spectrometry 28
Gastroesophageal reflux 35
Genetic disorders 60
Glutaric
academia 29
aciduria I 5, 6
Gowers sign 64
Grade level assessment device 15
Gram stain 55
Guillain Barre syndrome 65
H
Hallervorden-Spatz disease 32
Haloperidol 37, 49
Headaches 4
Hearing
assessment 14, 18
deficit 14
Hemiballismus 49
Hemiplegia 35
Hemolytic anemia 3, 50
Hemorrhage 21
in MRI of brain 22
Herpes
encephalitis 53
simplex encephalitis 56
Horizontal suspension 59
Hydrocephalus 9
Hypercoagulable states 23
Hyperkinetic syndromes 36
Hypertension 4
Hypoglycemia 52
Hypokalemia 66
Hypokalemic periodic paralysis 66, 67
Hypoparathyroidism 50
Hypotension 53
Hypotonic 35
cerebral palsy 60, 62
I
Imipramine 49
Indications in
lower limb 37
upper limb 37
Infantile
botulism 62
spasms 45
Infarction 21
Infections 23
Intelligence test 14
Intracranial
pressure 4, 55
space occupying lesion 19, 56
venous sinuses 7
IQ test 14
Isovaleric academia 29
J
Japanese B encephalitis 53
K
Ketogenic diet 47
Krabbe's disease 32
L
Lactic acidosis 29
Landau-Kleffners syndrome 17, 18
Large molecule disorders 26
Learning disability 12
Leighs disease 32
Lennox-Gastaut syndrome 44
Leukodystrophies 5
Leukovorin 40
Levodopa 36, 37
Limb girdle 70
Long-term prophylaxis 47
Low
molecular weight heparin 24
pitched weak cry, poor cough 60
Lower
limb 37
motor neuron type disease 61
Lowes syndrome 60, 62
Lumbar puncture 55
M
Maple syrup urine disease 28
Meningitis 19, 40
Mental retardation 34
Metabolic
cause of encephalopathy 52
myopathy 60
Metachromatic leukodystrophy 5, 32
Metoclopramide 49
Microcephaly 59
Midazolam 40
Migraine 8, 10, 42
Mitochondrial disorders 23
Motor posturing 55
Moya Moya syndrome 23
MRI
brain 18, 32, 45
of brain in acute stroke 21
Mucopolysaccharidosis 5, 32
Muscle
atrophy 60
disorders 60
weakness 64
Muscular dystrophies 69
Myasthenia 63, 67, 69, 71
gravis 62, 66, 67
Myoclonic seizures 44, 45
Myositis 66
Myotonic
dystrophy 68
muscular dystrophy 70
N
Neonate with seizures 39
Nerve conduction velocities 32
Neurocutaneous syndrome 3
Neuromuscular junction
abnormalities 60
disease 67
Neuroregression 5
Night terrors 43
Noninflammatory acute encephalopathy 53
Nonketotic hyperglycinemia 41
Normal
head circumference 60
speech development 16
O
Ocular disorders 9
Optineuron 40
Organic acidemias 29
Organophosphorus poisoning 66
P
Papilledema 55
Paradoxical chest wall movements 60
Parotitis 53
Partial seizures 45
Penumbra 19
Periosteum 7
Peripheral causes of floppy baby 62
Peroxisomal disorders 60
Phenobarbitone 49
Phenytoin 49
Phonemic awareness 15
Phonics 15
Physiotherapy 36
Plaster casts and orthoses 36
Polymyositis 69, 71
Pompe's disease 60, 63, 69
Pontine lesion 66, 67
Porphyria 66, 67
Post infectious disorders 49
Posthemorrhagic hydrocephalus in preterms 4, 6
Postinfectious autoimmune neuropsychiatric disorders 49
Prader-Willi syndrome 60, 62
Progressive proximal muscle weakness 69
Prolonged QT syndrome 43
Propionic and methylmalonic academia 29
Prosody 16
Proximal parts of major cerebral arteries 7
Psychological
assessment 14, 18
problems 14
Pyogenic meningitis 55, 56
Pyridoxine 40
Q
Quadriparesis 35
R
Renal tubular dysfunction 50
Reye's syndrome 53
Rule out
genetic disorders 49
meningitis 53
S
Salmonella typhi 55
Scissoring of lower limbs 59
Seizures 9, 10
Selective posterior rhizotomy 38
Semantics 16
Sensorium 42
Sensory impairement 35
Serum
ammonia 53
creatinine and blood urea nitrogen 53
Sickle cell anemia 22, 23
Sinusitis 9
Slowly progressive weakness 64
Small molecule disorders 26
Sodium 52
Sotos syndrome 1, 5
Space occupying lesion 54
Spasticity 30
Speech problems 16
Spinal cord
defects 60
disease 67
injury 60
dysraphism 60, 62
Spinomuscular atrophy 60
Squint 34
Static encephalopathies 60
Stroke in children 22
Subacute infarct 21
Subcutaneous tissue and skin 7
Surgeries useful in cerebral palsy 38
Surgery 36
Swallowing dysfunction 35
Sydenhams chorea 50
Syncopal attacks 42
Syntax 16
T
Tension
headache 8
type headache 11
Thrombophilia panel 23
Tics 49
Tizanidine 36
Todd's paresis 19
Tongue fasciculations 60
Tonic or atonic seizure 44
Traction response 59
Transitory neonatal myasthenia 60
Transverse myelitis 66, 67
Tremor 49
Trihexphenidyl 36, 37
Trisomy 21 60, 62
Tubercular meningitis 54, 56
Tumor 9
Types of
movement disorders 49
muscular dystrophy 69
seizure 43
speech problems 16
Typhoid 55
encephalopathy 57
fever 53
Typical febrile seizure 46
U
Unfractionated heparin 24
Upgoing planters 4
Upper limb 37
V
Vascular embolic material 21
Vasculitis 22
Venous stasis 22
Vertical suspension 59
Very long chain fatty acids 32
Vesicular rash 53
Vision assessment 14
Visual deficit 14
Vocabulary 15
W
Wilsons disease 50
X
XX-linked adrenoleukodystrophy 32
Z
Zellwegers syndrome 32, 60, 62
×
Chapter Notes

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1Algorithms in Pediatric Neurology
Mission
To write a non-boring book which can solve some problems of a busy pediatrician.
Besides the noble art of getting things done, there is the noble art of leaving things undone. The wisdom of life consists in the elimination of non-essentials.
— Lin Yutang
2
3Algorithms in Pediatric Neurology: (A Beginner's Guide)
Gouri Rao Passi MBBS MD DNB MNAMS Consultant, Department of Pediatrics In charge, Pediatric Neurology Clinic Choithram Hospital and Research Center Indore, Madhya Pradesh, India
4Published by
Jaypee Brothers Medical Publishers (P) Ltd
Corporate Office
4838/24 Ansari Road, Daryaganj, New Delhi - 110002, India
Phone: +91-11-43574357, Fax: +91-11-43574314
Offices in India
Overseas Offices
Algorithms in Pediatric Neurology
© 2011, Jaypee Brothers Medical Publishers
All rights reserved. No part of this publication should be reproduced, stored in a retrieval system, or transmitted in any form or by any means: electronic, mechanical, photocopying, recording, or otherwise, without the prior written permission of the author and the publisher.
This book has been published in good faith that the material provided by author is original. Every effort is made to ensure accuracy of material, but the publisher, printer and author will not be held responsible for any inadvertent error(s). In case of any dispute, all legal matters are to be settled under Delhi jurisdiction only.
First Edition: 2011
9789350252505
Typeset at JPBMP typesetting unit
Printed at Ajanta Offset
5Dedicated to
My Mother for her wisdom and capacity for wonder
6
7Preface
Our lives are frittered away by detail; simplify, simplify.
— Henry David Thoreau
This book aims to simplify and demystify some of the common problems in pediatric neurology especially encountered by the general pediatricians and pediatric students (both undergraduates and postgraduates). It tries to describe a practical approach towards the diagnosis and treatment of various neurological conditions which would prove extremely useful in day to day clinical practice.
Pediatric neurology has come a long way. There was a time when a pediatrician's best advice was to tell the parents to simply wait and let the child outgrow his problems. Today magnetic resonance imaging, genetics and basic science related to the understanding of complex illnesses have changed the way we handle these problems.
However, the clinical approach to most problems can be further simplified. This book, titled Algorithms in Pediatric Neurology intends to enable the ordinary pediatrician to recognize many disorders in a simplified manner and give practical suggestions in their management. These algorithms are based on the concept of listening, watching and thinking before initiating treatment.
I plead guilty to the sins of oversimplification and a happy disregard for details. But it is in the larger good of empowering the general pediatrician and student of pediatrics to try to look at and understand pediatric neurology problems.
Unstinting support from my family kept me going through this project and the naïve questions from my students will always inspire me to look for simple solutions to difficult problems.
Gouri Rao Passi