APPROACH TO CNS DISEASES

Dr. Shami Pokhrel

LMC
• Diseases of the nervous system is common in pediatric
practice

• Almost 20-30 percent of children encounter

neurological illnesses

• These are major contributor to childhood morbidity and

disability

• Accurate early diagnosis is likely to be more rewarding

• History gives away most of the diagnosis

• The mode of onset gives clues about the

etiology.

• ACUTE, SUBACUTE AND INSIDIOUS

• RELAPSING AND REMITTING AND PROGRESSIVE

• Developmental history

• If disease develop at or neat the time of birth,

all the developmental milestones are delayed

• Regression of milestones can be observed in

several other neurological diseases

• ALWAYS ASK FOR FAMILY HISTORY AND

CONSANGUINITY
 PHYSICAL EXAMINATION
• Inspection: posture, quality and symmetry of
spontaneous movements, behavior, quality
and symmetry of spontaneous movements,
behavior, apathy, interest in surroundings,
hyperkinesis, involuntary movements

• Cranial nerves
• Second and third cranial nerve : response to light
stimuli and pupillary reflexes shows integrity of both
the nerves
• Fourth nerve: down and out movement of eyes
• Fifth nerve: conjuctival and corneal reflex
• Sixth nerve: convergent squint
• Seventh nerve
• Eight nerve, ninth and tenth nerve
• Eleventh and twelfth nerve
 Acute onset
• A 2-year-old boy was admitted to the Pediatric
Emergency Room in an extremely poor general
condition, with apnea, asystole, immeasurable oxygen
saturation and the signs of severe brain injury
(Glasgow Coma Scale 3)
• Based on the information from his father, the boy had
a fever and adipsia for several hours and vomited
twice. The symptoms appeared in the afternoon a day
before the hospital admission; based on this
presentation, a non-specific upper respiratory
infection had been diagnosed by a family physician in
an outpatient setting. The patient passed away 30
mins post- admission despite all the measures.
• A 23-month-old full-term Moroccan baby boy born to
a non-consanguineous couple was referred to our
hospital with the complaint of sudden onset left-sided
hemiparesis. On neurological examination, there were
no signs of meningeal irritation, his gait was
hemiplegic, tone was decreased over left side, power
was 2/5 over left upper and lower limb, and deep
tendon reflexes were exaggerated
• Preliminary neuroimaging suggested an arterial
ischemic process. Clinical and laboratory evaluation
excluded hematologic, metabolic, and vasculitic
causes. What next????
• A 9-year-old girl was presented with a 12- month
history of occasionally headache. She complained of
last month progressive headache with nausea and
vomiting. She had no history of head trauma, previous
hospitalization, specific drug use, or familial disease.
Her neurologic examination was normal. Papilledema
was found in eye examination that was caused by
increased intracranial pressure. A complete blood cell
count indicated an overall increase in the number of
WBCs. What investigation you would like to do?
• Motor examination
• Developmental examination- hearing and
vision evaluation is also mandatory
• Lumber puncture
• EEG
• EPR
• Electromyograpghy
• Nerve conduction study
• USG
• CT scan
• MRI
• PET
• Carotid doppler studies
• Myelography
• Biopsy of brain
THANK YOU