Paediatric Neurology by Ingrid Gamstorp (Auth.)

By Ingrid Gamstorp (Auth.)

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Sensation Sensation is always difficult to test in children. Active cooperation in testing the response to pinprick cannot be expected below the age of 9 - 1 1 years. 36. A 3y2-year-old girl with a mild left-sided hemiparesis. When she is running, her left arm comes up in front of her with the elbow bent. The co-movements, normally seen in both arms of a running child, are absent in this arm. Notice also the mild central facial paresis on the left side age and can be expected from 6 years. Position sense and two-point-discrimination can often be tested accurately from 6 - 8 years of age.

In children in w h o m the fontanelles have closed, skull X-ray is helpful in the demonstration of increased intracranial pressure. 14) and a decalcification of the back wall of the sella turcica. A localized thinning of the skull b o n e may suggest a growing cyst, a subdural hygroma, or a slow-growing brain t u m o u r . T h e two last-mentioned conditions may also cause irritation and localized thickening of the b o n e . 14. , above). Note the separation of sutures 56 Special examinations of sutures and fontanelles closing abnormally early), but should be confirmed on skull X-ray before surgical intervention is considered.

T h e normal range of other electrolytes is essentially the same in children and adults. In some of the metabolic disorders described in Chapter 5, the infant must have received food for some time before the metabolic defect can be diagnosed. A n infant with galactosaemia will thus show neither clinical symptoms nor urinary excretion of galactose until he has received milk. A n infant with phenylketonuria must have received protein for at least 2 - 4 days before an elevated phenylalanine blood level can be expected.

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