The clinical significance of opisthotonus — like posture in infants
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nounced dysarthric features. The most important conclusion is that patients with a bilateral peripheral facial para- lysis had no or only mild dysarthria, contrary to patients with a bilateral central facial weakness, and one patient with a central facial paresis on one side and a peripheral paralysis on the other. These last patients all had a severe dysarthna. In all patients with (sub~acutc lesions, the prognosis of the acquired dysarthria was good. and was independent of the severity 01‘ the in- itial neurological deficit, and of the etiological mechanism. The clinical sign~~cance of ~isthotonus - like posture in infants. B.C.L. Touwen (Groningen) Hyperextension of the neck and trunk associat- ed with retraction of the shoulders is often regarded as an early sign of a developing neurological impairment which may lead to cerebral palsy. The condition is especially found in infants who are prematurely born or who have suffered from intrauterine growth retardation, and becomes conspicuous at about 2-5 months of (corrected) age. Follow-up results over the first 18 months of life in a group of 105 infants with this symptomatology attending the out-patient clinic for infants at risk for developmental neurological disturbances showed that the presence of additional neuro- logical symptomatology rather than hyperex- tension as a single phenomenon determines prognosis. It is suggested that environmental factors such as the position of the infant in the incubator during periods of rapid muscle growth, contribute largely to the genesis of the condition, if no additional neurological signs are evident. In the case of marked additional neurological symptomatology physiotherapy did not prevent the development of cerebral palsy, although the extent of the handicap seemed to be mitigated. On the other hand physiotherapeutical advise in otherwise nor- mal infants prevented the development of stereotyped postural abnormalities. The finding that the majority of later impaired infants be- longed to a neonatally neurologically deviant group emphasizes the need for follow up of neurologica~y impaired newborns. Hydrocephalus and cervical spinal cord compression caused by mixed type sub- ependymoma. J.A.G. Geelen, A.A. de La Fuente, R. de Graaf (Enschede) The case of a lo-months-old boy is presented. The delivery was in breech position and post- natally signs of cerebral dysfunction were present for several hours. Furthermore a right upper cervical brachial plexuslesion was observed. During the first 8 months the child developed well and the plexuslesion improved. However, at the age of 9 months the child showed a rapid moor-dete~ora~on. The head~rcumference was too large. CAT-scan- ning of the head and the upper cervical region showed widening of the cerebral as well as the third and fourth ventricles. It was presumed that this communicating hydrocephalus was 238 caused by meningeal adhesions due to perinatal haemorrhage. However, after ventriculo- peritoneal shunting the child deteriorated further. The clinical picture was mainly charac- terized by tetraplegia and severe respiratory in- sufficiency. The post-mortem examination revealed no microscopical intra-cerebral ab- normalities nor neurosurgical complications. The examination of the cervical spinal cord revealed a ventral lobulated tumour eompres- sing the spinal cord. The microscopical examination demonstrated a mixed type subependymoma originating in the fourth ven- tricle and extending as a thin layer of tissue subdurally to the cervical area. The mixed type subependymoma consisted of astrocytes with numerous fibrils and ependymal cells forming
Transcript of The clinical significance of opisthotonus — like posture in infants
nounced dysarthric features. The most important conclusion is that
patients with a bilateral peripheral facial para- lysis had no or only mild dysarthria, contrary to patients with a bilateral central facial weakness, and one patient with a central facial paresis on one side and a peripheral paralysis on the other.
These last patients all had a severe dysarthna. In all patients with (sub~acutc lesions, the prognosis of the acquired dysarthria was good. and was independent of the severity 01‘ the in- itial neurological deficit, and of the etiological mechanism.
The clinical sign~~cance of ~isthotonus - like posture in infants.
B.C.L. Touwen (Groningen)
Hyperextension of the neck and trunk associat- ed with retraction of the shoulders is often regarded as an early sign of a developing neurological impairment which may lead to cerebral palsy. The condition is especially found in infants who are prematurely born or who have suffered from intrauterine growth retardation, and becomes conspicuous at about 2-5 months of (corrected) age. Follow-up results over the first 18 months of life in a group of 105 infants with this symptomatology attending the out-patient clinic for infants at risk for developmental neurological disturbances showed that the presence of additional neuro- logical symptomatology rather than hyperex- tension as a single phenomenon determines
prognosis. It is suggested that environmental factors such as the position of the infant in the incubator during periods of rapid muscle growth, contribute largely to the genesis of the condition, if no additional neurological signs are evident. In the case of marked additional neurological symptomatology physiotherapy did not prevent the development of cerebral palsy, although the extent of the handicap seemed to be mitigated. On the other hand physiotherapeutical advise in otherwise nor- mal infants prevented the development of stereotyped postural abnormalities. The finding that the majority of later impaired infants be- longed to a neonatally neurologically deviant group emphasizes the need for follow up of neurologica~y impaired newborns.
Hydrocephalus and cervical spinal cord compression caused by mixed type sub- ependymoma.
J.A.G. Geelen, A.A. de La Fuente, R. de Graaf (Enschede)
The case of a lo-months-old boy is presented. The delivery was in breech position and post- natally signs of cerebral dysfunction were present for several hours. Furthermore a right upper cervical brachial plexuslesion was observed. During the first 8 months the child developed well and the plexuslesion improved. However, at the age of 9 months the child showed a rapid moor-dete~ora~on. The head~rcumference was too large. CAT-scan- ning of the head and the upper cervical region showed widening of the cerebral as well as the third and fourth ventricles. It was presumed that this communicating hydrocephalus was
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caused by meningeal adhesions due to perinatal haemorrhage. However, after ventriculo- peritoneal shunting the child deteriorated further. The clinical picture was mainly charac- terized by tetraplegia and severe respiratory in- sufficiency. The post-mortem examination revealed no microscopical intra-cerebral ab- normalities nor neurosurgical complications. The examination of the cervical spinal cord revealed a ventral lobulated tumour eompres- sing the spinal cord. The microscopical examination demonstrated a mixed type
subependymoma originating in the fourth ven- tricle and extending as a thin layer of tissue subdurally to the cervical area. The mixed type subependymoma consisted of astrocytes with numerous fibrils and ependymal cells forming
