TAILIEUCHUNG - A Lange Medical Book Pediatrics on call - part 5

Ở trẻ lớn hơn, bệnh có thể biểu hiện dấu hiệu của tăng áp lực nội sọ (hôn mê, đau đầu và nôn mửa) hoặc rối loạn chức năng tiểu não (thất điều). Bất thường hệ thần kinh trung ương khác có thể có mặt, bao gồm cả agenesis của các corpus callosum, heterotopias, khối u bẩm sinh | 66. METABOLIC DISEASES 299 hypoplasia complete or partial agenesis of the cerebellar vermis . Hydrocephalus can develop in utero or during early childhood typically first year of life . In older children the disorder can present with signs of increased intracranial pressure lethargy headache and vomiting or cerebellar dysfunction ataxia . Other CNS anomalies may be present including agenesis of the corpus callosum heterotopias congenital tumors and aqueductal stenosis. REFERENCES Bernard JP Moscoso G Renier D Ville Y Cystic malformation of the posterior fossa. Prenat Diagn 2001 21 1064-1069. Niesen CE. Malformations of the posterior fossa Current perspectives. Sem Pediatr Neurol 2002 9 320-334. Pascual-Casatroviejo I Velez A Pascual-Pascual S et al. Dandy-Walker malformation Analysis of 38 cases. Child Nerv Sys 1991 7 88-97. 66. METABOLIC DISEASES I. Problem. A full-term neonate who previously appeared well presents with rapidly increasing lethargy after 3-4 days of poor feeding. II. Immediate Questions A. Is there a family history of neonatal losses Such a history is highly suspicious for metabolic disease caused by enzyme deficiencies. These diseases typically are transmitted in an autosomal-recessive or occasionally X-linked fashion making the recurrence risk for these families significant. B. Is there associated vomiting Can be nonspecific or excessive with hyperammonemia. C. Does patient have an unusual odor Organic acids are volatile and thus can be associated with an unusual odor of sweat urine or earwax. Maple syrup urine disease MSUD is often suspected from sweet-smelling earwax. A foul sweaty feet or cat urine odor can occur in several of the organic acidemias. D. If available what were the newborn screening results Newborn screening studies in many states include many of the organic acidemias fatty acid oxidation defects and urea cycle defects. Check screening results of child or other family member if available. Because of limitations of screening tests

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