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1、Neurologic&MuscularDisordersZhouShuizhen(周水珍)DepartmentofNeurologyChildren’sHospitalofFuDanUniversityPartI:GeneralConsideration?AnatomicalandphysiologyfeaturesofthechildCNS?Neurologicalexaminationofchildren?Keyfactsaboutneurologicaldisordersinchildren:–Infectionso
2、ftheCNS–Neurocutaneoussyndromes–Cerebralpalsy–Progressivemusculardystrophy–Seizuredisorders(epilepsies&non-epilepsyseizures)–Convulsions&Weakness(PBL)PhysiologicandanatomicalfeaturesofthechildCNS1.Brain-weight:atbirth6m1y2y4-6yadult370700900100013001500(g)-cerebra
3、/pallium/cellnumber…-myelinization:fetalperiod~4yrs.2.SpinalCord-weight:2~6g(atbirth)-terminal:L3(fetal);L1(4y)-myelinization:3yNeurologicalexaminationofchildren?Achild’snervoussystemiscontinuousdevelopment?Methodsofneurologicalmustbeadaptedtothechild’sdevelopment
4、alstage?Neurologicalsignsarealteredbyexternalfactors?Examinationrevealspresenceofabnormalities,locationsoflesionsandcluesofetiologyI.Generalobservation1.Generalobservation:Hyperactivity,attention,emotionalstate2.Consciousness:Level;Quality3.Speech&language:Eyetoey
5、econtact;GesturesArticulation;Understanding;Expression4.FaciesandHead:Size,shapeofhead;Fontanelle,size&tension;Bruit,transilluminationofhead5.Neck:Movement,deformity,signsofmeningealirritation6.Skin:Cafeaulaitspots,telangiectasis,haemangiomasII.Cranialnerves1.Smel
6、l2.Vision-field,acuity,abnormaleyemovement3.Pupilsize,reactions4.Fundi5.Ocularmovement,squint,nystangmus,ptosis,sun-setsign6.Jawmovement,jawjerk,facialsensation&cornealreflex7.Earexamination,hearing,vestibularfunction8.Paltalmovement,gagreflex9.Rotatehead,elevates
7、houlders,extendneck10.Tongue-protrusion,atrophy,fasciculation,percussion-myotoniaIII.MotorFunctions1.Observespontaneousposture&movement:–Lying,sitting,standing,walking,running,climbing&descending,grasping,manipulation.2.Musclebulk,consistency3.Muscletone–fascicula
8、tion,myotonia4.Musclepower,jointbyjoint5.Ataxia–Truncalwhilesitting&standing–Limds:Reaching,Finger-nose,Heel-kneeRapidalternatingmovements6.Involuntarym
