The sclera are visible between the upper eyelid and the iris,Sunsetting sign is seen usually in hydrocephalus due to loss of upward conjugate gaze caused by raised intracranial pressure (ICP)
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Showing posts with label NEUROLOGY. Show all posts
Showing posts with label NEUROLOGY. Show all posts
Appearance of Sunset sign in infant eyes
Assessment of Head injuries in children
Perform a primary survey and ensure that the child’s airway, cervical spine, breathing and circulation are secure.
Rapidly assess the child’s mental state using the AVPU scale. Use firm supraorbital pressure as the painful stimulus.
* A Alert
* V Responds to voice
* P Responds to pain
----> Purposefully
----> Non-purposefully :
Assess pupil size, equality and reactivity and look for other focal neurological signs.
* Neck and cervical spine – deformity, tenderness, muscle spasm
* Head – scalp bruising, lacerations, swelling, tenderness, bruising behind the ear (Battles sign)
* Eyes – pupil size, equality and reactivity, fundoscopy
* Ears – blood behind the ear drum, CSF leak
* Nose – deformity, swelling, bleeding, CSF leak
* Mouth –dental trauma, soft tissue injuries
* Facial fractures
* Motor function – examine limbs for presence of reflexes and any lateralising weakness
* Perform a formal Glasgow Coma Score
* Consider the possibility of non-accidental injury during secondary survey especially in infants with head injury.
* Other injuries
Rapidly assess the child’s mental state using the AVPU scale. Use firm supraorbital pressure as the painful stimulus.
* A Alert
* V Responds to voice
* P Responds to pain
----> Purposefully
----> Non-purposefully :
- Withdrawal/flexor response
- Extensor response
Assess pupil size, equality and reactivity and look for other focal neurological signs.
Perform a secondary survey looking specifically at:
* Neck and cervical spine – deformity, tenderness, muscle spasm
* Head – scalp bruising, lacerations, swelling, tenderness, bruising behind the ear (Battles sign)
* Eyes – pupil size, equality and reactivity, fundoscopy
* Ears – blood behind the ear drum, CSF leak
* Nose – deformity, swelling, bleeding, CSF leak
* Mouth –dental trauma, soft tissue injuries
* Facial fractures
* Motor function – examine limbs for presence of reflexes and any lateralising weakness
* Perform a formal Glasgow Coma Score
* Consider the possibility of non-accidental injury during secondary survey especially in infants with head injury.
* Other injuries
Duchenne muscular dystrophy and Gower sign
Duchenne Muscular Dystrophy is a common sex-linked recessive trait appearing in 20 to 30 per 100,000 boys. The disease results from absence of a large protein called dystrophin that is associated with the muscle fiber plasma membrane.
Becker muscular dystrophy arises from an abnormality in the same gene locus that results in the presence of dystrophin that is abnormal in either amount or molecular structure. It has the same clinical symptoms as Duchenne dystrophy, but onset is later, and progression is slower.
Clinically Manifested at about 2 to 3 years of age, boys develop an awkward gait and an inability to run properly. Some have an antecedent history of mild slowness in attaining motor milestones, such as walking and climbing stairs.
By Examination .......> firm calf hypertrophy and mild to moderate proximal leg weakness exhibited by a hyperlordotic, waddling gait and inability to arise from the ground easily. The child typically arises from a lying position on the floor by using his arms to "climb up" his legs and body (Gower sign). Arm weakness is evident by 6 years of age, and most boys are confined to a wheelchair by 12 years of age. By age 16, little mobility of arms remains, and respiratory difficulties increase.
Cause of death :Pneumonia or congestive heart failure resulting from myocardial involvement.
Becker muscular dystrophy arises from an abnormality in the same gene locus that results in the presence of dystrophin that is abnormal in either amount or molecular structure. It has the same clinical symptoms as Duchenne dystrophy, but onset is later, and progression is slower.
Clinically Manifested at about 2 to 3 years of age, boys develop an awkward gait and an inability to run properly. Some have an antecedent history of mild slowness in attaining motor milestones, such as walking and climbing stairs.
By Examination .......> firm calf hypertrophy and mild to moderate proximal leg weakness exhibited by a hyperlordotic, waddling gait and inability to arise from the ground easily. The child typically arises from a lying position on the floor by using his arms to "climb up" his legs and body (Gower sign). Arm weakness is evident by 6 years of age, and most boys are confined to a wheelchair by 12 years of age. By age 16, little mobility of arms remains, and respiratory difficulties increase.
Cause of death :Pneumonia or congestive heart failure resulting from myocardial involvement.
Gower's Sign:
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