moya-moya精品课件

ON EXAMINATION:
• Child looks comfortable and Alert. • Vitals: Pulse: 90/min R/R : 24/min B.P : 90/40 mm Hg Temp: 98.60C • No pallor, icterus, rash, lymphadenopathy,edema, Phakomas or any joint swelling or bony tenderness • ENT Examn: Normal • Anthropometry: HT : 101cms (93%) WT : 13kgs (72%) GRADE II PEM WT/HT : 86%
Hemorrhagic Stroke
Vascular Malformations Arteriovenous malformation Aneurysm Angiomas • Hematological Leukemia Thrombocytopenia Hemophilia • Disseminated intravascular coagulation • Trauma • Shaken baby syndrome • Prematurity Subependymal hemorrhage
Occlusive vascular disease is slightly more common (55%) than intracranial hemorrhage (45%)
Ischemic causes:
• Heart Diseases Congential heart disease Rheumatic heart disease Infective endocarditis Complication of surgery • Hematologic Disorders Thrombocytosis Polycythemia Leukemia Antithrombin 3, Protein C and Protein S deficiency • Infective Vasculitis Pyogenic Tuberculous Fungal AIDS • Non Infective Vasculitis SLE Polyarteritis nodosa Takayasu arteritis • Non specific Moya Moya Syndrome Trauma Blunt cervical arterial trauma
HISTORY OF PAST ILLNESS
• Similar episode of sudden onset of weakness 5 months back _ Right side of the body. • Was admitted at KCH for 2 days and discharged and was referred to Nutritional rehabilitation center. • Resolved spontaneously in period of a month and was doing well since then.
Plantar
RT: Withdrawl
Lf: Withdrawl
• SUPERFICIAL REFLEX: Normal • SENSOTY SYSTEM • COORDINATION • GAIT : Normal : Intact : Dragging of left foot
• CARDIOVASCULAR SYSTEM; S1, S2 : Normal No added sounds • RESPIRATORY SYSTEM: B/L equal air entry with VBS • P/A : soft, no visceromegaly, BS- N
• BIRTH HISTORY—FT/S/F/NVD at Home ante-natal/intra-partum or postpartum period: Uneventful
• IMMUNIZATION HISTORY: Completed according to EPI schedule. • DEVELOPMEENTAL HISTORY:Normal for her age • NUTRITIONAL HISTORY: Taking less than required calorie (70kc/kg/d).
Ischemic causes contd….
• Oral foreign bodies injuring the carotid artery • Hereditary Metabolic Homocystinuria Mitochondrial myopathy, encephalopathy, lactic acidosis and stroke like episodes (MELAS) • Toxic Phencyclidine Methamhateminne Phenylpropanolamine Cocaine
HISTORY OF PRESENT ILLNESS
• Sudden onset of weakness of left side of the body and deviation of face towards right for 1 day. • Mild headache for 4 days. • The weakness was non-progressive. • No H/O drooling or difficulty in swallowing or speech difficulty • No H/O fever, vomiting,ear discharge, sore-throat. • No H/O altered sensorium, visual disturbance, loss of consciousness or abnormal movements of the body.
PROV. DX:
ACUTE STROKE SYNDROME
• INVESTIGATIONS: • CBC: Hb : 12 gm% Platelet : 120,000/cmm TC : 5000/cmm P- 58%, L- 40% ESR : 20 mm/ 1st hour PBF : Normocytic Normochromic • Mantoux test : Negative
STANDARD EVALUATIONS:
• Complete blood count , platelet and coagulation profile • LFT • Electrolytes, BUN, and creatinine, Glucose • Total protein, Uric acid • Calcium, phosphate • Cholesterol, triglycerides • Electrocardiogram • Carotid duplex studies
FAMILY HISTORY
• Father : 25years/ painlter • Mother: 23years/ House-wife • Siblings: Elder : 10 years/F Younger: 3years/F
• No H/ O similar illness/ TB in the family o consanguinity of marriage.
CNS EXAMINATION:
• • • • • • Conscious, cooperative and alert Oriented to time , place and person. Memory: Intact. Speech: Normal No signs of meningeal irritation CRANIAL NERVES: Pupils: B/L equal and reacting to light Fundus:Normal Left sided facial palsy ( UMN Type)
• Stroke is defined as the abrupt or ictal onset of focal or global neurologic symptoms caused by ischemia or hemorrhage within or around the brain resulting from diseases of the cerebral blood vessels. • Annual incidence of cerebral infarction in children, all over the world, varies between 1.2 per 100,000 to 2.7 per 100,000. • less than 1% of all pediatric admissions and 510% of all stroke in young (<40 years) • The two primary pathophysiologic features of cerebrovascular disease are interruption of blood flow to part of the brain or rupture of blood vessels with bleeding into the cerebral parenchyma.
MOTOR SYSTEM EXAM…
upper limbs lower limbs
BULK
TONE POWER DTJ
Right N N 5/5 N
Left N Less 2/5