Introduction
A historical perspective and classification of OBPP was first described by the Scottish obstetrician William Smellie in an article for midwives in 1764 [1] He documented the observation of resolution of bilateral upper extremity paralysis in a child with face presentation at birth. Danyau performed an autopsy of a newborn with brachial plexus palsy in 1851, providing the first anatomic description of this lesion.[2] but classic description of shoulder paralysis, internal rotation contracture and waiter’s tip deformity was given by Erb in 1874 as cited by Gilbert A et al. [3,4]. Duchenne and Balliere and Erb described cases of upper trunk nerve injury, attributing the findings to traction on the upper trunk, now called Erb’s palsy (or Duchenne-Erb’s palsy).[5] In 1885, the French neurologist Augusta Klumpke [6] described the clinical picture of OBPP affecting the lower plexus trunk at C8-Th1, leading to paralysis of the muscles of the hand and ipsilateral pupillary dilatation, called Horners sign. Therefore, OBPP affecting the lower trunk is often referred to as Klumpkes palsy. OBPP diagnosed at birth is defined into three groups in accordance with the International Classification of Diseases :
• P 14.0 Erbs palsy caused by injury at delivery
• P 14.1 Klumpkes palsy caused by injury at delivery
• P 14.3 Other injury of the brachial plexus at delivery
P 14.0 and P 14.1 are the most common diagnoses. P 14.3 is rarely used and seems to be applied in cases with
More severe symptoms in children with cerebral palsy may result in basically no muscle control, greatly affecting their lives.” (Cogher, Savage & Smith, 1992)
The diagnosis is hemoptysis due to lesion on the lung. This is coded as 239.1
The human body is made up of many organ systems that consist of organs and tissues of different anatomies and diverse nomenclature. These organs systems, organs and tissues are prone to thousands of diseases, and one of these diseases is cerebral palsy, which is a disease of the nervous system in simple terms. Research relating to cerebral palsy is carried out, whereby the disorder is described, along with its history, and how it affects the nervous system and the brain. The anatomy of the body systems involves with regard to this disorder, the effects of the disorder on these body systems and other body systems are also researched and discussed. Furthermore, the research focuses on the causes of cerebral palsy, its complications, signs, and symptoms, and the diagnosis of the disorder, along with its treatment and side effects of the treatment. A recap of the research focusing on prevention strategies, the anatomy and physiology of cerebral palsy and the nervous system is presented.
1. Review and analyze the laboratory data. What diagnosis is supported by these values? Give your rationale.
Visual fields full to confrontation. Extraocular muscles intact. PERRLADC. Normal facial symmetry, sensation and movement. Tongue and uvula were midline. Normal auditory acuity. Shoulder shrug is normal.
Carey reported that she experienced occasional numbness of the upper extremities and that she would occasionally drop objects from both hands. Upon physical examination, Dr. Abiera noted that Ms. Carey’s range of motion of the cervical spine was decreased on flexion and tenderness on palpation of posterior cervical muscles with spasms and trigger points was present. In addition, Dr. Abiera noted that the range of motion of lumbar spine was within normal range, however there was still some tenderness on palpation of thoracic paraspinals muscles.
She reports tenderness to the posterior aspect of the cervical spine, trapezius region and scapular region with deep palpation.
Phantom Limb Pain (PLP) is a serious condition that occurs when a person who has lost a part of their body though amputation, trauma (brachial plexus), or loss of nervous connections in an appendage, perceives that the limb is still there and experiences sensations coming from this area. It was first described in 1866 by S. Weir Mitchell, an American neurologist, through a short story published in Atlantic Monthly. While Mitchell may then have wondered if this was specific to wounded Civil War soldiers, it has since been established as quite common (1). Over 70% of amputees report phantom limb pain for years after amputation (2). Several theories have been proposed regarding PLP, although there is still much to be
They may develop alone or in combination, but as the disease progresses, all are usually present. There is no true paralysis. The symptoms are always bilateral but usually involve one side early in the illness. Because the onset is insidious, the beginning of symptoms is difficult to document. Early in the disease, reflex status, sensory status, and mental status usually are normal. Postural abnormalities (flexed, forward leaning), difficulty walking, and weakness develop. Speech may be slurred. Autonomic-neuroendocrine symptoms include inappropriate diaphoresis, orthostatic hypotension, drooling, gastric retention, constipation, and urinary retention. Depression is also prevalent.
Bell’s Palsy is defined by a temporary, unilateral paralysis of the face caused by inflammation of the facial nerve (cranial nerve VII). Inflammation of the facial nerve is unknown although theories about a viral infection or disorders of the immune system have been found in research as possible causes. An MRI or CT scan can be used in order to diagnosis Bell’s Palsy by ruling out any other disorders with the same symptoms such as stroke, Lyme disease, or tumors. The disorder occurs suddenly and without any warning making it impossible for prevention. [1] Sir Charles Bell was the founder of this disorder from his studies of the facial nerve and how the interruptions of the nerve pathway caused paralysis. Bell’s Palsy generally
The earliest hypothesis regarding the cause of phantom limbs and pain was that of neuromas. These were thought to be nodules comprised of remaining nerves located at the end of the stump. These neuromas presumably continued to generate impulses that traveled up the spinal cord to portions of the thalamus and somatosensory domains of the cortex. As a result, treatment involved cutting the nerves just above the neuroma in an attempt to interrupt signaling at each somatosensory level (5). This and other related theories were deemed unsatisfactory because of the fact the phantom pain always returned, indicating that there was a more complex reason.
Electrodiagnostic consultation report dated 10/02/15 revealed normal study of both upper limbs and cervical paraspinals. No evidence of cervical radiculopathy. No median or ulnar neuropathy.
All cranial nerves tested within normal limits. Pt passed visual fields exam and no problems with gag reflex. Pt moved muscles evenly and bilaterally and was able to shrug shoulders and move head from side to side.
Overall, OBBP is considered as one of the disorders that occur among children at birth. The severity of the lesions may differ from one infant to another and is can be detected according to the injury of brachial plexus nerve roots. Some of its types can cause major deformities in child's upper limb and the child may need surgical operation, while some types can be treated and the infant can recover fully with physical therapy interventions.
In any case, the diagnosis should be suspected in patients with one or more of the following: