Head injury for children with special needs
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Apr 27, 2024
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About This Presentation
Head injury
Slide Content
Head Injury
Head injury is a pathologic process involving the scalp, skull, meninges,
or brain as a result of mechanical force.
ELology
•The three major causes of brain damage in childhood are (1) falls, (2) motor
vehicle injuries, and (3) bicycle injuries.
•Neurologic injury accounts for the highest mortality rate, with boys aSected twice
as oTen as girls. Falls are the major source of all head injuries in children between 0
to 14 years old
• Incomplete motor development contributes to falls at young ages, and the natural
curiosity and exuberance of children also increase their risk of injury.
وأ اياحسلا وأ ةمجمجلا وأ سأرلا ةورف لمشت ةيضرم ةيلمع يه سأرلا ةباصإ
.ةيكيناكيم ةوقل ةجيتن غامدلا
تاباصإ (2) ،طوقسلا (1) يه ةلوفطلا ةلحرم يف غامدلا فلتل ةيسيئرلا ةثMثلا بابسRا
.تاجاردلا تاباصإ (3) و ،تارايسلا
سأرلا تاباصإ عيمجل يسيئرلا ردصWا وه طوقسلا .تانبلا ددع فعض ضرملل د\وRا ضر ع ت ي ثيح ،تايفولل لدعم ىلعأ ةيبصعلا تاباص`ا لثمت
اًماع 14 ىلإ 0 bب مهرامعأ حوارتت نيذلا لافطRا ىدل
.ةباصiل مهضرعت رطخ نم اًضيأ ناديزي لافطRا ىدل ةيويحلاو يعيبطلا لوضفلا نأ امك ،ةركبم نس يف طوقسلا يف لمتكWا ريغ يكرحلا روطتلا مهاسي
Head injury is a pathologic process involving the scalp, skull, meninges,
or brain as a result of mechanical force.
ELology
•The three major causes of brain damage in childhood are (1) falls, (2) motor
vehicle injuries, and (3) bicycle injuries.
•Neurologic injury accounts for the highest mortality rate, with boys aSected twice
as oTen as girls. Falls are the major source of all head injuries in children between 0
to 14 years old
• Incomplete motor development contributes to falls at young ages, and the natural
curiosity and exuberance of children also increase their risk of injury.
وأ اياحسلا وأ ةمجمجلا وأ سأرلا ةورف لمشت ةيضرم ةيلمع يه سأرلا ةباصإ
.ةيكيناكيم ةوقل ةجيتن غامدلا
تاباصإ (2) ،طوقسلا (1) يه ةلوفطلا ةلحرم يف غامدلا فلتل ةيسيئرلا ةثMثلا بابسRا
.تاجاردلا تاباصإ (3) و ،تارايسلا
سأرلا تاباصإ عيمجل يسيئرلا ردصWا وه طوقسلا .تانبلا ددع فعض ضرملل د\وRا ضر ع ت ي ثيح ،تايفولل لدعم ىلعأ ةيبصعلا تاباص`ا لثمت
اًماع 14 ىلإ 0 bب مهرامعأ حوارتت نيذلا لافطRا ىدل
.ةباصiل مهضرعت رطخ نم اًضيأ ناديزي لافطRا ىدل ةيويحلاو يعيبطلا لوضفلا نأ امك ،ةركبم نس يف طوقسلا يف لمتكWا ريغ يكرحلا روطتلا مهاسي
Pathophysiology
•The pathology of brain injury is directly related to the force of impact.
Intracranial contents (brain, blood, CSF) are damaged because the force
is too great to be absorbed by the skull and Musculo-ligamentous
support of the head.
•Primary head injuries are those that occur at the Lme of trauma and
include skull fracture, contusions, intracranial hematoma, and diSuse
injury. Subsequent complicaLons include hypoxic brain damage,
increased ICP, infecLon, and cerebral edema.
يغامدلا لئاسلا ،مدلا ،غامدلا) ةمجمجلا لخاد تايوتحWا ررضتت .ريثأتلا ةوقب اًرشابم اًطابترا غامدلا ةباصإ ضارمأ طبترت
.سأرلل يطابرلا يلضعلا معدلاو ةمجمجلا اهصتمت نأ نم ربكأ ةوقلا نR (يكوشلا
ةقحMلا تافعاضWا لمشت .ةرشتنWا تاباص`او ،ةمجمجلا لخاد يومدلا مر و ل او ،تامدكلاو ،ةمجمجلا رسك لمشتو ةمدصلا ةقطنم يف ثدحت يتلا كلت يه ةيلوRا سأرلا تاباصإ
.ةيغامدلا ةمذولاو ،ىودعلاو ،يردصلا صفقلا لخاد طغضلا ةدايزو ،ةجسكRا صقن نع جتانلا غامدلا فلت
•The pathology of brain injury is directly related to the force of impact.
Intracranial contents (brain, blood, CSF) are damaged because the force
is too great to be absorbed by the skull and Musculo-ligamentous
support of the head.
•Primary head injuries are those that occur at the Lme of trauma and
include skull fracture, contusions, intracranial hematoma, and diSuse
injury. Subsequent complicaLons include hypoxic brain damage,
increased ICP, infecLon, and cerebral edema.
يغامدلا لئاسلا ،مدلا ،غامدلا) ةمجمجلا لخاد تايوتحWا ررضتت .ريثأتلا ةوقب اًرشابم اًطابترا غامدلا ةباصإ ضارمأ طبترت
.سأرلل يطابرلا يلضعلا معدلاو ةمجمجلا اهصتمت نأ نم ربكأ ةوقلا نR (يكوشلا
ةقحMلا تافعاضWا لمشت .ةرشتنWا تاباص`او ،ةمجمجلا لخاد يومدلا مر و ل او ،تامدكلاو ،ةمجمجلا رسك لمشتو ةمدصلا ةقطنم يف ثدحت يتلا كلت يه ةيلوRا سأرلا تاباصإ
.ةيغامدلا ةمذولاو ،ىودعلاو ،يردصلا صفقلا لخاد طغضلا ةدايزو ،ةجسكRا صقن نع جتانلا غامدلا فلت
AcceleraLon or deceleraLon is responsible for most head injuries. When the staLonary
head receives a blow, the sudden acceleraLon causes deformaLon of the skull and
mass movement of the brain. Sudden deceleraLon, such as takes place in a fall, causes
the greatest cerebral injury at the point of impact.
•Children with an acceleraLon/deceleraLon injury demonstrate diSuse generalized
cerebral swelling produced by increased blood volume or a redistribuLon of cerebral
blood volume (cerebral hyperemia) rather than by increased water content (edema).
•Another eSect of brain movement is shearing stresses, which are caused by unequal
movement or diSerent rates of acceleraLon at various levels of the brain. A shearing
force may tear small arteries and cause subdural hemorrhages.
يدؤي .غامدلل ةيعامج ةكرحو ةمجمجلا يف اًهوشت ببسي ئجافWا عراستلا نإف ،ةبرض يدومعلا سأرلا ىقلتي امدنع .سأرلا تاباصإ مظعم نع ً\وؤسم ؤطابتلا وأ عراستلا دعي
.مادطصا ةطقن دنع ةيغامد ةباصإ ربكأ ثودح ىلإ ،طوقسلا دنع ثدحي يذلا لثم ،ئجافWا ؤطابتلا
ً\دب (يغامدلا مدلا ناقتحا) يغامدلا مدلا مجح عيزوت ةداعإ وأ مدلا مجح ةدايز نع جتان مدختسم ريغ اًممعم اًيغامد اًمروت ؤطابتلا/عراستلا ةباصإب نوباصWا لافطRا رهظُي
.(ةمذولا) ءاWا ىوتحم ةدايز نم
ىلإ صقلا ةوق يدؤت دق .غامدلا نم ةفلتخم تايوتسم يف ةفلتخWا عراستلا ت\دعم وأ ةيواستWا ريغ ةكرحلا نع جتنت يتلاو ،صقلا طوغض وهو غامدلا ةكرح نم رخآ مسق كانه
.ةيفاجلا تحت اًفيزن ببستو ةر ي غ ص ل ا bيارشلا قيزمت
head receives a blow, the sudden acceleraLon causes deformaLon of the skull and
mass movement of the brain. Sudden deceleraLon, such as takes place in a fall, causes
the greatest cerebral injury at the point of impact.
•Children with an acceleraLon/deceleraLon injury demonstrate diSuse generalized
cerebral swelling produced by increased blood volume or a redistribuLon of cerebral
blood volume (cerebral hyperemia) rather than by increased water content (edema).
•Another eSect of brain movement is shearing stresses, which are caused by unequal
movement or diSerent rates of acceleraLon at various levels of the brain. A shearing
force may tear small arteries and cause subdural hemorrhages.
يدؤي .غامدلل ةيعامج ةكرحو ةمجمجلا يف اًهوشت ببسي ئجافWا عراستلا نإف ،ةبرض يدومعلا سأرلا ىقلتي امدنع .سأرلا تاباصإ مظعم نع ً\وؤسم ؤطابتلا وأ عراستلا دعي
.مادطصا ةطقن دنع ةيغامد ةباصإ ربكأ ثودح ىلإ ،طوقسلا دنع ثدحي يذلا لثم ،ئجافWا ؤطابتلا
ً\دب (يغامدلا مدلا ناقتحا) يغامدلا مدلا مجح عيزوت ةداعإ وأ مدلا مجح ةدايز نع جتان مدختسم ريغ اًممعم اًيغامد اًمروت ؤطابتلا/عراستلا ةباصإب نوباصWا لافطRا رهظُي
.(ةمذولا) ءاWا ىوتحم ةدايز نم
ىلإ صقلا ةوق يدؤت دق .غامدلا نم ةفلتخم تايوتسم يف ةفلتخWا عراستلا ت\دعم وأ ةيواستWا ريغ ةكرحلا نع جتنت يتلاو ،صقلا طوغض وهو غامدلا ةكرح نم رخآ مسق كانه
.ةيفاجلا تحت اًفيزن ببستو ةر ي غ ص ل ا bيارشلا قيزمت
ComplicaLons
•The major complicaLons of trauma to the
head are hemorrhage, infecLon, edema,
and herniaLon through the brainstem.
Vascular rupture may occur even in minor
head injuries, causing hemorrhage between
the skull and cerebral surfaces.
•Epidural Hemorrhage
•Subdural hemorrhage
•Cerebral edema
ثدحي دق .غامدلا عذج ربع قتفلاو ةمذولاو ىودعلاو فزنلا يه سأرلا تامدصل ةيسيئرلا تافعاضWا
.خWا حطسأو ةمجمجلا bب اًفيزن ببسي امم ،ةطيسبلا سأرلا تاباصإ يف ىتح ةيومدلا ةيعوRا قزمت
ةيفاجلا قوف فيزن •
ةيفاجلا تحت فيزن •
ةيغامد ةمذو •
•The major complicaLons of trauma to the
head are hemorrhage, infecLon, edema,
and herniaLon through the brainstem.
Vascular rupture may occur even in minor
head injuries, causing hemorrhage between
the skull and cerebral surfaces.
•Epidural Hemorrhage
•Subdural hemorrhage
•Cerebral edema
ثدحي دق .غامدلا عذج ربع قتفلاو ةمذولاو ىودعلاو فزنلا يه سأرلا تامدصل ةيسيئرلا تافعاضWا
.خWا حطسأو ةمجمجلا bب اًفيزن ببسي امم ،ةطيسبلا سأرلا تاباصإ يف ىتح ةيومدلا ةيعوRا قزمت
ةيفاجلا قوف فيزن •
ةيفاجلا تحت فيزن •
ةيغامد ةمذو •
Clinical Manifestations of Acute
Head Injury
Minor Injury
•May or may not lose consciousness
•Transient period of confusion
•Somnolence
•Listlessness
•Irritability
•Pallor
•VomiLng (one or more episodes)
•Signs of Progression
•Altered mental status (e.g., di^culty arousing child)
•MounLng agitaLon
•Development of focal lateral neurologic signs
•Marked changes in vital signs
Severe Injury
•Signs of increased ICP
•Bulging fontanel (infant)
•ReLnal hemorrhages
•Extraocular palsies (especially CN III)
•Hemiparesis
•Quadriplegia
•Elevated temperature
•Unsteady gait (older child)
•Papilledema (older child)
•ReLnal hemorrhages
Associated Signs
•Scalp trauma
•Other injuries (e.g., to extremiLes)
•CN, Cranial nerve; ICP, intracranial pressure.
ةفيفط ةباصإ
هدقفي \ وأ يعولا دقفي دق
كابترا نم ةر ب ا ع ةر ت ف
ساعنلا
لومخلا
جيهتلا
بوحشلا
مدقتلا تامMع
(ةبون نم رثكأ وأ ةدحاو) ءيقلا
(لفطلا ةر ا ث إ يف ةبوعص ،لاثWا ليبس ىلع) ةيلقعلا ةلاحلا ريغت
ديدشلا بضغلا
تامMعلا روطت
ةيبناجلا ةيبصعلا
ةيرؤبلا
ةيويحلا تامMعلا يف ةظوحلم تاريغت
ةر ي ط خ ةباصإ
ةيلودلا تانراقWا جمانرب ةدايز تامMع
(عيضرلا) خوفايلا خافتنا
ةيكبشلا فيزن
يفصنلا للشلا
(CN III ةصاخ) bعلا جراخ للشلا
يعابرلا للشلا
ةر ار ح ل ا ةجرد عافترا
(انس ربكRا لفطلا) ةرقتسم ريغ ةيشم
(انس ربكRا لفطلا) يرصبلا بصعلا ةميلح ةمذو
bعلا ةيكبش يف فيزن
ةطبترWا تامMعلا
سأرلا ةورف ضوضر
( فارطRا ،لاثWا ليبس ىلع) ىرخأ تاباصإ
.ةمجمجلا لخاد طغضلا ،يفحقلا بصعلا
Head Injury
Minor Injury
•May or may not lose consciousness
•Transient period of confusion
•Somnolence
•Listlessness
•Irritability
•Pallor
•VomiLng (one or more episodes)
•Signs of Progression
•Altered mental status (e.g., di^culty arousing child)
•MounLng agitaLon
•Development of focal lateral neurologic signs
•Marked changes in vital signs
Severe Injury
•Signs of increased ICP
•Bulging fontanel (infant)
•ReLnal hemorrhages
•Extraocular palsies (especially CN III)
•Hemiparesis
•Quadriplegia
•Elevated temperature
•Unsteady gait (older child)
•Papilledema (older child)
•ReLnal hemorrhages
Associated Signs
•Scalp trauma
•Other injuries (e.g., to extremiLes)
•CN, Cranial nerve; ICP, intracranial pressure.
ةفيفط ةباصإ
هدقفي \ وأ يعولا دقفي دق
كابترا نم ةر ب ا ع ةر ت ف
ساعنلا
لومخلا
جيهتلا
بوحشلا
مدقتلا تامMع
(ةبون نم رثكأ وأ ةدحاو) ءيقلا
(لفطلا ةر ا ث إ يف ةبوعص ،لاثWا ليبس ىلع) ةيلقعلا ةلاحلا ريغت
ديدشلا بضغلا
تامMعلا روطت
ةيبناجلا ةيبصعلا
ةيرؤبلا
ةيويحلا تامMعلا يف ةظوحلم تاريغت
ةر ي ط خ ةباصإ
ةيلودلا تانراقWا جمانرب ةدايز تامMع
(عيضرلا) خوفايلا خافتنا
ةيكبشلا فيزن
يفصنلا للشلا
(CN III ةصاخ) bعلا جراخ للشلا
يعابرلا للشلا
ةر ار ح ل ا ةجرد عافترا
(انس ربكRا لفطلا) ةرقتسم ريغ ةيشم
(انس ربكRا لفطلا) يرصبلا بصعلا ةميلح ةمذو
bعلا ةيكبش يف فيزن
ةطبترWا تامMعلا
سأرلا ةورف ضوضر
( فارطRا ،لاثWا ليبس ىلع) ىرخأ تاباصإ
.ةمجمجلا لخاد طغضلا ،يفحقلا بصعلا
DiagnosLc EvaluaLon
•A detailed health history, both past and present, is essenLal in
evaluaLng the child with a cranio-cerebral trauma.
•Because head injuries are frequently accompanied by injuries in other
areas, the examinaLon is performed with care to avoid further damage
اًرمأ ،رضاحلاو يضاWا يف ،لصفWا يحصلا خيراتلا دعي
.ةيغامد ةيفحق ةمدصب باصWا لفطلا مييقت يف اًيرورض
ررضلا نم ديزWا بنجتل ةيانعب صحفلا ءارجإ متي ،ىرخأ قطانم يف تاباصإب ةبوحصم نوكت ام اًريثك سأرلا تاباصإ نR اًرظن
•A detailed health history, both past and present, is essenLal in
evaluaLng the child with a cranio-cerebral trauma.
•Because head injuries are frequently accompanied by injuries in other
areas, the examinaLon is performed with care to avoid further damage
اًرمأ ،رضاحلاو يضاWا يف ،لصفWا يحصلا خيراتلا دعي
.ةيغامد ةيفحق ةمدصب باصWا لفطلا مييقت يف اًيرورض
ررضلا نم ديزWا بنجتل ةيانعب صحفلا ءارجإ متي ،ىرخأ قطانم يف تاباصإب ةبوحصم نوكت ام اًريثك سأرلا تاباصإ نR اًرظن
Emergency Treatment- Head Injury
Assess child: A: Airway B: Breathing C: CirculaLon
•Neurologic and thermoregulatory status
•Stabilize neck and spine immediately. Use jaw thrust, not chin liT, to open airway.
•Clean any abrasions with soap and water.
•Apply clean dressing. • If child is bleeding, apply pressure and then ice to relieve pain and swelling.
•Keep child NPO unLl instructed otherwise.
•Assess pain but do not give analgesics or sedaLves.
•Check pupil reacLon every 4 hours (including twice during night) for 48 hours.
•Awaken twice during the night to check LOC.
Seek medical afenLon for any of the following:
•Injury sustained at high speed (e.g., automobile) • Fall from a signigcant distance (e.g., height greater than that of the child) • Injury sustained
from great force (e.g., baseball bat) • Injury sustained under suspicious circumstances
•Loss of consciousness • Amnesia • Discomfort (crying) more than 10 minutes aTer injury
•Headache that is severe, worsening, interferes with sleep, or lasts more than 24 hours • Fluid leak from ears or nose; blackened eyes
• VomiLng three or more Lmes, beginning aTer injury, or conLnuing 4 to 6 hours aTer injury • Swelling in front of or above earlobe or swelling
that increases in size
• Confusion or abnormal behaving • Di^culty arousing child from sleep
•Di^culty speaking • Blurred vision or diplopia
•Unsteady gait • Di^culty using extremiLes, weakness, or incoordinaLon
•Neck pain or sLSness • Pupils dilated, unequal, or gxed • Infant with bulging fontanel
•Seizures LOC, Level of consciousness; NPO, nothing by mouth.
Assess child: A: Airway B: Breathing C: CirculaLon
•Neurologic and thermoregulatory status
•Stabilize neck and spine immediately. Use jaw thrust, not chin liT, to open airway.
•Clean any abrasions with soap and water.
•Apply clean dressing. • If child is bleeding, apply pressure and then ice to relieve pain and swelling.
•Keep child NPO unLl instructed otherwise.
•Assess pain but do not give analgesics or sedaLves.
•Check pupil reacLon every 4 hours (including twice during night) for 48 hours.
•Awaken twice during the night to check LOC.
Seek medical afenLon for any of the following:
•Injury sustained at high speed (e.g., automobile) • Fall from a signigcant distance (e.g., height greater than that of the child) • Injury sustained
from great force (e.g., baseball bat) • Injury sustained under suspicious circumstances
•Loss of consciousness • Amnesia • Discomfort (crying) more than 10 minutes aTer injury
•Headache that is severe, worsening, interferes with sleep, or lasts more than 24 hours • Fluid leak from ears or nose; blackened eyes
• VomiLng three or more Lmes, beginning aTer injury, or conLnuing 4 to 6 hours aTer injury • Swelling in front of or above earlobe or swelling
that increases in size
• Confusion or abnormal behaving • Di^culty arousing child from sleep
•Di^culty speaking • Blurred vision or diplopia
•Unsteady gait • Di^culty using extremiLes, weakness, or incoordinaLon
•Neck pain or sLSness • Pupils dilated, unequal, or gxed • Infant with bulging fontanel
•Seizures LOC, Level of consciousness; NPO, nothing by mouth.
TherapeuLc Management
•The majority of children with mild traumaLc brain injury are observed at
home aTer a careful examinaLon. Nurses should provide parents with verbal
and wrifen instrucLons of signs and symptoms that warrant concern and the
need for medical re-evaluaLon
•Parents are instructed to check the child every 2 hours to determine any
changes in responsiveness. The child is maintained on NPO (nothing by mouth)
status or restricted to clear liquids unLl it is determined that vomiLng will not
occur. Fluid balance is closely monitored by daily weights; accurate I/O
measurements; and serum osmolality to detect early signs of water retenLon.
•Headaches are usually controlled with acetaminophen, although opioids may
be needed. AnLepilepLcs are used for seizure control.
•AnLbioLcs may be administered if laceraLons or penetraLng injuries.
ىلع رصتقي وأ (مفلا قيرط نع ءيش \) NPO ةلاح يف لفطلا ءاقبإ متي .ةباجتس\ا يف تارييغت يأ ديدحتل bتعاس لك لفطلا صحف نيدلاولا نم بلطُي
جارخ`ا/لاخد`ا تاسايق ؛ةيمويلا نازوRا ةطساوب بثك نع لئاوسلا نزاوت ةبقارم متت .ءيقلا ثودح مدع ديدحت متي ىتح ةيفاصلا لئاوسلا لوانت
.ءاWا ةدوعل ةر ك ب W ا تامMعلا نع فشكلل مدلا يف ةيلومسوRاو ؛ةقيقدلا
هنأ نم مغرلا ىلع ،bفونيماتيسRا مادختساب ةداع عادصلا يف مكحتلا متي
عرصلا تاداضم مادختسا متي .ةينويفRا داوWا ىلإ ةجاح كانه نوكت دق
.تابونلا يف مكحتلل
.قارتخا وأ حورجلاب ةباص`ا ةلاح يف ةيويحلا تاداضWا ءاطعإ نكمي
ديوزت تاضرمWا ىلع بجي .ةيانعب مهصحف دعب لزنWا يف ةفيفخ ةيغامد تاباصإب bباصWا لافطRا ةيبلاغ ةظحMم متت
يبطلا مييقتلا ةداعإ ىلإ ةجاحلاو قلقلا يعدتست يتلا ضارعRاو تامMعلا لوح ةيطخو ةيهفش تاميلعتب رومRا ءايلوأ
•The majority of children with mild traumaLc brain injury are observed at
home aTer a careful examinaLon. Nurses should provide parents with verbal
and wrifen instrucLons of signs and symptoms that warrant concern and the
need for medical re-evaluaLon
•Parents are instructed to check the child every 2 hours to determine any
changes in responsiveness. The child is maintained on NPO (nothing by mouth)
status or restricted to clear liquids unLl it is determined that vomiLng will not
occur. Fluid balance is closely monitored by daily weights; accurate I/O
measurements; and serum osmolality to detect early signs of water retenLon.
•Headaches are usually controlled with acetaminophen, although opioids may
be needed. AnLepilepLcs are used for seizure control.
•AnLbioLcs may be administered if laceraLons or penetraLng injuries.
ىلع رصتقي وأ (مفلا قيرط نع ءيش \) NPO ةلاح يف لفطلا ءاقبإ متي .ةباجتس\ا يف تارييغت يأ ديدحتل bتعاس لك لفطلا صحف نيدلاولا نم بلطُي
جارخ`ا/لاخد`ا تاسايق ؛ةيمويلا نازوRا ةطساوب بثك نع لئاوسلا نزاوت ةبقارم متت .ءيقلا ثودح مدع ديدحت متي ىتح ةيفاصلا لئاوسلا لوانت
.ءاWا ةدوعل ةر ك ب W ا تامMعلا نع فشكلل مدلا يف ةيلومسوRاو ؛ةقيقدلا
هنأ نم مغرلا ىلع ،bفونيماتيسRا مادختساب ةداع عادصلا يف مكحتلا متي
عرصلا تاداضم مادختسا متي .ةينويفRا داوWا ىلإ ةجاح كانه نوكت دق
.تابونلا يف مكحتلل
.قارتخا وأ حورجلاب ةباص`ا ةلاح يف ةيويحلا تاداضWا ءاطعإ نكمي
ديوزت تاضرمWا ىلع بجي .ةيانعب مهصحف دعب لزنWا يف ةفيفخ ةيغامد تاباصإب bباصWا لافطRا ةيبلاغ ةظحMم متت
يبطلا مييقتلا ةداعإ ىلإ ةجاحلاو قلقلا يعدتست يتلا ضارعRاو تامMعلا لوح ةيطخو ةيهفش تاميلعتب رومRا ءايلوأ
Surgical Therapy
•Scalp laceraLons are sutured. Depressed fractures require surgical
reducLon and removal of bone fragments. Torn dura is sutured.
Prognosis
•The prognosis is more favorable for children than for adults. More than
90% of children with concussions or simple linear fractures recover
without symptoms aTer the iniLal period.
•Children may experience a higher frequency of psychological
disturbances aTer head injury than adults. Many children are leT with
signigcant disabiliLes aTer head injury that appear months later as
learning di^culLes, behavioral changes, or emoLonal disturbances.
.ةقزمWا ةيفاجلا ةطايخ متي .ماظعلا اياظش ةلاز` ةيحارج ةيلمع ءارجإ ةضفخنWا روسكلا بلطتت .سأرلا ةورف تاقزمت ةطايخ متي
نم نوناعي نيذلا لافطRا نم %90 نم رثكأ .bغلابلل هنم لافط?ل ةمءMم رثكأ صيخشتلا
.ةر ي خ R ا ةرتفلا دعب ضارعأ روهظ نود نوفاعتي ةطيسب ةيطخ روسك وأ تاجاجترا
تاريغت وأ ملعت تابوعص لكش ىلع رهشأ دعب رهظت سأرلا يف تاباصإ دعب ةر ي ب ك تاقاع` لافطRا نم ديدعلا ضر ع ت ي .bغلابلاب ةنراقم سأرلا ةباصإ دعب اًراركت رثكأ ةيسفن تابارطضا نم لافطRا يناعي دق
.ةيفطاع تابارطضا وأ ةيكولس
•Scalp laceraLons are sutured. Depressed fractures require surgical
reducLon and removal of bone fragments. Torn dura is sutured.
Prognosis
•The prognosis is more favorable for children than for adults. More than
90% of children with concussions or simple linear fractures recover
without symptoms aTer the iniLal period.
•Children may experience a higher frequency of psychological
disturbances aTer head injury than adults. Many children are leT with
signigcant disabiliLes aTer head injury that appear months later as
learning di^culLes, behavioral changes, or emoLonal disturbances.
.ةقزمWا ةيفاجلا ةطايخ متي .ماظعلا اياظش ةلاز` ةيحارج ةيلمع ءارجإ ةضفخنWا روسكلا بلطتت .سأرلا ةورف تاقزمت ةطايخ متي
نم نوناعي نيذلا لافطRا نم %90 نم رثكأ .bغلابلل هنم لافط?ل ةمءMم رثكأ صيخشتلا
.ةر ي خ R ا ةرتفلا دعب ضارعأ روهظ نود نوفاعتي ةطيسب ةيطخ روسك وأ تاجاجترا
تاريغت وأ ملعت تابوعص لكش ىلع رهشأ دعب رهظت سأرلا يف تاباصإ دعب ةر ي ب ك تاقاع` لافطRا نم ديدعلا ضر ع ت ي .bغلابلاب ةنراقم سأرلا ةباصإ دعب اًراركت رثكأ ةيسفن تابارطضا نم لافطRا يناعي دق
.ةيفطاع تابارطضا وأ ةيكولس
Nursing Care Management
•The goals of nursing management of the child with a head injury are to maintain adequate
venLlaLon, oxygenaLon, and circulaLon; to monitor and treat increased ICP; to minimize cerebral
oxygen requirements; and to support the child and family during the recovery phases.
•The child is placed on bed rest, usually with the head of the bed elevated slightly and the head in
midline posiLon. Appropriate safety measures are implemented. Frequent examinaLons of vital
signs, neurologic signs, and LOC are extremely important nursing observaLons.
•A key nursing role is to provide sedaLon and analgesia for the child. Carefully observe, record, and
report in detail any seizure acLvity.
•Bleeding from the ear suggests the possibility of a basal skull fracture. Clear nasal drainage is
suggesLve of an anterior basal skull fracture. Observe the amount and characterisLcs of the drainage
and document. Intake and output are measured and recorded
•Family Support
•RehabilitaLon
•Nurses can exert a valuable inkuence on prevenLon of children's head injuries through educaLon.
ةيفاك ةيمك ىلع ظافحلا يف سأرلا يف ةباصإب باصWا لفطلل ةيضيرمتلا ةر ا د ` ا فادهأ لثمتت
ليلقتل ؛ةيلودلا تانراقWا جمانرب ةدايز جMعو دصرل ؛ةيومدلا ةر و د ل او bجسكRاو ديرولا نم
.يفاعتلا لحارم لMخ ةرسRاو لفطلا معدو .يغامدلا bجسكوRا تابلطتم
.عرص ةبون يأ نع ليصفتلاب غMب`او ليجستو ةبقارم .لفطلل ملRا bكستو ريدختلا ريفوت يف يسيئرلا يضيرمتلا رودلا لثمتي •
يفنRا فيرصتلا ريشي .ةمجمجلا ةيدعاق يف رسك ثودح ةيلامتحا ىلإ نذRا نم فيزنلا ريشي
.ةقيثولاو فر ص ل ا صئاصخو ةيمك بقار .ةيمامRا ةيدعاقلا ةمجمجلا يف رسك دوجو ىلإ فافشلا
تاجرخWاو لوخدWا ليجستو سايق متي
يرسRا معدلا
ليهأت ةداعا
يف اًميق اًريثأت نسرامي نأ تاضرمملل نكمي •
ميلعتلا لMخ نم لافطRا سأر تاباصإ نم ةياقولا
دعت .ةبسانWا ةمMسلا ريبادت ذيفنت متي .طسولا طخ عضو يف سأرلا نوكيو ًMيلق اًعفترم ريرسلا سأر نوكي ام ًةداعو ،ريرسلا دنسم ىلع لفطلا عضو متي
.ةياغلل ةمهWا ةيضيرمتلا تاظحMWا نم LOCو ةيبصعلا تامMعلاو ةيويحلا تامMعلل ةرر ك ت W ا تاصوحفلا
•The goals of nursing management of the child with a head injury are to maintain adequate
venLlaLon, oxygenaLon, and circulaLon; to monitor and treat increased ICP; to minimize cerebral
oxygen requirements; and to support the child and family during the recovery phases.
•The child is placed on bed rest, usually with the head of the bed elevated slightly and the head in
midline posiLon. Appropriate safety measures are implemented. Frequent examinaLons of vital
signs, neurologic signs, and LOC are extremely important nursing observaLons.
•A key nursing role is to provide sedaLon and analgesia for the child. Carefully observe, record, and
report in detail any seizure acLvity.
•Bleeding from the ear suggests the possibility of a basal skull fracture. Clear nasal drainage is
suggesLve of an anterior basal skull fracture. Observe the amount and characterisLcs of the drainage
and document. Intake and output are measured and recorded
•Family Support
•RehabilitaLon
•Nurses can exert a valuable inkuence on prevenLon of children's head injuries through educaLon.
ةيفاك ةيمك ىلع ظافحلا يف سأرلا يف ةباصإب باصWا لفطلل ةيضيرمتلا ةر ا د ` ا فادهأ لثمتت
ليلقتل ؛ةيلودلا تانراقWا جمانرب ةدايز جMعو دصرل ؛ةيومدلا ةر و د ل او bجسكRاو ديرولا نم
.يفاعتلا لحارم لMخ ةرسRاو لفطلا معدو .يغامدلا bجسكوRا تابلطتم
.عرص ةبون يأ نع ليصفتلاب غMب`او ليجستو ةبقارم .لفطلل ملRا bكستو ريدختلا ريفوت يف يسيئرلا يضيرمتلا رودلا لثمتي •
يفنRا فيرصتلا ريشي .ةمجمجلا ةيدعاق يف رسك ثودح ةيلامتحا ىلإ نذRا نم فيزنلا ريشي
.ةقيثولاو فر ص ل ا صئاصخو ةيمك بقار .ةيمامRا ةيدعاقلا ةمجمجلا يف رسك دوجو ىلإ فافشلا
تاجرخWاو لوخدWا ليجستو سايق متي
يرسRا معدلا
ليهأت ةداعا
يف اًميق اًريثأت نسرامي نأ تاضرمملل نكمي •
ميلعتلا لMخ نم لافطRا سأر تاباصإ نم ةياقولا
دعت .ةبسانWا ةمMسلا ريبادت ذيفنت متي .طسولا طخ عضو يف سأرلا نوكيو ًMيلق اًعفترم ريرسلا سأر نوكي ام ًةداعو ،ريرسلا دنسم ىلع لفطلا عضو متي
.ةياغلل ةمهWا ةيضيرمتلا تاظحMWا نم LOCو ةيبصعلا تامMعلاو ةيويحلا تامMعلل ةرر ك ت W ا تاصوحفلا
INTRACRANIAL INFECTIONS- Bacterial MeningiLs
•Bacterial meningiLs is an acute inkammaLon of the meninges and CSF. Immediate
acLon must be taken to idenLfy the causaLve organism and to iniLate prompt
treatment.
• Currently S. pneumoniae is the leading cause of bacterial meningiLs in children 3
months to 11 years old, whereas Neisseria meningiLdis is the leading cause in
children 11 to 17 years old. The leading causes of neonatal meningiLs are group B
streptococci.
•Meningococcal meningiLs occurs in epidemic form and is the only type readily
transmifed by droplet infecLon from nasopharyngeal secreLons. It occurs
predominantly in school-age children and adolescents. Pneumococcal and
meningococcal infecLons can occur at any Lme but are more common in later winter
and early spring.
.يروفلا جMعلا يف ءدبلاو ببسWا نئاكلا ديدحتل يروف ءارجإ ذاختا بجيو .يكوشلا يغامدلا لئاسلاو اياحسلا يف داح باهتلا يه ةيريتكبلا اياحسلا
يه ةيئاحسلا ةيرسينلا نأ bح يف ،اًماع 11 ىلإ رهشأ 3 bب مهرامعأ حوارتت نيذلا لافطRا ىدل ةيريتكبلا اياحسلاب ةباصiل يسيئرلا ببسلا اًيلاح S. pneumoniae دعت
.ب ةعومجWا تايدقعلا يه ةيديلولا اياحسلل ةيسيئرلا بابسRا .اًماع 17 ىلإ 11 bب مهرامعأ حوارتت نيذلا لافطRا ىدل يسيئرلا ببسلا
لافطRا دنع يسيئر لكشب ثدحيو .يفنRا موعلبلا تازارفإ نم ذاذرلا ىودع قيرط نع ةلوهسب لقتني يذلا ديحولا عونلا يهو يئابو لكش يف ةيئاحسلا تاروكWا ثدحت
.عيبرلا لئاوأو ءاتشلا رخاوأ يف اًعويش رثكأ اهنكلو ناكم يأ يف ةيئاحسلا تاروكWاو ةيوئرلا تاروكWا ىودع ثدحت نأ نكمي .ةسردWا نس يف bقهارWاو
•Bacterial meningiLs is an acute inkammaLon of the meninges and CSF. Immediate
acLon must be taken to idenLfy the causaLve organism and to iniLate prompt
treatment.
• Currently S. pneumoniae is the leading cause of bacterial meningiLs in children 3
months to 11 years old, whereas Neisseria meningiLdis is the leading cause in
children 11 to 17 years old. The leading causes of neonatal meningiLs are group B
streptococci.
•Meningococcal meningiLs occurs in epidemic form and is the only type readily
transmifed by droplet infecLon from nasopharyngeal secreLons. It occurs
predominantly in school-age children and adolescents. Pneumococcal and
meningococcal infecLons can occur at any Lme but are more common in later winter
and early spring.
.يروفلا جMعلا يف ءدبلاو ببسWا نئاكلا ديدحتل يروف ءارجإ ذاختا بجيو .يكوشلا يغامدلا لئاسلاو اياحسلا يف داح باهتلا يه ةيريتكبلا اياحسلا
يه ةيئاحسلا ةيرسينلا نأ bح يف ،اًماع 11 ىلإ رهشأ 3 bب مهرامعأ حوارتت نيذلا لافطRا ىدل ةيريتكبلا اياحسلاب ةباصiل يسيئرلا ببسلا اًيلاح S. pneumoniae دعت
.ب ةعومجWا تايدقعلا يه ةيديلولا اياحسلل ةيسيئرلا بابسRا .اًماع 17 ىلإ 11 bب مهرامعأ حوارتت نيذلا لافطRا ىدل يسيئرلا ببسلا
لافطRا دنع يسيئر لكشب ثدحيو .يفنRا موعلبلا تازارفإ نم ذاذرلا ىودع قيرط نع ةلوهسب لقتني يذلا ديحولا عونلا يهو يئابو لكش يف ةيئاحسلا تاروكWا ثدحت
.عيبرلا لئاوأو ءاتشلا رخاوأ يف اًعويش رثكأ اهنكلو ناكم يأ يف ةيئاحسلا تاروكWاو ةيوئرلا تاروكWا ىودع ثدحت نأ نكمي .ةسردWا نس يف bقهارWاو
Pathophysiology
•The most common route of infecLon is vascular disseminaLon from a focus of
infecLon elsewhere. For example, organisms from the nasopharynx invade the
underlying blood vessels cross the blood brain barrier, and mulLply in the CSF.
•Organisms also gain entry by direct implantaLon aTer penetraLng wounds, skull
fractures, lumbar puncture or surgical procedures, anatomic abnormaliLes such as
spina bigda, or foreign bodies such as an internal ventricular shunt or an external
ventricular device. Once implanted, the organisms spread into the CSF, by which the
infecLon spreads throughout the subarachnoid space.
•The brain becomes hyperemic and edematous, and the enLre surface of the brain is
covered by a layer of purulent exudate that varies with the type of organism. As
infecLon extends to the ventricles, thick pus, gbrin, or adhesions may occlude the
narrow passages and obstruct the kow of CSF.
نم ةيحلا تانئاكلا وزغت ،لاثWا ليبس ىلع .رخآ ناكم يف ىودعلا ةر ؤ ب نم يئاعولا راشتن\ا وه ىودعلل اًعويش رثكRا قيرطلا •
.يكوشلا يغامدلا لئاسلا يف رثاكتتو ،غامدلا يف مدلا زجاح ربعتو ،اهتحت ةدوجوWا ةيومدلا ةيعوRا يفنRا موعلبلا
وأ ينطقلا لزبلا وأ ةمجمجلا روسك وأ ةقرتخWا حورجلا دعب رشابم عرز قيرط نع اًضيأ ةيحلا تانئاكلا لخدت
bطبلا ةليوحت لثم ةبيرغلا ماسجRا وأ ةر ي ب ك ل ا ةنسنسلا لثم ةيحيرشتلا تاهوشتلا وأ ةيحارجلا تايلمعلا
،يكوشلا يغامدلا لئاسلا يف ةيحلا تانئاكلا رشتنت ،اهعرز درجمب .يجراخلا ينيطبلا زاهجلا وأ ةيلخادلا
.ةيتوبكنعلا تحت ءاضفلا ءاحنأ عيمج يف ىودعلا رشتنت هلMخ نم يذلاو
فلتخت يتلا ةيحيقلا تازارف`ا نم ةقبطب غامدلا حطس ىطغيو ،امذوتمو مدلا طرفم غامدلا حبصي
نيربجلا وأ كيمسلا حيقلا يدؤي دق ،bنيطبلا ىلإ ىودعلا دتمت امدنع .يحلا نئاكلا عون فMتخاب
.يكوشلا يغامدلا لئاسلا قفدت ةقاعإو ةقيضلا تارمWا دس ىلإ تاقاصتلا وأ
•The most common route of infecLon is vascular disseminaLon from a focus of
infecLon elsewhere. For example, organisms from the nasopharynx invade the
underlying blood vessels cross the blood brain barrier, and mulLply in the CSF.
•Organisms also gain entry by direct implantaLon aTer penetraLng wounds, skull
fractures, lumbar puncture or surgical procedures, anatomic abnormaliLes such as
spina bigda, or foreign bodies such as an internal ventricular shunt or an external
ventricular device. Once implanted, the organisms spread into the CSF, by which the
infecLon spreads throughout the subarachnoid space.
•The brain becomes hyperemic and edematous, and the enLre surface of the brain is
covered by a layer of purulent exudate that varies with the type of organism. As
infecLon extends to the ventricles, thick pus, gbrin, or adhesions may occlude the
narrow passages and obstruct the kow of CSF.
نم ةيحلا تانئاكلا وزغت ،لاثWا ليبس ىلع .رخآ ناكم يف ىودعلا ةر ؤ ب نم يئاعولا راشتن\ا وه ىودعلل اًعويش رثكRا قيرطلا •
.يكوشلا يغامدلا لئاسلا يف رثاكتتو ،غامدلا يف مدلا زجاح ربعتو ،اهتحت ةدوجوWا ةيومدلا ةيعوRا يفنRا موعلبلا
وأ ينطقلا لزبلا وأ ةمجمجلا روسك وأ ةقرتخWا حورجلا دعب رشابم عرز قيرط نع اًضيأ ةيحلا تانئاكلا لخدت
bطبلا ةليوحت لثم ةبيرغلا ماسجRا وأ ةر ي ب ك ل ا ةنسنسلا لثم ةيحيرشتلا تاهوشتلا وأ ةيحارجلا تايلمعلا
،يكوشلا يغامدلا لئاسلا يف ةيحلا تانئاكلا رشتنت ،اهعرز درجمب .يجراخلا ينيطبلا زاهجلا وأ ةيلخادلا
.ةيتوبكنعلا تحت ءاضفلا ءاحنأ عيمج يف ىودعلا رشتنت هلMخ نم يذلاو
فلتخت يتلا ةيحيقلا تازارف`ا نم ةقبطب غامدلا حطس ىطغيو ،امذوتمو مدلا طرفم غامدلا حبصي
نيربجلا وأ كيمسلا حيقلا يدؤي دق ،bنيطبلا ىلإ ىودعلا دتمت امدنع .يحلا نئاكلا عون فMتخاب
.يكوشلا يغامدلا لئاسلا قفدت ةقاعإو ةقيضلا تارمWا دس ىلإ تاقاصتلا وأ
Clinical ManifestaLons of Bacterial MeningiLs
CHILDREN AND ADOLESCENTS
•Usually abrupt onset
•Fever
•Chills
•Headache
•VomiLng
•AlteraLons in sensorium
•Seizures (oTen the iniLal sign)
•Irritability
•AgitaLon
May develop:
•Photophobia
•Delirium, HallucinaLons
•Aggressive behavior
•Drowsiness
•Stupor
•Coma
•Nuchal rigidity; may progress to opisthotonos
•PosiLve Kernig and Brudzinski signs
•HyperacLvity but variable rekex responses
•Signs and symptoms peculiar to individual organisms:
•Petechial or purpuric rashes (meningococcal infecLon),
especially when associated with a shock-like state
• Joint involvement (meningococcal and Haemophilus
inkuenzae infecLon)
•Chronically draining ear (pneumococcal meningiLs)
INFANTS AND YOUNG CHILDREN
•Classic picture (above) rarely seen in children between 3
months and 2 years old
•Fever
•Poor feeding
•VomiLng
•Marked irritability
•Frequent seizures (oTen accompanied by a high-pitched cry)
•Bulging fontanel Nuchal rigidity possible
•Brudzinski and Kernig signs not helpful in diagnosis
•Subdural empyema (H. inkuenzae infecLon)
نوقهارWاو لافطRا
ةداع ةئجافم ةيادب
ىمح
ةريرعشق
عادص
ءيقلا
راعشتس\ا يف تارييغت
(ةيلوRا ةمMعلا نوكت ام اًبلاغ) تابونلا
جيهتلا
ضيرحتلا
:روطتت دق
ءوضلا باهر
ةسولهلاو نايذهلا
يناودعلا كولسلا
ساعنلا
لوهذ
ةبوبيغ
opisthotonos ىلإ روطتي دق ؛نهارلا تقولا
ةيباجي`ا يكسنيزدوربو جينريك تامMع
ةر ي غ ت W ا ةسكعنWا تاباجتس\ا نكلو طاشنلا طر ف
ةزيمWا ضارعRاو تامMعلا
:ةيدرفلا تانئاكلل
تاروكWا ىودع) يرفرفلا وأ يطقنلا يدلجلا حفطلا
ةمدصلا هبشت ةلاحب طبتري امدنع ةصاخ ،(ةيئاحسلا
(ةيلزنلا ةيمدتسWاو ةيئاحسلا تاروكWا ىودع) لصافWا ةباصإ
باهتلا) نمزم لكشب نذRا فيرصت
(ةيوئرلا تاروكWاب اياحسلا
راغصلا لافطRاو عضرلا
bتنسو رهشأ 3 bب مهرامعأ حوارتت نيذلا لافطRا دنع رهظت ام ًاردان (هMعأ) ةيكيسMكلا ةر و ص ل ا
ىمح
ةئيسلا ةيذغتلا
ءيقلا
ظوحلم جيهتلا
(ةر ب ن ل ا ةيلاع ةخرصب ةبوحصم نوكت ام اًبلاغ) ةر ر ك ت م تابون
ةنكمم ةيوفقلا ةبMص - خوفايلا خافتنا
جينريكو يكسنيزدورب تامMع
صيخشتلا يف ةديفم تسيل
(ةيلزنلا ةيمدتسWا ىودع) ةيفاجلا تحت ةليبدلا
CHILDREN AND ADOLESCENTS
•Usually abrupt onset
•Fever
•Chills
•Headache
•VomiLng
•AlteraLons in sensorium
•Seizures (oTen the iniLal sign)
•Irritability
•AgitaLon
May develop:
•Photophobia
•Delirium, HallucinaLons
•Aggressive behavior
•Drowsiness
•Stupor
•Coma
•Nuchal rigidity; may progress to opisthotonos
•PosiLve Kernig and Brudzinski signs
•HyperacLvity but variable rekex responses
•Signs and symptoms peculiar to individual organisms:
•Petechial or purpuric rashes (meningococcal infecLon),
especially when associated with a shock-like state
• Joint involvement (meningococcal and Haemophilus
inkuenzae infecLon)
•Chronically draining ear (pneumococcal meningiLs)
INFANTS AND YOUNG CHILDREN
•Classic picture (above) rarely seen in children between 3
months and 2 years old
•Fever
•Poor feeding
•VomiLng
•Marked irritability
•Frequent seizures (oTen accompanied by a high-pitched cry)
•Bulging fontanel Nuchal rigidity possible
•Brudzinski and Kernig signs not helpful in diagnosis
•Subdural empyema (H. inkuenzae infecLon)
نوقهارWاو لافطRا
ةداع ةئجافم ةيادب
ىمح
ةريرعشق
عادص
ءيقلا
راعشتس\ا يف تارييغت
(ةيلوRا ةمMعلا نوكت ام اًبلاغ) تابونلا
جيهتلا
ضيرحتلا
:روطتت دق
ءوضلا باهر
ةسولهلاو نايذهلا
يناودعلا كولسلا
ساعنلا
لوهذ
ةبوبيغ
opisthotonos ىلإ روطتي دق ؛نهارلا تقولا
ةيباجي`ا يكسنيزدوربو جينريك تامMع
ةر ي غ ت W ا ةسكعنWا تاباجتس\ا نكلو طاشنلا طر ف
ةزيمWا ضارعRاو تامMعلا
:ةيدرفلا تانئاكلل
تاروكWا ىودع) يرفرفلا وأ يطقنلا يدلجلا حفطلا
ةمدصلا هبشت ةلاحب طبتري امدنع ةصاخ ،(ةيئاحسلا
(ةيلزنلا ةيمدتسWاو ةيئاحسلا تاروكWا ىودع) لصافWا ةباصإ
باهتلا) نمزم لكشب نذRا فيرصت
(ةيوئرلا تاروكWاب اياحسلا
راغصلا لافطRاو عضرلا
bتنسو رهشأ 3 bب مهرامعأ حوارتت نيذلا لافطRا دنع رهظت ام ًاردان (هMعأ) ةيكيسMكلا ةر و ص ل ا
ىمح
ةئيسلا ةيذغتلا
ءيقلا
ظوحلم جيهتلا
(ةر ب ن ل ا ةيلاع ةخرصب ةبوحصم نوكت ام اًبلاغ) ةر ر ك ت م تابون
ةنكمم ةيوفقلا ةبMص - خوفايلا خافتنا
جينريكو يكسنيزدورب تامMع
صيخشتلا يف ةديفم تسيل
(ةيلزنلا ةيمدتسWا ىودع) ةيفاجلا تحت ةليبدلا
NEONATES
•Specigc Signs
•Child well at birth but within a few days begins to look and behave poorly
•Refuses feedings
•Poor sucking ability
•VomiLng or diarrhea
•Poor tone
•Lack of movement
•Weak cry
•Full, tense, and bulging fontanel may appear late in course of illness
•Neck usually supple
•Nonspecigc Signs That May Be Present
•Hypothermia or fever (depending on the infant's maturity)
•Jaundice
•Irritability
•Drowsiness
•Seizures
•Respiratory irregulariLes or apnea
•Cyanosis
•Weight loss
ةد\ولا يثيدح
ةددحم تامMع
روهظلا يف أدبي ةليلق مايأ نوضغ يف نكلو هتد\و دنع ةديج ةحصب عتمتي لفطلا
ئيس لكشب فر ص ت ل او
ةعاضرلا ضفري
ةفيعض صاصتما ىلع ةردقلا
لاهس`ا وأ ءيقلا
ةئيس ةجهل
ةكرحلا ةلق
ةفيعض ةخرص
ضر W ا نم رخأتم تقو يف خافتن\او رتوتWاو لماكلا خوفايلا رهظي دق
ةنرم نوكت ام ةداع ةبقرلا
ةدوجوم نوكت دق يتلا ةددحWا ريغ تامMعلا
(عيضرلا جضن ىلع اًدامتعا) ىمحلا وأ مسجلا ةر ار ح ضافخنا
ناقريلا جيهتلا
ساعنلا
تابونلا
سفنلا عاطقنا وأ يسفنتلا زاهجلا يف تابارطضا
ةقرز
نزولا نادقف
•Specigc Signs
•Child well at birth but within a few days begins to look and behave poorly
•Refuses feedings
•Poor sucking ability
•VomiLng or diarrhea
•Poor tone
•Lack of movement
•Weak cry
•Full, tense, and bulging fontanel may appear late in course of illness
•Neck usually supple
•Nonspecigc Signs That May Be Present
•Hypothermia or fever (depending on the infant's maturity)
•Jaundice
•Irritability
•Drowsiness
•Seizures
•Respiratory irregulariLes or apnea
•Cyanosis
•Weight loss
ةد\ولا يثيدح
ةددحم تامMع
روهظلا يف أدبي ةليلق مايأ نوضغ يف نكلو هتد\و دنع ةديج ةحصب عتمتي لفطلا
ئيس لكشب فر ص ت ل او
ةعاضرلا ضفري
ةفيعض صاصتما ىلع ةردقلا
لاهس`ا وأ ءيقلا
ةئيس ةجهل
ةكرحلا ةلق
ةفيعض ةخرص
ضر W ا نم رخأتم تقو يف خافتن\او رتوتWاو لماكلا خوفايلا رهظي دق
ةنرم نوكت ام ةداع ةبقرلا
ةدوجوم نوكت دق يتلا ةددحWا ريغ تامMعلا
(عيضرلا جضن ىلع اًدامتعا) ىمحلا وأ مسجلا ةر ار ح ضافخنا
ناقريلا جيهتلا
ساعنلا
تابونلا
سفنلا عاطقنا وأ يسفنتلا زاهجلا يف تابارطضا
ةقرز
نزولا نادقف
DiagnosLc EvaluaLon
•A lumbar puncture is the degniLve diagnosLc test for meningiLs. Culture and
sensiLvity tesLng are needed to idenLfy the causaLve organism. If there is
evidence or suspicion of increased ICP (papilledema, focal neurologic degcits,
bulging fontanel), a CT scan of the head may be warranted before the
procedure. Lumbar puncture is contraindicated in any paLent with imaging to
suggest that the procedure is not safe.
•A blood culture is advisable for all children suspected of having meningiLs
and occasionally will be posiLve when CSF culture is negaLve.
• Nose and throat cultures may provide helpful informaLon in some cases.
يصيخشتلا مييقتلا
وأ ليلد كانه ناك اذإ .ببسWا نئاكلا ديدحتل ةيساسحلاو ةفاقثلا تارابتخا ىلإ ةجاح كانه .اياحسلل قيقدلا صيخشتلا رابتخا وه ينطقلا لزبلا
ام كانه نوكي دقف ،(خوفايلا خافتناو ،ةيرؤبلا ةيبصعلا تاونقلاو ،يرصبلا بصعلا ةميلح ةمذو) يردصلا صفقلا لخاد طغضلا ةدايز يف هابتشا
.نمآ ريغ ءارج`ا نأ ىلإ ريشت ةيريوصت ةلاح يأ يف ينطقلا لزبلا مادختسا عنمُي .ءارج`ا لبق سأرلل ةيعطقWا ةعشRاب صحف ءارجإ رربي
مهتباصإ يف هبتشWا لافطRا عيمجل مد ةعرزم ءارجإب حصنُي
ةعرزم نوكت امدنع ةيباجيإ نوكت نايحRا ضعب يفو ،اياحسلاب
.ةيبلس يكوشلا يغامدلا لئاسلا
.ت\احلا ضعب يف ةديفم تامولعم ةر ج ن ح ل او فنRا عرازم رفوت دق
•A lumbar puncture is the degniLve diagnosLc test for meningiLs. Culture and
sensiLvity tesLng are needed to idenLfy the causaLve organism. If there is
evidence or suspicion of increased ICP (papilledema, focal neurologic degcits,
bulging fontanel), a CT scan of the head may be warranted before the
procedure. Lumbar puncture is contraindicated in any paLent with imaging to
suggest that the procedure is not safe.
•A blood culture is advisable for all children suspected of having meningiLs
and occasionally will be posiLve when CSF culture is negaLve.
• Nose and throat cultures may provide helpful informaLon in some cases.
يصيخشتلا مييقتلا
وأ ليلد كانه ناك اذإ .ببسWا نئاكلا ديدحتل ةيساسحلاو ةفاقثلا تارابتخا ىلإ ةجاح كانه .اياحسلل قيقدلا صيخشتلا رابتخا وه ينطقلا لزبلا
ام كانه نوكي دقف ،(خوفايلا خافتناو ،ةيرؤبلا ةيبصعلا تاونقلاو ،يرصبلا بصعلا ةميلح ةمذو) يردصلا صفقلا لخاد طغضلا ةدايز يف هابتشا
.نمآ ريغ ءارج`ا نأ ىلإ ريشت ةيريوصت ةلاح يأ يف ينطقلا لزبلا مادختسا عنمُي .ءارج`ا لبق سأرلل ةيعطقWا ةعشRاب صحف ءارجإ رربي
مهتباصإ يف هبتشWا لافطRا عيمجل مد ةعرزم ءارجإب حصنُي
ةعرزم نوكت امدنع ةيباجيإ نوكت نايحRا ضعب يفو ،اياحسلاب
.ةيبلس يكوشلا يغامدلا لئاسلا
.ت\احلا ضعب يف ةديفم تامولعم ةر ج ن ح ل او فنRا عرازم رفوت دق
TherapeuLc Management
•Acute bacterial meningiLs is a medical emergency that requires early recogniLon and immediate therapy to
prevent death and avoid residual disabiliLes. The iniLal therapeuLc management includes:
•IsolaLon precauLons
• IniLaLon of anLmicrobial therapy
•Maintenance of hydraLon and venLlaLon
•ReducLon of increased ICP
•Management of systemic shock
• Control of seizures
•Control of temperature
Treatment of complicaLons
•The child is isolated from other children, usually in an intensive care unit for close observaLon.
•An IV infusion is started to facilitate administraLon of anLmicrobial agents, kuids, anLepilepLc drugs, and blood, if
needed. The child is placed in respiratory isolaLon.
Drug Alert
•Dexamethasone may play a role in the iniLal management of symptoms occurring from a cytokine mediated
inkammatory response aTer treatment has begun. AnLbioLc treatment with cephalosporins demonstrates
superiority for promptly sterilizing the CSF and reducing the incidence of severe hearing impairment.
:يلي ام يلوRا جMعلا ةر ا د إ نمضتت .ةيقبتWا تاقاع`ا بنجتو ةافولا عنW اًيروف اًجMعو اًركبم اًفاشتكا بلطتت ةئراط ةيبط ةلاح ةداحلا ةيريتكبلا اياحسلا دعت
لزعلا تاطايتحا
تابوركيملل داضWا جMعلا يف ءدبلا •
ةيوهتلاو بيطرتلا ةنايص
ةيلودلا تانراقWا جمانرب ةدايز نم دحلا •
ةيماظنلا ةمدصلا ةر ا د إ
تابونلا ىلع ةرطيسلا •
ةر ار ح ل ا ةجرد يف مكحتلا •
تافعاضWا جMع
يف ةداع ،نيرخ?ا لافطRا نع لفطلا لزع متي
.ةقيقدلا ةبقارملل ةزكرWا ةيانعلا ةدحو
ةيودا هيبنت
لئاوسلاو تابوركيملل ةداضWا لماوعلا ءاطعإ ليهستل يديرولا بيرستلاب ءدبلا متي •
.ةيسفنت ةلزع يف لفطلا عضو متي .رمRا مزل اذإ ،مدلاو عرصلل ةداضWا ةيودRاو
يف قوفتلا تانيروبسولافيسلا مادختساب ةيويحلا تاداضWاب جMعلا رهظُي .جMعلا ءدب دعب تانيكوتيسلا ةطساوب ةيباهتلا ةباجتسMل ةجيتن ثدحت يتلا ضارع?ل يلوRا ريبدتلا يف اًرود نوزاثيماسكيد بعلي دق
.ديدشلا عمسلا فعض ثو د ح ليلقتو يكوشلا يغامدلا لئاسلل يروفلا ميقعتلا
•Acute bacterial meningiLs is a medical emergency that requires early recogniLon and immediate therapy to
prevent death and avoid residual disabiliLes. The iniLal therapeuLc management includes:
•IsolaLon precauLons
• IniLaLon of anLmicrobial therapy
•Maintenance of hydraLon and venLlaLon
•ReducLon of increased ICP
•Management of systemic shock
• Control of seizures
•Control of temperature
Treatment of complicaLons
•The child is isolated from other children, usually in an intensive care unit for close observaLon.
•An IV infusion is started to facilitate administraLon of anLmicrobial agents, kuids, anLepilepLc drugs, and blood, if
needed. The child is placed in respiratory isolaLon.
Drug Alert
•Dexamethasone may play a role in the iniLal management of symptoms occurring from a cytokine mediated
inkammatory response aTer treatment has begun. AnLbioLc treatment with cephalosporins demonstrates
superiority for promptly sterilizing the CSF and reducing the incidence of severe hearing impairment.
:يلي ام يلوRا جMعلا ةر ا د إ نمضتت .ةيقبتWا تاقاع`ا بنجتو ةافولا عنW اًيروف اًجMعو اًركبم اًفاشتكا بلطتت ةئراط ةيبط ةلاح ةداحلا ةيريتكبلا اياحسلا دعت
لزعلا تاطايتحا
تابوركيملل داضWا جMعلا يف ءدبلا •
ةيوهتلاو بيطرتلا ةنايص
ةيلودلا تانراقWا جمانرب ةدايز نم دحلا •
ةيماظنلا ةمدصلا ةر ا د إ
تابونلا ىلع ةرطيسلا •
ةر ار ح ل ا ةجرد يف مكحتلا •
تافعاضWا جMع
يف ةداع ،نيرخ?ا لافطRا نع لفطلا لزع متي
.ةقيقدلا ةبقارملل ةزكرWا ةيانعلا ةدحو
ةيودا هيبنت
لئاوسلاو تابوركيملل ةداضWا لماوعلا ءاطعإ ليهستل يديرولا بيرستلاب ءدبلا متي •
.ةيسفنت ةلزع يف لفطلا عضو متي .رمRا مزل اذإ ،مدلاو عرصلل ةداضWا ةيودRاو
يف قوفتلا تانيروبسولافيسلا مادختساب ةيويحلا تاداضWاب جMعلا رهظُي .جMعلا ءدب دعب تانيكوتيسلا ةطساوب ةيباهتلا ةباجتسMل ةجيتن ثدحت يتلا ضارع?ل يلوRا ريبدتلا يف اًرود نوزاثيماسكيد بعلي دق
.ديدشلا عمسلا فعض ثو د ح ليلقتو يكوشلا يغامدلا لئاسلل يروفلا ميقعتلا
Prognosis
•Less than 10% of cases of bacterial meningiLs are fatal. Survivors can experience
signigcant physical and neurologic sequelae, including hearing loss, learning
disability, and seizure disorder. In older children, the residual eSects are related
to the inkammatory process itself or result from vasculiLs associated with the
disease.
PrevenLon
•Vaccines are available for types A, C, Y, and W-135 meningococci and Hib.
Meningococcal polysaccharide vaccinaLon is rouLnely given to children 11 to 12
years old, with a booster at 16 years old. RouLne vaccinaLons for Hib and
pneumococcal conjugate vaccines are recommended for all children beginning at
2 months old
12 ىلإ 11 bب مهرامعأ حوارتت نيذلا لافط?ل ينيتور لكشب ديراكسلا ددعتم ةيئاحسلا تاروكWا حاقل ءاطعإ متي .ةيلزنلا ةيمدتسWاو ةيئاحسلا تاروكWا نم W-135و Yو Cو A عاون?ل تاحاقللا رفوتت
نيرهش رمع نم اًءدب لافطRا عيمجل ةيوئرلا تاروكWا دض ةقفارتWا تاحاقللاو (B) يئابولا دبكلا باهتلا دض ينيتورلا ميعطتلاب ىصوي .اًماع 16 رمع دنع ةززعم ةعرج عم ،اًماع
،اًنس ربكRا لافطRا يف .تابونلا بارطضاو ،ملعتلا تابوعصو ،عمسلا نادقف كلذ يف امب ،ةريبك ةيبصعو ةيدسج ليباقع نم نوجانلا يناعي نأ نكمي .ةلتاق نوكت ةيموثرجلا اياحسلاب ةباص`ا ت\اح نم %10 نم لقأ
.ضر W ا ب ةطبترWا ةيومدلا ةيعوRا نع جتنت وأ اهسفن ةيباهتلا ةيلمعلاب ةيقبتWا فئاوطلا طبترت
ةياقو
•Less than 10% of cases of bacterial meningiLs are fatal. Survivors can experience
signigcant physical and neurologic sequelae, including hearing loss, learning
disability, and seizure disorder. In older children, the residual eSects are related
to the inkammatory process itself or result from vasculiLs associated with the
disease.
PrevenLon
•Vaccines are available for types A, C, Y, and W-135 meningococci and Hib.
Meningococcal polysaccharide vaccinaLon is rouLnely given to children 11 to 12
years old, with a booster at 16 years old. RouLne vaccinaLons for Hib and
pneumococcal conjugate vaccines are recommended for all children beginning at
2 months old
12 ىلإ 11 bب مهرامعأ حوارتت نيذلا لافط?ل ينيتور لكشب ديراكسلا ددعتم ةيئاحسلا تاروكWا حاقل ءاطعإ متي .ةيلزنلا ةيمدتسWاو ةيئاحسلا تاروكWا نم W-135و Yو Cو A عاون?ل تاحاقللا رفوتت
نيرهش رمع نم اًءدب لافطRا عيمجل ةيوئرلا تاروكWا دض ةقفارتWا تاحاقللاو (B) يئابولا دبكلا باهتلا دض ينيتورلا ميعطتلاب ىصوي .اًماع 16 رمع دنع ةززعم ةعرج عم ،اًماع
،اًنس ربكRا لافطRا يف .تابونلا بارطضاو ،ملعتلا تابوعصو ،عمسلا نادقف كلذ يف امب ،ةريبك ةيبصعو ةيدسج ليباقع نم نوجانلا يناعي نأ نكمي .ةلتاق نوكت ةيموثرجلا اياحسلاب ةباص`ا ت\اح نم %10 نم لقأ
.ضر W ا ب ةطبترWا ةيومدلا ةيعوRا نع جتنت وأ اهسفن ةيباهتلا ةيلمعلاب ةيقبتWا فئاوطلا طبترت
ةياقو
Nursing Care Management
•Keep the room as quiet as possible, and keep environmental sLmuli at a
minimum because most children with meningiLs are sensiLve to noise, bright
lights, and other external sLmuli. A side-lying posiLon is more oTen assumed
because of nuchal rigidity. EvaluaLng the child for pain and implemenLng
appropriate relief measures are important during the iniLal 24 to 72 hours.
Acetaminophen with codeine is oTen used.
• ObservaLon of vital signs, neurologic signs, LOC, urinary output, are carried
out at frequent intervals.
•The child with dulled sensorium is usually kept NPO. Other children are
allowed clear liquids iniLally and, if tolerated, progress to a diet suitable for
their age. Careful monitoring and recording of I/O are needed.
•Family support
ةيضيرمتلا ةياعرلا ةر ا د إ
باهتلاب bباصWا لافطRا مظعم نR ،نكمم دح ىندأ ىلإ ةيئيبلا تازفحWا نم للقو ،ناكم`ا ردق ةفرغلا ءو د ه ىلع ظفاح
ءاقلتس\ا عضو ضرتفُي ام اًبلاغ .ىرخRا ةيجراخلا تازفحWاو ةعطاسلا ءاوضRاو ءاضوضلل bساسح نونوكي اياحسلا
72 ىلإ 24 ـلا لMخ ةبسانWا فيفختلا ريبادت ذيفنتو ملRا ثيح نم لفطلا مييقت مهWا نم .ةيوفقلا ةبMصلا ببسب يبناجلا
.bيادوكلا عم bفونيماتيسRا مدختسُي ام اًبلاغ .ىلوRا ةعاس
.ةرر ك ت م تارتف ىلع ،لوبلا جاتنإ و ،LOCو ،ةيبصعلا تامMعلاو ،ةيويحلا تامMعلا ةبقارم ءارجإ متي
حمسُيو .NPO سحلا فعضب باصWا لفطلاب ظافتح\ا متي ام ًةداع
،لمحتلا مت اذإ و ،ةيادبلا يف ةيفاص لئاوس لوانتب نيرخ?ا لافط?ل
ىلإ ةجاح كانه .مهرامعR بسانم يئاذغ ماظن ىلإ لاقتن\ا متي
.ةيانعب جارخ`ا/لاخد`ا ليجستو ةبقارم
يرسRا معدلا
•Keep the room as quiet as possible, and keep environmental sLmuli at a
minimum because most children with meningiLs are sensiLve to noise, bright
lights, and other external sLmuli. A side-lying posiLon is more oTen assumed
because of nuchal rigidity. EvaluaLng the child for pain and implemenLng
appropriate relief measures are important during the iniLal 24 to 72 hours.
Acetaminophen with codeine is oTen used.
• ObservaLon of vital signs, neurologic signs, LOC, urinary output, are carried
out at frequent intervals.
•The child with dulled sensorium is usually kept NPO. Other children are
allowed clear liquids iniLally and, if tolerated, progress to a diet suitable for
their age. Careful monitoring and recording of I/O are needed.
•Family support
ةيضيرمتلا ةياعرلا ةر ا د إ
باهتلاب bباصWا لافطRا مظعم نR ،نكمم دح ىندأ ىلإ ةيئيبلا تازفحWا نم للقو ،ناكم`ا ردق ةفرغلا ءو د ه ىلع ظفاح
ءاقلتس\ا عضو ضرتفُي ام اًبلاغ .ىرخRا ةيجراخلا تازفحWاو ةعطاسلا ءاوضRاو ءاضوضلل bساسح نونوكي اياحسلا
72 ىلإ 24 ـلا لMخ ةبسانWا فيفختلا ريبادت ذيفنتو ملRا ثيح نم لفطلا مييقت مهWا نم .ةيوفقلا ةبMصلا ببسب يبناجلا
.bيادوكلا عم bفونيماتيسRا مدختسُي ام اًبلاغ .ىلوRا ةعاس
.ةرر ك ت م تارتف ىلع ،لوبلا جاتنإ و ،LOCو ،ةيبصعلا تامMعلاو ،ةيويحلا تامMعلا ةبقارم ءارجإ متي
حمسُيو .NPO سحلا فعضب باصWا لفطلاب ظافتح\ا متي ام ًةداع
،لمحتلا مت اذإ و ،ةيادبلا يف ةيفاص لئاوس لوانتب نيرخ?ا لافط?ل
ىلإ ةجاح كانه .مهرامعR بسانم يئاذغ ماظن ىلإ لاقتن\ا متي
.ةيانعب جارخ`ا/لاخد`ا ليجستو ةبقارم
يرسRا معدلا
Reye Syndrome
•RS is a disorder degned as a metabolic encephalopathy associated with other
characterisLc organ involvement. It is characterized by fever, profoundly impaired
consciousness, and disordered hepaLc funcLon. The eLology of RS is not well
understood, but most cases follow a common viral illness, typically inkuenza or varicella.
RS is a condiLon characterized pathologically by cerebral edema and fafy changes of
the liver.
•The onset of RS is notable for profuse eSortless vomiLng and lethargy that quickly
progresses to neurologic impairment, including delirium, seizures, and coma, and can
ulLmately lead to increase ICP, herniaLon, and death. The cause of RS is a mitochondrial
insult induced by various viruses, drugs, exogenous toxins, and geneLc factors.
•Elevated serum ammonia levels tend to correlate with the clinical manifestaLons and
prognosis. DegniLve diagnosis is established by liver biopsy.
يار ةمزMتم
.دبكلا فئاظو بارطضاو ،قيمعلا يعولا فعضو ،ىمحلاب زيمتيو .ىرخأ ةزيمم ءاضعأ ةباصإب طبتري يبMقتسا يغامد لMتعا هنأ ىلع فنصُي بارطضا وه يديوتامورلا لصافWا باهتلا
.ةيدبكلا تاريغتلاو ةيغامدلا ةمذولاب يضرم لكشب زيمتت ةلاح يه RS .قامحلا وأ ازنولفنRا ًةداع ،اًعئاش اًيسوريف اًضرم عبتت ت\احلا مظعم نكلو ،اًديج ةموهفم ريغ RS تاببسم
امب ،يبصع فعض ىلإ ةعرسب روطتي يذلاو دهج نود ريزغلا لومخلاو ءيقلاب يديوتامورلا لصافWا باهتلا ةيادب زيمتت
ببس .توWاو قتفلاو ةيلودلا تانراقWا جمانرب ةدايز ىلإ ةياهنلا يف يدؤي نأ نكميو ،ةبوبيغلاو تابونلاو نايذهلا كلذ يف
.ةيثارولا لماوعلاو ةيجراخلا مومسلاو ةيودRاو تاسوريفلا نم ديدعلا نع ةمجانلا ايردنوكوتيWا ةناهإ وه RS
ةيريرسلا رهاظWاب طابترا ىلإ لصWا يف ةعفترWا اينومRا تايوتسم ليمت
.دبكلا ةعزخ قيرط نع يئاهنلا صيخشتلا ديدحت متي .صيخشتلاو
•RS is a disorder degned as a metabolic encephalopathy associated with other
characterisLc organ involvement. It is characterized by fever, profoundly impaired
consciousness, and disordered hepaLc funcLon. The eLology of RS is not well
understood, but most cases follow a common viral illness, typically inkuenza or varicella.
RS is a condiLon characterized pathologically by cerebral edema and fafy changes of
the liver.
•The onset of RS is notable for profuse eSortless vomiLng and lethargy that quickly
progresses to neurologic impairment, including delirium, seizures, and coma, and can
ulLmately lead to increase ICP, herniaLon, and death. The cause of RS is a mitochondrial
insult induced by various viruses, drugs, exogenous toxins, and geneLc factors.
•Elevated serum ammonia levels tend to correlate with the clinical manifestaLons and
prognosis. DegniLve diagnosis is established by liver biopsy.
يار ةمزMتم
.دبكلا فئاظو بارطضاو ،قيمعلا يعولا فعضو ،ىمحلاب زيمتيو .ىرخأ ةزيمم ءاضعأ ةباصإب طبتري يبMقتسا يغامد لMتعا هنأ ىلع فنصُي بارطضا وه يديوتامورلا لصافWا باهتلا
.ةيدبكلا تاريغتلاو ةيغامدلا ةمذولاب يضرم لكشب زيمتت ةلاح يه RS .قامحلا وأ ازنولفنRا ًةداع ،اًعئاش اًيسوريف اًضرم عبتت ت\احلا مظعم نكلو ،اًديج ةموهفم ريغ RS تاببسم
امب ،يبصع فعض ىلإ ةعرسب روطتي يذلاو دهج نود ريزغلا لومخلاو ءيقلاب يديوتامورلا لصافWا باهتلا ةيادب زيمتت
ببس .توWاو قتفلاو ةيلودلا تانراقWا جمانرب ةدايز ىلإ ةياهنلا يف يدؤي نأ نكميو ،ةبوبيغلاو تابونلاو نايذهلا كلذ يف
.ةيثارولا لماوعلاو ةيجراخلا مومسلاو ةيودRاو تاسوريفلا نم ديدعلا نع ةمجانلا ايردنوكوتيWا ةناهإ وه RS
ةيريرسلا رهاظWاب طابترا ىلإ لصWا يف ةعفترWا اينومRا تايوتسم ليمت
.دبكلا ةعزخ قيرط نع يئاهنلا صيخشتلا ديدحت متي .صيخشتلاو
Nursing Care Management
•The most important aspect of successful management of a child with
RS is early diagnosis and aggressive supporLve therapy. Cerebral edema
with increased ICP represents the most immediate threat to life.
•Care and observaLons are implemented as for any child with an altered
state of consciousness and increasing ICP. Accurate and frequent
monitoring of I/O is essenLal for adjusLng kuid volumes to prevent both
dehydraLon and cerebral edema. Monitor laboratory studies to
determine impaired coagulaLon, such as prolonged bleeding Lme.
•Keep parents of children with RS informed of the child's progress and
explain diagnosLc procedures and therapeuLc management.
ةيضيرمتلا ةياعرلا ةر ا د إ
ةرر ك ت W او ةقيقدلا ةبقارWا دعت .ةيلودلا تانراقWا جمانرب يف ةدايزو ةر ي غ ت م يعو ةلاح نم يناعي لفط يR ةبسنلاب لاحلا وه امك تاظحMWاو ةياعرلا ذيفنت متي
.ةليوطلا فيزنلا ةدم لثم ،رثختلا فعض ديدحتل ةيربخWا تاساردلا ةبقارم .ةيغامدلا ةمذولاو فافجلا عنW لئاوسلا ماجحأ طبضل ةيرورض جارخ`ا/لاخدiل
باصWا لفطلل ةحجانلا ةر ا د ` ا يف بناج مهأ
RS.يناودعلا معادلا جMعلاو ركبWا صيخشتلا وه
تانراقWا جمانرب ةدايز عم ةيغامدلا ةمذولا لثمت
ةايحلل احاحلإ رثكRا ديدهتلا ةيلودلا.
.ةيجMعلا ةر ا د ` او ةيصيخشتلا تاءارج`ا حرشو لفطلا مدقتب عMطا ىلع يديوتامورلا لصافWا باهتلاب bباصWا لافطRا ءابآ ءاقبإ
•The most important aspect of successful management of a child with
RS is early diagnosis and aggressive supporLve therapy. Cerebral edema
with increased ICP represents the most immediate threat to life.
•Care and observaLons are implemented as for any child with an altered
state of consciousness and increasing ICP. Accurate and frequent
monitoring of I/O is essenLal for adjusLng kuid volumes to prevent both
dehydraLon and cerebral edema. Monitor laboratory studies to
determine impaired coagulaLon, such as prolonged bleeding Lme.
•Keep parents of children with RS informed of the child's progress and
explain diagnosLc procedures and therapeuLc management.
ةيضيرمتلا ةياعرلا ةر ا د إ
ةرر ك ت W او ةقيقدلا ةبقارWا دعت .ةيلودلا تانراقWا جمانرب يف ةدايزو ةر ي غ ت م يعو ةلاح نم يناعي لفط يR ةبسنلاب لاحلا وه امك تاظحMWاو ةياعرلا ذيفنت متي
.ةليوطلا فيزنلا ةدم لثم ،رثختلا فعض ديدحتل ةيربخWا تاساردلا ةبقارم .ةيغامدلا ةمذولاو فافجلا عنW لئاوسلا ماجحأ طبضل ةيرورض جارخ`ا/لاخدiل
باصWا لفطلل ةحجانلا ةر ا د ` ا يف بناج مهأ
RS.يناودعلا معادلا جMعلاو ركبWا صيخشتلا وه
تانراقWا جمانرب ةدايز عم ةيغامدلا ةمذولا لثمت
ةايحلل احاحلإ رثكRا ديدهتلا ةيلودلا.
.ةيجMعلا ةر ا د ` او ةيصيخشتلا تاءارج`ا حرشو لفطلا مدقتب عMطا ىلع يديوتامورلا لصافWا باهتلاب bباصWا لافطRا ءابآ ءاقبإ
Seizure Disorders
•A seizure is a “transient occurrence of signs and/or symptoms due to abnormal excessive
and synchronous neuronal acLvity in the brain”. Seizures are the most common pediatric
neurologic disorder. About 4% to 10% of children will have at least one seizure in the grst 16
years of life.
•The manifestaLon of seizures depends on the region of the brain in which they originate and
may include unconsciousness or altered consciousness, involuntary movements, and changes
in percepLon, behaviors, sensaLons, and/or posture. PotenLal causes include infecLons,
intracranial lesions or hemorrhage, metabolic disorders, trauma, brain malformaLons,
geneLc disorders, or toxic ingesLon.
•Epilepsy is degned as two or more unprovoked seizures more than 24 hours apart and can
be caused by a variety of pathologic processes in the brain. A single seizure is not classiged as
epilepsy and is generally not treated with long-term anLepilepLc drugs. Some seizures may
result from an acute medical or neurologic illness and cease aTer the illness is treated.
عرص تابون
.لافطRا دنع ًاعويش رثكRا يبصعلا بارطضا يه تابونلا ."غامدلا يف يعيبطلا ريغ نمازتWاو طرفWا يبصعلا طاشنلا ببسب ضارعRا وأ/و تامMعلل رباع ثدح" يه ةبونلا
.رمعلا نم اًماع 16 لوأ لMخ لقRا ىلع ةدحاو عرص ةبون نم لافطRا نم %10 ىلإ %4 يلاوح يناعي
،تايكولسلاو ،كارد`ا يف تاريغتلاو ،ةيدارإMلا تاكرحلاو ،يعولا ريغت وأ يعولا نادقف لمشت دقو اهيف أشنت يتلا غامدلا ةقطنم ىلع تابونلا روهظ دمتعي
وأ غامدلا تاهوشت وأ تامدصلا وأ ةيضيRا تابارطضا وأ ةمجمجلا لخاد فزنلا وأ تاف?ا وأ تاباهتلا ةلمتحWا بابسRا لمشت .ةيعضولا وأ/و ،سيساحRاو
.ةماسلا داوWا عMتبا وأ ةيثارولا تابارطضا
لكشب اهجMع متي \و عرص اهنأ ىلع ةدحاولا ةبونلا فينصت متي \ .غامدلا يف ةيضرWا تايلمعلا نم ةعونتم ةعومجم هببس نوكي نأ نكميو ،ةعاس 24 نم رثكأ امهنيب لصفي رثكأ وأ bترربم ريغ ناتبون هنأ ىلع عرصلا فيرعت متي
.ضر W ا جMع دعب فقوتتو داح يبصع وأ يبط ضر م نع تابونلا ضعب جتنت دق .ليوطلا ىدWا ىلع عرصلل ةداضم ةيودأب ماع
•A seizure is a “transient occurrence of signs and/or symptoms due to abnormal excessive
and synchronous neuronal acLvity in the brain”. Seizures are the most common pediatric
neurologic disorder. About 4% to 10% of children will have at least one seizure in the grst 16
years of life.
•The manifestaLon of seizures depends on the region of the brain in which they originate and
may include unconsciousness or altered consciousness, involuntary movements, and changes
in percepLon, behaviors, sensaLons, and/or posture. PotenLal causes include infecLons,
intracranial lesions or hemorrhage, metabolic disorders, trauma, brain malformaLons,
geneLc disorders, or toxic ingesLon.
•Epilepsy is degned as two or more unprovoked seizures more than 24 hours apart and can
be caused by a variety of pathologic processes in the brain. A single seizure is not classiged as
epilepsy and is generally not treated with long-term anLepilepLc drugs. Some seizures may
result from an acute medical or neurologic illness and cease aTer the illness is treated.
عرص تابون
.لافطRا دنع ًاعويش رثكRا يبصعلا بارطضا يه تابونلا ."غامدلا يف يعيبطلا ريغ نمازتWاو طرفWا يبصعلا طاشنلا ببسب ضارعRا وأ/و تامMعلل رباع ثدح" يه ةبونلا
.رمعلا نم اًماع 16 لوأ لMخ لقRا ىلع ةدحاو عرص ةبون نم لافطRا نم %10 ىلإ %4 يلاوح يناعي
،تايكولسلاو ،كارد`ا يف تاريغتلاو ،ةيدارإMلا تاكرحلاو ،يعولا ريغت وأ يعولا نادقف لمشت دقو اهيف أشنت يتلا غامدلا ةقطنم ىلع تابونلا روهظ دمتعي
وأ غامدلا تاهوشت وأ تامدصلا وأ ةيضيRا تابارطضا وأ ةمجمجلا لخاد فزنلا وأ تاف?ا وأ تاباهتلا ةلمتحWا بابسRا لمشت .ةيعضولا وأ/و ،سيساحRاو
.ةماسلا داوWا عMتبا وأ ةيثارولا تابارطضا
لكشب اهجMع متي \و عرص اهنأ ىلع ةدحاولا ةبونلا فينصت متي \ .غامدلا يف ةيضرWا تايلمعلا نم ةعونتم ةعومجم هببس نوكي نأ نكميو ،ةعاس 24 نم رثكأ امهنيب لصفي رثكأ وأ bترربم ريغ ناتبون هنأ ىلع عرصلا فيرعت متي
.ضر W ا جMع دعب فقوتتو داح يبصع وأ يبط ضر م نع تابونلا ضعب جتنت دق .ليوطلا ىدWا ىلع عرصلل ةداضم ةيودأب ماع
Pathophysiology
Abnormal electrical discharges (1) may arise from the simultaneous activation of neurons in both hemispheres of
the brain (generalized seizures); (2) may be restricted to one area of the cerebral cortex, producing manifestations
characteristic of that particular anatomic focus (partial seizure); or (3) may begin in a localized area of the cortex
as a partial seizure and spread to other portions of the brain and, if su^ciently extensive, produce generalized
seizure activity.
•A seizure occurs when there is sudden excessive excitation and loss of inhibition within neuronal circuits,
allowing the circuits to amplify their discharges simultaneously. These discharges occur in response to the activity
of sodium, potassium, calcium, and chloride ion channels. Primary generalized seizures begin with abnormal
discharges in both hemispheres, which can involve connections between the thalamus and neocortex.
Seizures are classified into two major categories:
•Partial seizures, which have a local onset and involve a relatively small location in the brain
•Generalized seizures, which involve both hemispheres of the brain from onset or secondarily generalize from
partial seizures
ﺔﯾﻌﯾﺑط رﯾﻏ ﺔﯾﺋﺎﺑرﮭﻛ تﺎﻐﯾرﻔﺗ ﺄﺷﻧﺗ دﻗ)1 ( ﻲﻓ ﺔﯾﺑﺻﻌﻟا ﺎﯾﻼﺧﻠﻟ نﻣازﺗﻣﻟا طﯾﺷﻧﺗﻟا نﻣ
ﺔﯾﺧﻣﻟا ةرﻛﻟا ﻲﻔﺻﻧ)ﺔﻣﻣﻌﻣ تﺎﺑوﻧ( ؛)2 ( ةرﺷﻘﻟا نﻣ ةدﺣاو ﺔﻘطﻧﻣ ﻰﻠﻋ رﺻﺗﻘﯾ دﻗ
ددﺣﻣﻟا ﻲﺣﯾرﺷﺗﻟا زﯾﻛرﺗﻟا كﻟذﻟ ةزﯾﻣﻣ رھﺎظﻣ روﮭظ ﻰﻟإ يدؤﯾ ﺎﻣﻣ ،ﺔﯾﻏﺎﻣدﻟا) ﺔﺑوﻧ
ﺔﯾﺋزﺟ( وأ ؛)3 ( ءازﺟأ ﻰﻟإ رﺷﺗﻧﺗو ﺔﯾﺋزﺟ ﺔﺑوﻧﻛ ةرﺷﻘﻟا نﻣ ﺔﯾﻌﺿوﻣ ﺔﻘطﻧﻣ ﻲﻓ أدﺑﺗ دﻗ
مﻣﻌﻣ ﺔﺑوﻧ طﺎﺷﻧ ﺞﺗﻧﺗ ﺎﮭﻧﺈﻓ ،فﺎﻛ لﻛﺷﺑ قﺎطﻧﻟا ﺔﻌﺳاو تﻧﺎﻛ اذإو ،غﺎﻣدﻟا نﻣ ىرﺧأ.
طﯾﺑﺛﺗﻟا نادﻘﻓو ﺔﺋﺟﺎﻔﻣ ﺔطرﻔﻣ ةرﺎﺛإ كﺎﻧھ نوﻛﯾ ﺎﻣدﻧﻋ ﺔﺑوﻧﻟا ثدﺣﺗ
و ﻲﻓ ﺎﮭﺗﺎﻐﯾرﻔﺗ مﯾﺧﺿﺗﺑ رﺋاودﻠﻟ ﺢﻣﺳﯾ ﺎﻣﻣ ،ﺔﯾﺑﺻﻌﻟا رﺋاودﻟا لﺧاد تﻗ
دﺣاو . موﯾدوﺻﻟا تﺎﻧوﯾأ تاوﻧﻗ طﺎﺷﻧﻟ ﺔﺑﺎﺟﺗﺳا تﺎﻔﯾرﺻﺗﻟا هذھ ثدﺣﺗ
دﯾروﻠﻛﻟاو موﯾﺳﻟﺎﻛﻟاو موﯾﺳﺎﺗوﺑﻟاو . ﺔﯾﻟوﻷا ﺔﻣﻣﻌﻣﻟا تﺎﺑوﻧﻟا أدﺑﺗ
أ نﻛﻣﯾ ﻲﺗﻟاو ،ﺔﯾﺿرﻷا ةرﻛﻟا ﻲﻔﺻﻧ ﻼﻛ ﻲﻓ ﺔﯾﻌﯾﺑط رﯾﻏ تازارﻓﺈﺑ ن
ﺔﺛﯾدﺣﻟا ﺔﯾﺧﻣﻟا ةرﺷﻘﻟاو دﺎﮭﻣﻟا نﯾﺑ تﻻﺎﺻﺗا ﻰﻠﻋ يوطﻧﺗ.
نﯾﺗﯾﺳﯾﺋر نﯾﺗﺋﻓ ﻰﻟإ تﺎطوﺑﺿﻣﻟا مﺳﻘﻧﺗ:
•ﺳﻧ رﯾﻐﺻ ﻊﻗوﻣ ﻰﻠﻋ رﺛؤﺗو ﺔﯾﻌﺿوﻣ ﺔﯾادﺑ ﺎﮭﻟ ﻲﺗﻟاو ،ﺔﯾﺋزﺟﻟا تﺎﺑوﻧﻟا ﺎًﯾﺑ
غﺎﻣدﻟا ﻲﻓ
• تﺎﺑوﻧﻟا وأ ﺔﯾادﺑﻟا ذﻧﻣ غﺎﻣدﻟا ﻲﻔﺻﻧ ﻼﻛ لﻣﺷﺗ ﻲﺗﻟا ،ﺔﻣﻣﻌﻣﻟا تﺎﺑوﻧﻟا
ﺔﯾﺋزﺟﻟا تﺎﺑوﻧﻟا نﻣ يوﻧﺎﺛ لﻛﺷﺑ ﺔﻣﺎﻌﻟا
Abnormal electrical discharges (1) may arise from the simultaneous activation of neurons in both hemispheres of
the brain (generalized seizures); (2) may be restricted to one area of the cerebral cortex, producing manifestations
characteristic of that particular anatomic focus (partial seizure); or (3) may begin in a localized area of the cortex
as a partial seizure and spread to other portions of the brain and, if su^ciently extensive, produce generalized
seizure activity.
•A seizure occurs when there is sudden excessive excitation and loss of inhibition within neuronal circuits,
allowing the circuits to amplify their discharges simultaneously. These discharges occur in response to the activity
of sodium, potassium, calcium, and chloride ion channels. Primary generalized seizures begin with abnormal
discharges in both hemispheres, which can involve connections between the thalamus and neocortex.
Seizures are classified into two major categories:
•Partial seizures, which have a local onset and involve a relatively small location in the brain
•Generalized seizures, which involve both hemispheres of the brain from onset or secondarily generalize from
partial seizures
ﺔﯾﻌﯾﺑط رﯾﻏ ﺔﯾﺋﺎﺑرﮭﻛ تﺎﻐﯾرﻔﺗ ﺄﺷﻧﺗ دﻗ)1 ( ﻲﻓ ﺔﯾﺑﺻﻌﻟا ﺎﯾﻼﺧﻠﻟ نﻣازﺗﻣﻟا طﯾﺷﻧﺗﻟا نﻣ
ﺔﯾﺧﻣﻟا ةرﻛﻟا ﻲﻔﺻﻧ)ﺔﻣﻣﻌﻣ تﺎﺑوﻧ( ؛)2 ( ةرﺷﻘﻟا نﻣ ةدﺣاو ﺔﻘطﻧﻣ ﻰﻠﻋ رﺻﺗﻘﯾ دﻗ
ددﺣﻣﻟا ﻲﺣﯾرﺷﺗﻟا زﯾﻛرﺗﻟا كﻟذﻟ ةزﯾﻣﻣ رھﺎظﻣ روﮭظ ﻰﻟإ يدؤﯾ ﺎﻣﻣ ،ﺔﯾﻏﺎﻣدﻟا) ﺔﺑوﻧ
ﺔﯾﺋزﺟ( وأ ؛)3 ( ءازﺟأ ﻰﻟإ رﺷﺗﻧﺗو ﺔﯾﺋزﺟ ﺔﺑوﻧﻛ ةرﺷﻘﻟا نﻣ ﺔﯾﻌﺿوﻣ ﺔﻘطﻧﻣ ﻲﻓ أدﺑﺗ دﻗ
مﻣﻌﻣ ﺔﺑوﻧ طﺎﺷﻧ ﺞﺗﻧﺗ ﺎﮭﻧﺈﻓ ،فﺎﻛ لﻛﺷﺑ قﺎطﻧﻟا ﺔﻌﺳاو تﻧﺎﻛ اذإو ،غﺎﻣدﻟا نﻣ ىرﺧأ.
طﯾﺑﺛﺗﻟا نادﻘﻓو ﺔﺋﺟﺎﻔﻣ ﺔطرﻔﻣ ةرﺎﺛإ كﺎﻧھ نوﻛﯾ ﺎﻣدﻧﻋ ﺔﺑوﻧﻟا ثدﺣﺗ
و ﻲﻓ ﺎﮭﺗﺎﻐﯾرﻔﺗ مﯾﺧﺿﺗﺑ رﺋاودﻠﻟ ﺢﻣﺳﯾ ﺎﻣﻣ ،ﺔﯾﺑﺻﻌﻟا رﺋاودﻟا لﺧاد تﻗ
دﺣاو . موﯾدوﺻﻟا تﺎﻧوﯾأ تاوﻧﻗ طﺎﺷﻧﻟ ﺔﺑﺎﺟﺗﺳا تﺎﻔﯾرﺻﺗﻟا هذھ ثدﺣﺗ
دﯾروﻠﻛﻟاو موﯾﺳﻟﺎﻛﻟاو موﯾﺳﺎﺗوﺑﻟاو . ﺔﯾﻟوﻷا ﺔﻣﻣﻌﻣﻟا تﺎﺑوﻧﻟا أدﺑﺗ
أ نﻛﻣﯾ ﻲﺗﻟاو ،ﺔﯾﺿرﻷا ةرﻛﻟا ﻲﻔﺻﻧ ﻼﻛ ﻲﻓ ﺔﯾﻌﯾﺑط رﯾﻏ تازارﻓﺈﺑ ن
ﺔﺛﯾدﺣﻟا ﺔﯾﺧﻣﻟا ةرﺷﻘﻟاو دﺎﮭﻣﻟا نﯾﺑ تﻻﺎﺻﺗا ﻰﻠﻋ يوطﻧﺗ.
نﯾﺗﯾﺳﯾﺋر نﯾﺗﺋﻓ ﻰﻟإ تﺎطوﺑﺿﻣﻟا مﺳﻘﻧﺗ:
•ﺳﻧ رﯾﻐﺻ ﻊﻗوﻣ ﻰﻠﻋ رﺛؤﺗو ﺔﯾﻌﺿوﻣ ﺔﯾادﺑ ﺎﮭﻟ ﻲﺗﻟاو ،ﺔﯾﺋزﺟﻟا تﺎﺑوﻧﻟا ﺎًﯾﺑ
غﺎﻣدﻟا ﻲﻓ
• تﺎﺑوﻧﻟا وأ ﺔﯾادﺑﻟا ذﻧﻣ غﺎﻣدﻟا ﻲﻔﺻﻧ ﻼﻛ لﻣﺷﺗ ﻲﺗﻟا ،ﺔﻣﻣﻌﻣﻟا تﺎﺑوﻧﻟا
ﺔﯾﺋزﺟﻟا تﺎﺑوﻧﻟا نﻣ يوﻧﺎﺛ لﻛﺷﺑ ﺔﻣﺎﻌﻟا
Classification and Clinical Manifestations of Seizures
Simple Partial Seizures with Motor Signs Characterized by:
•Localized motor symptoms
•Somatosensory, psychic, autonomic symptoms
• Aversive seizure (most common motor seizure in children): Eye or eyes and head turn away from
the side of the focus; awareness of movement or loss of consciousness
• Rolandic (Sylvan) seizure: Tonic-clonic movements involving the face, salivation, arrested speech;
most common during sleep
• Jacksonian march (rare in children): Orderly, sequential progression of clonic movements beginning
in a foot, hand, or face and moving or “marching,” to adjacent body parts
ﻲﻠﯾ ﺎﻣﺑ زﯾﻣﺗﺗ ﺔﯾﻛرﺣ تﺎﻣﻼﻋ ﻊﻣ ﺔطﯾﺳﺑ ﺔﯾﺋزﺟ تﺎﺑوﻧ:
•ﺔﯾﻌﺿوﻣﻟا ﺔﯾﻛرﺣﻟا ضارﻋﻷا
•ﺔﯾدارإﻼﻟاو ﺔﯾﺳﻔﻧﻟاو ﺔﯾدﺳﺟﻟا ﺔﯾﺳﺣﻟا ضارﻋﻷا
ﺔﯾروﻔﻧﻟا ﺔﺑوﻧﻟا)لﺎﻔطﻷا دﻧﻋ ﺎًﻋوﯾﺷ رﺛﻛﻷا ﺔﯾﻛرﺣﻟا تﺎﺑوﻧﻟا :(ﺎﻌﺗﺑا نﯾﻌﻟا د
ﻲﻋوﻟا نادﻘﻓ وأ ﺔﻛرﺣﻟﺎﺑ ﻲﻋوﻟا ؛زﯾﻛرﺗﻟا بﻧﺎﺟ نﻋ سأرﻟاو نﯾﻧﯾﻌﻟا وأ
كﯾدﻧﻻور ﺔﺑوﻧ)نﺎﻔﻠﯾﺳ :(ﻧﻟا ءﺎﻧﺛأ ﺎﻋوﯾﺷ رﺛﻛﻷا ؛فﻗوﺗﻣﻟا مﻼﻛﻟاو ،بﺎﻌﻠﻟا نﻼﯾﺳو ،ﮫﺟوﻟا لﻣﺷﺗ ﺔﯾﻌﻣر ﺔﯾرﺗوﺗ تﺎﻛرﺣمو
ﺔﯾﻧوﺳﻛﺎﺟﻟا ةرﯾﺳﻣﻟا)لﺎﻔطﻷا دﻧﻋ ةردﺎﻧ :(ﯾﺟﺎﺟﺗرﻻا تﺎﻛرﺣﻠﻟ لﺳﻠﺳﺗﻣو مظﻧﻣ مدﻘﺗ ﺔ
وأ كرﺣﺗﺗو ﮫﺟوﻟا وأ دﯾﻟا وأ مدﻘﻟا ﻲﻓ أدﺑﺗ ﻲﺗﻟا"رﯾﺳﺗ "ةروﺎﺟﻣﻟا مﺳﺟﻟا ءازﺟأ ﻰﻟإ
Simple Partial Seizures with Motor Signs Characterized by:
•Localized motor symptoms
•Somatosensory, psychic, autonomic symptoms
• Aversive seizure (most common motor seizure in children): Eye or eyes and head turn away from
the side of the focus; awareness of movement or loss of consciousness
• Rolandic (Sylvan) seizure: Tonic-clonic movements involving the face, salivation, arrested speech;
most common during sleep
• Jacksonian march (rare in children): Orderly, sequential progression of clonic movements beginning
in a foot, hand, or face and moving or “marching,” to adjacent body parts
ﻲﻠﯾ ﺎﻣﺑ زﯾﻣﺗﺗ ﺔﯾﻛرﺣ تﺎﻣﻼﻋ ﻊﻣ ﺔطﯾﺳﺑ ﺔﯾﺋزﺟ تﺎﺑوﻧ:
•ﺔﯾﻌﺿوﻣﻟا ﺔﯾﻛرﺣﻟا ضارﻋﻷا
•ﺔﯾدارإﻼﻟاو ﺔﯾﺳﻔﻧﻟاو ﺔﯾدﺳﺟﻟا ﺔﯾﺳﺣﻟا ضارﻋﻷا
ﺔﯾروﻔﻧﻟا ﺔﺑوﻧﻟا)لﺎﻔطﻷا دﻧﻋ ﺎًﻋوﯾﺷ رﺛﻛﻷا ﺔﯾﻛرﺣﻟا تﺎﺑوﻧﻟا :(ﺎﻌﺗﺑا نﯾﻌﻟا د
ﻲﻋوﻟا نادﻘﻓ وأ ﺔﻛرﺣﻟﺎﺑ ﻲﻋوﻟا ؛زﯾﻛرﺗﻟا بﻧﺎﺟ نﻋ سأرﻟاو نﯾﻧﯾﻌﻟا وأ
كﯾدﻧﻻور ﺔﺑوﻧ)نﺎﻔﻠﯾﺳ :(ﻧﻟا ءﺎﻧﺛأ ﺎﻋوﯾﺷ رﺛﻛﻷا ؛فﻗوﺗﻣﻟا مﻼﻛﻟاو ،بﺎﻌﻠﻟا نﻼﯾﺳو ،ﮫﺟوﻟا لﻣﺷﺗ ﺔﯾﻌﻣر ﺔﯾرﺗوﺗ تﺎﻛرﺣمو
ﺔﯾﻧوﺳﻛﺎﺟﻟا ةرﯾﺳﻣﻟا)لﺎﻔطﻷا دﻧﻋ ةردﺎﻧ :(ﯾﺟﺎﺟﺗرﻻا تﺎﻛرﺣﻠﻟ لﺳﻠﺳﺗﻣو مظﻧﻣ مدﻘﺗ ﺔ
وأ كرﺣﺗﺗو ﮫﺟوﻟا وأ دﯾﻟا وأ مدﻘﻟا ﻲﻓ أدﺑﺗ ﻲﺗﻟا"رﯾﺳﺗ "ةروﺎﺟﻣﻟا مﺳﺟﻟا ءازﺟأ ﻰﻟإ
Simple Partial Seizures with Sensory Signs
•Uncommon in children younger than 8 years old Characterized by various sensations, including: • Numbness,
tingling, prickling, paresthesia, or pain originating in one area (e.g., face or extremities) and spreading to other
parts of the body
•Visual sensations or formed images
•Motor phenomena, such as posturing or hypertonia
Complex Partial Seizures (Psychomotor Seizures)
Observed more often in children from 3 years old through adolescence Characterized by:
•Period of altered behavior
•Amnesia for event (no recollection of behavior)
•Inability to respond to environment
•Impaired consciousness during event
•Drowsiness or sleep usually following seizure
•Confusion and amnesia possibly prolonged
•Complex sensory phenomena (aura): Most frequent sensation is strange feeling in the pit of the stomach that
rises toward the throat and is often accompanied by odd or unpleasant odors or tastes;
ﺔﯾﺳﺣ تﺎﻣﻼﻋ ﻊﻣ ﺔطﯾﺳﺑ ﺔﯾﺋزﺟ تﺎﺑوﻧ•
نﻋ مھرﺎﻣﻋأ لﻘﺗ نﯾذﻟا لﺎﻔطﻷا دﻧﻋ ﻊﺋﺎﺷ رﯾﻏ8تاوﻧﺳ . ،ﺔﻔﻠﺗﺧﻣ سﯾﺳﺎﺣﺄﺑ زﯾﻣﺗﯾ
كﻟذ ﻲﻓ ﺎﻣﺑ : •ﺔﻘطﻧﻣ ﻲﻓ ﺄﺷﻧﯾ يذﻟا مﻟﻷا وأ ،لﻣﻧﺗﻟا وأ ،زﺧوﻟا وأ ،زﺧوﻟا وأ ،لﯾﻣﻧﺗﻟا
ةدﺣاو)فارطﻷا وأ ﮫﺟوﻟا ،لﺎﺛﻣﻟا لﯾﺑﺳ ﻰﻠﻋ (مﺳﺟﻟا نﻣ ىرﺧأ ءازﺟأ ﻰﻟإ رﺷﺗﻧﯾو
•ﺔﻧوﻛﺗﻣﻟا روﺻﻟا وأ ﺔﯾرﺻﺑﻟا سﯾﺳﺎﺣﻷا
• ،رﺗوﺗﻟا طرﻓ وأ فوﻗوﻟا لﺛﻣ ،ﺔﯾﻛرﺣﻟا رھاوظﻟا
ةدﻘﻌﻣﻟا ﺔﯾﺋزﺟﻟا تﺎﺑوﻧﻟاو)ﺳﻔﻧﻟا ﺔﯾﻛرﺣﻟا تﺎﺑوﻧﻟاﺔﯾ(
رﻣﻋ نﻣ لﺎﻔطﻷا دﻧﻋ نﺎﯾﺣﻷا نﻣ رﯾﺛﻛ ﻲﻓ ظﺣﻼﯾ3ـﺑ زﯾﻣﺗﯾو ﺔﻘھارﻣﻟا نﺳ ﻰﺗﺣ تاوﻧﺳ:
•كوﻠﺳﻟا رﯾﻐﺗ ةرﺗﻓ
• ثدﺣﻠﻟ ةرﻛاذﻟا نادﻘﻓ)كوﻠﺳﻟا رﻛذﺗ مدﻋ(•
ﺔﺋﯾﺑﻠﻟ ﺔﺑﺎﺟﺗﺳﻻا ﻰﻠﻋ ةردﻘﻟا مدﻋ
ثدﺣﻟا ءﺎﻧﺛأ ﻲﻋوﻟا فﻌﺿ
•ﺔﺑوﻧﻟا دﻌﺑ ةدﺎﻋ موﻧﻟا وأ سﺎﻌﻧﻟا•
ﺔﻠﯾوط تارﺗﻔﻟ ةرﻛاذﻟا نادﻘﻓو كﺎﺑﺗرا ثودﺣ لﺎﻣﺗﺣا•
• ةدﻘﻌﻣﻟا ﺔﯾﺳﺣﻟا رھاوظﻟا)ﺔﻟﺎﮭﻟا :(ﻊﻔﺗرﺗ ﻲﺗﻟا ةدﻌﻣﻟا ةرﻔﺣ ﻲﻓ بﯾرﻐﻟا روﻌﺷﻟا وھ ًﺎﻋوﯾﺷ رﺛﻛﻷا سﺎﺳﺣﻹا
ﺔﮭﯾرﻛ وأ ﺔﺑﯾرﻏ تﺎﻗاذﻣ وأ ﺢﺋاورﺑ ﺔﺑوﺣﺻﻣ نوﻛﺗ ﺎﻣ ًﺎﺑﻟﺎﻏو ﻖﻠﺣﻟا وﺣﻧ.
•Uncommon in children younger than 8 years old Characterized by various sensations, including: • Numbness,
tingling, prickling, paresthesia, or pain originating in one area (e.g., face or extremities) and spreading to other
parts of the body
•Visual sensations or formed images
•Motor phenomena, such as posturing or hypertonia
Complex Partial Seizures (Psychomotor Seizures)
Observed more often in children from 3 years old through adolescence Characterized by:
•Period of altered behavior
•Amnesia for event (no recollection of behavior)
•Inability to respond to environment
•Impaired consciousness during event
•Drowsiness or sleep usually following seizure
•Confusion and amnesia possibly prolonged
•Complex sensory phenomena (aura): Most frequent sensation is strange feeling in the pit of the stomach that
rises toward the throat and is often accompanied by odd or unpleasant odors or tastes;
ﺔﯾﺳﺣ تﺎﻣﻼﻋ ﻊﻣ ﺔطﯾﺳﺑ ﺔﯾﺋزﺟ تﺎﺑوﻧ•
نﻋ مھرﺎﻣﻋأ لﻘﺗ نﯾذﻟا لﺎﻔطﻷا دﻧﻋ ﻊﺋﺎﺷ رﯾﻏ8تاوﻧﺳ . ،ﺔﻔﻠﺗﺧﻣ سﯾﺳﺎﺣﺄﺑ زﯾﻣﺗﯾ
كﻟذ ﻲﻓ ﺎﻣﺑ : •ﺔﻘطﻧﻣ ﻲﻓ ﺄﺷﻧﯾ يذﻟا مﻟﻷا وأ ،لﻣﻧﺗﻟا وأ ،زﺧوﻟا وأ ،زﺧوﻟا وأ ،لﯾﻣﻧﺗﻟا
ةدﺣاو)فارطﻷا وأ ﮫﺟوﻟا ،لﺎﺛﻣﻟا لﯾﺑﺳ ﻰﻠﻋ (مﺳﺟﻟا نﻣ ىرﺧأ ءازﺟأ ﻰﻟإ رﺷﺗﻧﯾو
•ﺔﻧوﻛﺗﻣﻟا روﺻﻟا وأ ﺔﯾرﺻﺑﻟا سﯾﺳﺎﺣﻷا
• ،رﺗوﺗﻟا طرﻓ وأ فوﻗوﻟا لﺛﻣ ،ﺔﯾﻛرﺣﻟا رھاوظﻟا
ةدﻘﻌﻣﻟا ﺔﯾﺋزﺟﻟا تﺎﺑوﻧﻟاو)ﺳﻔﻧﻟا ﺔﯾﻛرﺣﻟا تﺎﺑوﻧﻟاﺔﯾ(
رﻣﻋ نﻣ لﺎﻔطﻷا دﻧﻋ نﺎﯾﺣﻷا نﻣ رﯾﺛﻛ ﻲﻓ ظﺣﻼﯾ3ـﺑ زﯾﻣﺗﯾو ﺔﻘھارﻣﻟا نﺳ ﻰﺗﺣ تاوﻧﺳ:
•كوﻠﺳﻟا رﯾﻐﺗ ةرﺗﻓ
• ثدﺣﻠﻟ ةرﻛاذﻟا نادﻘﻓ)كوﻠﺳﻟا رﻛذﺗ مدﻋ(•
ﺔﺋﯾﺑﻠﻟ ﺔﺑﺎﺟﺗﺳﻻا ﻰﻠﻋ ةردﻘﻟا مدﻋ
ثدﺣﻟا ءﺎﻧﺛأ ﻲﻋوﻟا فﻌﺿ
•ﺔﺑوﻧﻟا دﻌﺑ ةدﺎﻋ موﻧﻟا وأ سﺎﻌﻧﻟا•
ﺔﻠﯾوط تارﺗﻔﻟ ةرﻛاذﻟا نادﻘﻓو كﺎﺑﺗرا ثودﺣ لﺎﻣﺗﺣا•
• ةدﻘﻌﻣﻟا ﺔﯾﺳﺣﻟا رھاوظﻟا)ﺔﻟﺎﮭﻟا :(ﻊﻔﺗرﺗ ﻲﺗﻟا ةدﻌﻣﻟا ةرﻔﺣ ﻲﻓ بﯾرﻐﻟا روﻌﺷﻟا وھ ًﺎﻋوﯾﺷ رﺛﻛﻷا سﺎﺳﺣﻹا
ﺔﮭﯾرﻛ وأ ﺔﺑﯾرﻏ تﺎﻗاذﻣ وأ ﺢﺋاورﺑ ﺔﺑوﺣﺻﻣ نوﻛﺗ ﺎﻣ ًﺎﺑﻟﺎﻏو ﻖﻠﺣﻟا وﺣﻧ.
Diagnostic Evaluation
• The assessment and diagnosis rely heavily on a thorough history,
skilled observation, and several diagnostic tests.
• A detailed description of the seizure should be obtained from the
caregiver(s) who witnessed it. Ask questions about the child's behavior
during the event, especially at the onset, and the time at which the
seizure occurred (e.g., early morning, while awake, or during sleep).
Any factors that may have precipitated the seizure are important.
•The duration and progression of the seizure (if any) and the postictal
feelings and behavior (e.g., confusion) should be noted
ﺔﯾﺻﯾﺧﺷﺗﻟا تارﺎﺑﺗﺧﻻا نﻣ دﯾدﻌﻟاو ةرھﺎﻣﻟا ﺔظﺣﻼﻣﻟاو ﻖﯾﻗدﻟا ﺦﯾرﺎﺗﻟا ﻰﻠﻋ رﯾﺑﻛ لﻛﺷﺑ صﯾﺧﺷﺗﻟاو مﯾﯾﻘﺗﻟا دﻣﺗﻌﯾ.
ﺎھدﮭﺷ يذﻟا ﺔﯾﺎﻋرﻟا مدﻘﻣ نﻣ ﺔﺑوﻧﻠﻟ ﻲﻠﯾﺻﻔﺗ فﺻو ﻰﻠﻋ لوﺻﺣﻟا بﺟﯾ . لوﺣ ﺔﻠﺋﺳأ حرطا
ﺔﺑوﻧﻟا ﮫﯾﻓ تﺛدﺣ يذﻟا تﻗوﻟاو ،ﺔﯾادﺑﻟا ﻲﻓ ﺔﺻﺎﺧ ،ثدﺣﻟا ءﺎﻧﺛأ لﻔطﻟا كوﻠﺳ)ﺛﻣﻟا لﯾﺑﺳ ﻰﻠﻋ ،لﺎ
موﻧﻟا ءﺎﻧﺛأ وأ ،ظﺎﻘﯾﺗﺳﻻا ءﺎﻧﺛأ ،رﻛﺎﺑﻟا حﺎﺑﺻﻟا ﻲﻓ .(ﺔﻣﮭﻣ ﺔﺑوﻧﻟﺎﺑ تﻠﺟﻋ نوﻛﺗ دﻗ لﻣاوﻋ يأ.
ﺔﺑوﻧﻟا روطﺗو ةدﻣ ﺔظﺣﻼﻣ بﺟﯾ)تدﺟو نإ (
ﻲﻟﺎﺗﻟا كوﻠﺳﻟاو رﻋﺎﺷﻣﻟاو)كﺎﺑﺗرﻻا لﺛﻣ.(
• The assessment and diagnosis rely heavily on a thorough history,
skilled observation, and several diagnostic tests.
• A detailed description of the seizure should be obtained from the
caregiver(s) who witnessed it. Ask questions about the child's behavior
during the event, especially at the onset, and the time at which the
seizure occurred (e.g., early morning, while awake, or during sleep).
Any factors that may have precipitated the seizure are important.
•The duration and progression of the seizure (if any) and the postictal
feelings and behavior (e.g., confusion) should be noted
ﺔﯾﺻﯾﺧﺷﺗﻟا تارﺎﺑﺗﺧﻻا نﻣ دﯾدﻌﻟاو ةرھﺎﻣﻟا ﺔظﺣﻼﻣﻟاو ﻖﯾﻗدﻟا ﺦﯾرﺎﺗﻟا ﻰﻠﻋ رﯾﺑﻛ لﻛﺷﺑ صﯾﺧﺷﺗﻟاو مﯾﯾﻘﺗﻟا دﻣﺗﻌﯾ.
ﺎھدﮭﺷ يذﻟا ﺔﯾﺎﻋرﻟا مدﻘﻣ نﻣ ﺔﺑوﻧﻠﻟ ﻲﻠﯾﺻﻔﺗ فﺻو ﻰﻠﻋ لوﺻﺣﻟا بﺟﯾ . لوﺣ ﺔﻠﺋﺳأ حرطا
ﺔﺑوﻧﻟا ﮫﯾﻓ تﺛدﺣ يذﻟا تﻗوﻟاو ،ﺔﯾادﺑﻟا ﻲﻓ ﺔﺻﺎﺧ ،ثدﺣﻟا ءﺎﻧﺛأ لﻔطﻟا كوﻠﺳ)ﺛﻣﻟا لﯾﺑﺳ ﻰﻠﻋ ،لﺎ
موﻧﻟا ءﺎﻧﺛأ وأ ،ظﺎﻘﯾﺗﺳﻻا ءﺎﻧﺛأ ،رﻛﺎﺑﻟا حﺎﺑﺻﻟا ﻲﻓ .(ﺔﻣﮭﻣ ﺔﺑوﻧﻟﺎﺑ تﻠﺟﻋ نوﻛﺗ دﻗ لﻣاوﻋ يأ.
ﺔﺑوﻧﻟا روطﺗو ةدﻣ ﺔظﺣﻼﻣ بﺟﯾ)تدﺟو نإ (
ﻲﻟﺎﺗﻟا كوﻠﺳﻟاو رﻋﺎﺷﻣﻟاو)كﺎﺑﺗرﻻا لﺛﻣ.(
• A long-term video EEG may be done to record the child during
wakefulness and sleep. Amplitude-integrated electroencephalography
(aEEG) monitoring is increasingly available in neonatal and pediatric
intensive care units.
•Nurses in a variety of settings are now being taught how to place a
EEG leads and obtain recordings. Although the EEG is valuable, it should
not be used alone to determine the type of seizure.
wakefulness and sleep. Amplitude-integrated electroencephalography
(aEEG) monitoring is increasingly available in neonatal and pediatric
intensive care units.
•Nurses in a variety of settings are now being taught how to place a
EEG leads and obtain recordings. Although the EEG is valuable, it should
not be used alone to determine the type of seizure.
Therapeutic Management
• The goal of treatment of seizures and epilepsy is to control the seizures
or to reduce their frequency and severity so that the child may live as
normal a life as possible. Discovering and correcting the underlying
cause of the seizures can lead to complete control of all seizures.
•If the seizure activity is a manifestation of an infectious, traumatic, or
metabolic process, the seizure therapy is instituted as part of the
general therapeutic regimen. There are four treatment options for
epilepsy: drug therapy, ketogenic diet therapy, vagus nerve stimulation
(VNS), and epilepsy surgery.
ردﻗ ﺔﯾﻌﯾﺑط ةﺎﯾﺣ لﻔطﻟا شﯾﻌﯾ ﻰﺗﺣ ﺎﮭﺗدﺷو ﺎھرارﻛﺗ لﯾﻠﻘﺗ وأ تﺎﺑوﻧﻟا ﻰﻠﻋ ةرطﯾﺳﻟا وھ عرﺻﻟاو تﺎﺑوﻧﻟا جﻼﻋ نﻣ فدﮭﻟا
نﺎﻛﻣﻹا .تﺎﺑوﻧﻟا ﻊﯾﻣﺟ ﻰﻠﻋ ﺔﻠﻣﺎﻛﻟا ةرطﯾﺳﻟا ﻰﻟإ يدؤﯾ نأ نﻛﻣﯾ ﮫﺣﯾﺣﺻﺗو تﺎﺑوﻧﻟا ءارو نﻣﺎﻛﻟا بﺑﺳﻟا فﺎﺷﺗﻛا نإ.
مﺎظﻧﻟا نﻣ ءزﺟﻛ تﺎﺑوﻧﻟا جﻼﻋ ءارﺟإ مﺗﯾ ،ﺔﯾﺑﻼﻘﺗﺳا وأ ﺔﻣﻟؤﻣ وأ ﺔﯾدﻌﻣ ﺔﯾﻠﻣﻋ رھﺎظﻣ نﻣ اًرﮭظﻣ تﺎﺑوﻧﻟا طﺎﺷﻧ نﺎﻛ اذإ
مﺎﻌﻟا ﻲﺟﻼﻌﻟا .عرﺻﻟا جﻼﻌﻟ تارﺎﯾﺧ ﺔﻌﺑرأ كﺎﻧھ :ﮭﺑﻣﻟا بﺻﻌﻟا زﯾﻔﺣﺗو ،ﻲﻧوﺗﯾﻛﻟا ﻲﺋاذﻐﻟا مﺎظﻧﻟﺎﺑ جﻼﻌﻟاو ،ﻲﺋاودﻟا جﻼﻌﻟا م
()عرﺻﻟا ﺔﺣارﺟو ،.
• The goal of treatment of seizures and epilepsy is to control the seizures
or to reduce their frequency and severity so that the child may live as
normal a life as possible. Discovering and correcting the underlying
cause of the seizures can lead to complete control of all seizures.
•If the seizure activity is a manifestation of an infectious, traumatic, or
metabolic process, the seizure therapy is instituted as part of the
general therapeutic regimen. There are four treatment options for
epilepsy: drug therapy, ketogenic diet therapy, vagus nerve stimulation
(VNS), and epilepsy surgery.
ردﻗ ﺔﯾﻌﯾﺑط ةﺎﯾﺣ لﻔطﻟا شﯾﻌﯾ ﻰﺗﺣ ﺎﮭﺗدﺷو ﺎھرارﻛﺗ لﯾﻠﻘﺗ وأ تﺎﺑوﻧﻟا ﻰﻠﻋ ةرطﯾﺳﻟا وھ عرﺻﻟاو تﺎﺑوﻧﻟا جﻼﻋ نﻣ فدﮭﻟا
نﺎﻛﻣﻹا .تﺎﺑوﻧﻟا ﻊﯾﻣﺟ ﻰﻠﻋ ﺔﻠﻣﺎﻛﻟا ةرطﯾﺳﻟا ﻰﻟإ يدؤﯾ نأ نﻛﻣﯾ ﮫﺣﯾﺣﺻﺗو تﺎﺑوﻧﻟا ءارو نﻣﺎﻛﻟا بﺑﺳﻟا فﺎﺷﺗﻛا نإ.
مﺎظﻧﻟا نﻣ ءزﺟﻛ تﺎﺑوﻧﻟا جﻼﻋ ءارﺟإ مﺗﯾ ،ﺔﯾﺑﻼﻘﺗﺳا وأ ﺔﻣﻟؤﻣ وأ ﺔﯾدﻌﻣ ﺔﯾﻠﻣﻋ رھﺎظﻣ نﻣ اًرﮭظﻣ تﺎﺑوﻧﻟا طﺎﺷﻧ نﺎﻛ اذإ
مﺎﻌﻟا ﻲﺟﻼﻌﻟا .عرﺻﻟا جﻼﻌﻟ تارﺎﯾﺧ ﺔﻌﺑرأ كﺎﻧھ :ﮭﺑﻣﻟا بﺻﻌﻟا زﯾﻔﺣﺗو ،ﻲﻧوﺗﯾﻛﻟا ﻲﺋاذﻐﻟا مﺎظﻧﻟﺎﺑ جﻼﻌﻟاو ،ﻲﺋاودﻟا جﻼﻌﻟا م
()عرﺻﻟا ﺔﺣارﺟو ،.
•The initiation of anticonvulsant therapy is based on several factors, including the child's age,
type of seizure, risk of recurrence, and other comorbid or predisposing medical issues. The
dosage is gradually increased until the seizures are controlled or the maximum recommended
dose has been reached and seizures are still not controlled. If a child develops intolerable side
effects, the medication is stopped and another one tried. Monotherapy remains the treatment
method of choice for epilepsy, but a combination of medications may be a viable alternative for
children who cannot attain seizure control with only one medication.
•A serious potential adverse side effect of antiepileptic medication is allergic drug rash. The rash
can start with hives and is usually very itchy. Allergic drug rashes from antiepileptic drugs can
spread quickly and become severe, life-threatening events. The drug should be stopped with any
rash.
•A physician or nurse practitioner should evaluate the child within 24 hours or sooner if the child
develops edema or respiratory problems.
•Treatment includes antihistamines, epinephrine, glucocorticoids, anabolic steroids, and/or
airway management depending on the severity of the reaction.
• ،ﺎھرارﻛﺗ رطﺧو ،ﺔﺑوﻧﻟا عوﻧو ،لﻔطﻟا رﻣﻋ كﻟذ ﻲﻓ ﺎﻣﺑ ،لﻣاوﻋ ةدﻋ ﻰﻠﻋ جﻼﺗﺧﻼﻟ دﺎﺿﻣﻟا جﻼﻌﻟا ءدﺑ دﻣﺗﻌﯾ
ﺔﺑھؤﻣﻟا وأ ﺔﺑﺣﺎﺻﻣﻟا ﺔﯾﺑطﻟا تﻼﻛﺷﻣﻟا نﻣ ﺎھرﯾﻏو . وأ تﺎﺑوﻧﻟا ﻰﻠﻋ ةرطﯾﺳﻟا مﺗﯾ ﻰﺗﺣ ًﺎﯾﺟﯾردﺗ ﺔﻋرﺟﻟا ةدﺎﯾز مﺗﯾ
ﺎﮭﯾﻠﻋ ةرطﯾﺳﻠﻟ ﺔﻠﺑﺎﻗ رﯾﻏ تﺎﺑوﻧﻟا لازﺗ ﻻو ﺎﮭﺑ ﻰﺻوﻣﻟا ىوﺻﻘﻟا ﺔﻋرﺟﻟا ﻰﻟإ لوﺻوﻟا .ﯾﺑﻧﺎﺟ رﺎﺛﺂﺑ لﻔطﻟا بﯾﺻأ اذإ ﺔ
رﺧآ ءاود ﺔﺑرﺟﺗو ءاودﻟا فﺎﻘﯾإ مﺗﯾ ،قﺎطﺗ ﻻ . نوﻛﺗ دﻗ نﻛﻟو ،عرﺻﻟا جﻼﻌﻟ ﺔﻠﺿﻔﻣﻟا ﺔﻘﯾرطﻟا وھ يدﺎﺣﻷا جﻼﻌﻟا لظﯾ
ﻓ دﺣاو ءاود مادﺧﺗﺳﺎﺑ تﺎﺑوﻧﻟا ﻰﻠﻋ ةرطﯾﺳﻟا نوﻌﯾطﺗﺳﯾ ﻻ نﯾذﻟا لﺎﻔطﻸﻟ ﻖﯾﺑطﺗﻠﻟ ًﻼﺑﺎﻗ ًﻼﯾدﺑ ﺔﯾودﻷا نﻣ ﺔﻋوﻣﺟﻣطﻘ.
•ﺔﯾﺳﺎﺳﺣﻟا نﻋ ﺞﺗﺎﻧﻟا يدﻠﺟﻟا ﺢﻔطﻟا وھ عرﺻﻠﻟ ةدﺎﺿﻣﻟا ﺔﯾودﻸﻟ ﺔﻠﻣﺗﺣﻣﻟا ةرﯾطﺧﻟا ﺔﯾﺑﻧﺎﺟﻟا رﺎﺛﻵا نﻣ .ﺣﺑ ﺎًﺑوﺣﺻﻣ نوﻛﯾ ﺎﻣ ًةدﺎﻋو ىرﺷﻟﺎﺑ يدﻠﺟﻟا ﺢﻔطﻟا أدﺑﯾ نأ نﻛﻣﯾ ﺔﻛ
ةدﯾدﺷ .ةﺎﯾﺣﻟا ددﮭﺗ ةرﯾطﺧ ثادﺣأ ﻰﻟإ لوﺣﺗﯾو ﺔﻋرﺳﺑ عرﺻﻠﻟ ةدﺎﺿﻣﻟا ﺔﯾودﻷا نﻋ ﺞﺗﺎﻧﻟا يدﻠﺟﻟا ﺢﻔطﻟا رﺷﺗﻧﯾ نأ نﻛﻣﯾ .يدﻠﺟ ﺢﻔط يأ روﮭظ دﻧﻋ ءاودﻟا فﺎﻘﯾإ بﺟﯾ.
• لﻼﺧ لﻔطﻟا مﯾﯾﻘﺗ سرﺎﻣﻣﻟا ﺔﺿرﻣﻣﻟا وأ بﯾﺑطﻟا ﻰﻠﻋ بﺟﯾ24ﺔﻣذو نﻣ ﻲﻧﺎﻌﯾ لﻔطﻟا نﺎﻛ اذإ كﻟذ لﺑﻗ وأ ﺔﻋﺎﺳ
ﻲﺳﻔﻧﺗﻟا زﺎﮭﺟﻟا ﻲﻓ لﻛﺎﺷﻣ وأ.
•،تادﯾوﻛﯾﺗروﻛوﻛوﻠﺟﻟاو ،نﯾرﻔﻧﯾﺑﻹاو ،نﯾﻣﺎﺗﺳﯾﮭﻟا تادﺎﺿﻣ جﻼﻌﻟا لﻣﺷﯾ
و ،ﺔﯾﺋﺎﻧﺗﺑﻻا تادﯾورﯾﺗﺳﻟاو/لﻋﺎﻔﺗﻟا ةدﺷ ﻰﻠﻋ اًدﺎﻣﺗﻋا ءاوﮭﻟا ىرﺟﻣ ةرادإ وأ.
type of seizure, risk of recurrence, and other comorbid or predisposing medical issues. The
dosage is gradually increased until the seizures are controlled or the maximum recommended
dose has been reached and seizures are still not controlled. If a child develops intolerable side
effects, the medication is stopped and another one tried. Monotherapy remains the treatment
method of choice for epilepsy, but a combination of medications may be a viable alternative for
children who cannot attain seizure control with only one medication.
•A serious potential adverse side effect of antiepileptic medication is allergic drug rash. The rash
can start with hives and is usually very itchy. Allergic drug rashes from antiepileptic drugs can
spread quickly and become severe, life-threatening events. The drug should be stopped with any
rash.
•A physician or nurse practitioner should evaluate the child within 24 hours or sooner if the child
develops edema or respiratory problems.
•Treatment includes antihistamines, epinephrine, glucocorticoids, anabolic steroids, and/or
airway management depending on the severity of the reaction.
• ،ﺎھرارﻛﺗ رطﺧو ،ﺔﺑوﻧﻟا عوﻧو ،لﻔطﻟا رﻣﻋ كﻟذ ﻲﻓ ﺎﻣﺑ ،لﻣاوﻋ ةدﻋ ﻰﻠﻋ جﻼﺗﺧﻼﻟ دﺎﺿﻣﻟا جﻼﻌﻟا ءدﺑ دﻣﺗﻌﯾ
ﺔﺑھؤﻣﻟا وأ ﺔﺑﺣﺎﺻﻣﻟا ﺔﯾﺑطﻟا تﻼﻛﺷﻣﻟا نﻣ ﺎھرﯾﻏو . وأ تﺎﺑوﻧﻟا ﻰﻠﻋ ةرطﯾﺳﻟا مﺗﯾ ﻰﺗﺣ ًﺎﯾﺟﯾردﺗ ﺔﻋرﺟﻟا ةدﺎﯾز مﺗﯾ
ﺎﮭﯾﻠﻋ ةرطﯾﺳﻠﻟ ﺔﻠﺑﺎﻗ رﯾﻏ تﺎﺑوﻧﻟا لازﺗ ﻻو ﺎﮭﺑ ﻰﺻوﻣﻟا ىوﺻﻘﻟا ﺔﻋرﺟﻟا ﻰﻟإ لوﺻوﻟا .ﯾﺑﻧﺎﺟ رﺎﺛﺂﺑ لﻔطﻟا بﯾﺻأ اذإ ﺔ
رﺧآ ءاود ﺔﺑرﺟﺗو ءاودﻟا فﺎﻘﯾإ مﺗﯾ ،قﺎطﺗ ﻻ . نوﻛﺗ دﻗ نﻛﻟو ،عرﺻﻟا جﻼﻌﻟ ﺔﻠﺿﻔﻣﻟا ﺔﻘﯾرطﻟا وھ يدﺎﺣﻷا جﻼﻌﻟا لظﯾ
ﻓ دﺣاو ءاود مادﺧﺗﺳﺎﺑ تﺎﺑوﻧﻟا ﻰﻠﻋ ةرطﯾﺳﻟا نوﻌﯾطﺗﺳﯾ ﻻ نﯾذﻟا لﺎﻔطﻸﻟ ﻖﯾﺑطﺗﻠﻟ ًﻼﺑﺎﻗ ًﻼﯾدﺑ ﺔﯾودﻷا نﻣ ﺔﻋوﻣﺟﻣطﻘ.
•ﺔﯾﺳﺎﺳﺣﻟا نﻋ ﺞﺗﺎﻧﻟا يدﻠﺟﻟا ﺢﻔطﻟا وھ عرﺻﻠﻟ ةدﺎﺿﻣﻟا ﺔﯾودﻸﻟ ﺔﻠﻣﺗﺣﻣﻟا ةرﯾطﺧﻟا ﺔﯾﺑﻧﺎﺟﻟا رﺎﺛﻵا نﻣ .ﺣﺑ ﺎًﺑوﺣﺻﻣ نوﻛﯾ ﺎﻣ ًةدﺎﻋو ىرﺷﻟﺎﺑ يدﻠﺟﻟا ﺢﻔطﻟا أدﺑﯾ نأ نﻛﻣﯾ ﺔﻛ
ةدﯾدﺷ .ةﺎﯾﺣﻟا ددﮭﺗ ةرﯾطﺧ ثادﺣأ ﻰﻟإ لوﺣﺗﯾو ﺔﻋرﺳﺑ عرﺻﻠﻟ ةدﺎﺿﻣﻟا ﺔﯾودﻷا نﻋ ﺞﺗﺎﻧﻟا يدﻠﺟﻟا ﺢﻔطﻟا رﺷﺗﻧﯾ نأ نﻛﻣﯾ .يدﻠﺟ ﺢﻔط يأ روﮭظ دﻧﻋ ءاودﻟا فﺎﻘﯾإ بﺟﯾ.
• لﻼﺧ لﻔطﻟا مﯾﯾﻘﺗ سرﺎﻣﻣﻟا ﺔﺿرﻣﻣﻟا وأ بﯾﺑطﻟا ﻰﻠﻋ بﺟﯾ24ﺔﻣذو نﻣ ﻲﻧﺎﻌﯾ لﻔطﻟا نﺎﻛ اذإ كﻟذ لﺑﻗ وأ ﺔﻋﺎﺳ
ﻲﺳﻔﻧﺗﻟا زﺎﮭﺟﻟا ﻲﻓ لﻛﺎﺷﻣ وأ.
•،تادﯾوﻛﯾﺗروﻛوﻛوﻠﺟﻟاو ،نﯾرﻔﻧﯾﺑﻹاو ،نﯾﻣﺎﺗﺳﯾﮭﻟا تادﺎﺿﻣ جﻼﻌﻟا لﻣﺷﯾ
و ،ﺔﯾﺋﺎﻧﺗﺑﻻا تادﯾورﯾﺗﺳﻟاو/لﻋﺎﻔﺗﻟا ةدﺷ ﻰﻠﻋ اًدﺎﻣﺗﻋا ءاوﮭﻟا ىرﺟﻣ ةرادإ وأ.
Nursing Care Management
• An important nursing responsibility is to observe the seizure episode
and accurately document the events. Any alterations in behavior
preceding the seizure and the characteristics of the episode, such as
sensory-hallucinatory phenomena (e.g., an aura), motor effects (e.g.,
eye movements, muscular contractions), alterations in consciousness,
and postictal state (e.g., behavior after the seizure), are noted and
recorded.
• The nurse should describe only what is observed rather than trying to
label a seizure type. Note the duration of the seizure.
ﺔﻗدﺑ ثادﺣﻷا ﻖﯾﺛوﺗو تﺎﺑوﻧﻟا ﺔﺑوﻧ ﺔﺑﻗارﻣ ﺔﻣﺎﮭﻟا ﺔﯾﺿﯾرﻣﺗﻟا تﺎﯾﻟوؤﺳﻣﻟا نﻣ . يأ
ﺔﯾﺳﺣﻟا ﺔﺳوﻠﮭﻟا رھاوظ لﺛﻣ ،ﺔﺑوﻧﻟا صﺋﺎﺻﺧو ﺔﺑوﻧﻟا ﻖﺑﺳﺗ كوﻠﺳﻟا ﻲﻓ تارﯾﻐﺗ)ﻣ لﺛ
ﺔﻟﺎﮭﻟا( ﺔﯾﻛرﺣﻟا تارﯾﺛﺄﺗﻟاو ،)ﺔﯾﻠﺿﻌﻟا تﺎﺻﻠﻘﺗﻟاو ،نﯾﻌﻟا تﺎﻛرﺣ لﺛﻣ(تارﯾﻐﺗﻟاو ،
ﺔﺑﺷﻧﻠﻟ ﺔﯾﻟﺎﺗﻟا ﺔﻟﺎﺣﻟاو ،ﻲﻋوﻟا ﻲﻓ)كوﻠﺳﻟا لﺛﻣ .(ﺔﺑوﻧﻟا دﻌﺑ(ﺟﺳﺗو ﺎﮭﻧﯾودﺗ مﺗﯾ ،ﺎﮭﻠﯾ.
ﺔﺑوﻧﻟا عوﻧ فﯾﻧﺻﺗ ﺔﻟوﺎﺣﻣ نﻣ ًﻻدﺑ ﮫﺗظﺣﻼﻣ تﻣﺗ ﺎﻣ طﻘﻓ فﺻﺗ نأ ﺔﺿرﻣﻣﻟا ﻰﻠﻋ بﺟﯾ .ﺔﺑوﻧﻟا ةدﻣ ظﺣﻻ.
• An important nursing responsibility is to observe the seizure episode
and accurately document the events. Any alterations in behavior
preceding the seizure and the characteristics of the episode, such as
sensory-hallucinatory phenomena (e.g., an aura), motor effects (e.g.,
eye movements, muscular contractions), alterations in consciousness,
and postictal state (e.g., behavior after the seizure), are noted and
recorded.
• The nurse should describe only what is observed rather than trying to
label a seizure type. Note the duration of the seizure.
ﺔﻗدﺑ ثادﺣﻷا ﻖﯾﺛوﺗو تﺎﺑوﻧﻟا ﺔﺑوﻧ ﺔﺑﻗارﻣ ﺔﻣﺎﮭﻟا ﺔﯾﺿﯾرﻣﺗﻟا تﺎﯾﻟوؤﺳﻣﻟا نﻣ . يأ
ﺔﯾﺳﺣﻟا ﺔﺳوﻠﮭﻟا رھاوظ لﺛﻣ ،ﺔﺑوﻧﻟا صﺋﺎﺻﺧو ﺔﺑوﻧﻟا ﻖﺑﺳﺗ كوﻠﺳﻟا ﻲﻓ تارﯾﻐﺗ)ﻣ لﺛ
ﺔﻟﺎﮭﻟا( ﺔﯾﻛرﺣﻟا تارﯾﺛﺄﺗﻟاو ،)ﺔﯾﻠﺿﻌﻟا تﺎﺻﻠﻘﺗﻟاو ،نﯾﻌﻟا تﺎﻛرﺣ لﺛﻣ(تارﯾﻐﺗﻟاو ،
ﺔﺑﺷﻧﻠﻟ ﺔﯾﻟﺎﺗﻟا ﺔﻟﺎﺣﻟاو ،ﻲﻋوﻟا ﻲﻓ)كوﻠﺳﻟا لﺛﻣ .(ﺔﺑوﻧﻟا دﻌﺑ(ﺟﺳﺗو ﺎﮭﻧﯾودﺗ مﺗﯾ ،ﺎﮭﻠﯾ.
ﺔﺑوﻧﻟا عوﻧ فﯾﻧﺻﺗ ﺔﻟوﺎﺣﻣ نﻣ ًﻻدﺑ ﮫﺗظﺣﻼﻣ تﻣﺗ ﺎﻣ طﻘﻓ فﺻﺗ نأ ﺔﺿرﻣﻣﻟا ﻰﻠﻋ بﺟﯾ .ﺔﺑوﻧﻟا ةدﻣ ظﺣﻻ.
Seizure Precautions
The extent of precautions depends on type, severity, and frequency of seizures. They may include:
•Side rails raised when child is sleeping or resting
•Side rails and other hard objects padded
•Waterproof mattress or pad on bed or crib
Appropriate precautions during potentially hazardous activities may include:
1.•Swimming with a companion
2.•Showers preferred; bathing only with close supervision
3.•Use of protective helmet and padding during bicycle riding, skateboarding, in-line skating
4.•Supervision during use of hazardous machinery or equipment
5.•Have child carry or wear medical identification.
6.•Alert other caregivers to need for any special precautions.
7.•Child may not drive or operate hazardous machinery or equipment unless seizure
free for designated period.
ﺎھرارﻛﺗو ﺎﮭﺗدﺷو تﺎﺑوﻧﻟا عوﻧ ﻰﻠﻋ تﺎطﺎﯾﺗﺣﻻا ىدﻣ دﻣﺗﻌﯾ .لﻣﺷﺗ دﻗ:
• ًﺎﺣﯾرﺗﺳﻣ وأ ًﺎﻣﺋﺎﻧ لﻔطﻟا نوﻛﯾ ﺎﻣدﻧﻋ ﺔﯾﺑﻧﺎﺟﻟا نﺎﺑﺿﻘﻟا ﻊﻓر مﺗﯾ
•ﺔﻧطﺑﻣ ىرﺧﻷا ﺔﺑﻠﺻﻟا ءﺎﯾﺷﻷاو ﺔﯾﺑﻧﺎﺟﻟا نﺎﺑﺿﻘﻟا
•لﺎﻔطﻷا رﯾرﺳ وأ رﯾرﺳﻟا ﻰﻠﻋ ءﺎﻣﻠﻟ ﺔﻣوﺎﻘﻣ ةدﺎﺳو وأ ﺔﺑﺗرﻣ
رطﺧ نوﻛﺗ نأ لﻣﺗﺣﯾ ﻲﺗﻟا ﺔطﺷﻧﻷا ءﺎﻧﺛأ ﺔﺑﺳﺎﻧﻣﻟا تﺎطﺎﯾﺗﺣﻻا لﻣﺷﺗ دﻗ ة
ﻲﻠﯾ ﺎﻣ:
1. •ﻖﻓارﻣ ﻊﻣ ﺔﺣﺎﺑﺳﻟا
2. •مﺎﻣﺣﺗﺳﻻا لﺿﻔﯾ .ﻖﯾﻗد فارﺷإ تﺣﺗ طﻘﻓ مﺎﻣﺣﺗﺳﻻا
3. • ،ﺞﻟزﺗﻟاو ،تﺎﺟاردﻟا بوﻛر ءﺎﻧﺛأ ةوﺷﺣﻟاو ﺔﯾﻗاوﻟا ةذوﺧﻟا مادﺧﺗﺳا
دﯾﻠﺟﻟا ﻰﻠﻋ ﺞﻟزﺗﻟاو
4.•Supervision ةرطﺧﻟا تادﻌﻣﻟا وأ تﻻﻵا مادﺧﺗﺳا ءﺎﻧﺛأ
5. •ﺔﯾﺑطﻟا ﺔﯾوﮭﻟا يدﺗرﯾ وأ لﻣﺣﯾ لﻔطﻟا لﻌﺟا.
6. • تﺎطﺎﯾﺗﺣا يأ ذﺎﺧﺗا ةرورﺿ ﻰﻟإ نﯾرﺧﻵا ﺔﯾﺎﻋرﻟا ﻲﻣدﻘﻣ ﮫﯾﺑﻧﺗ
ﺔﺻﺎﺧ.
7. • ةرطﺧﻟا تادﻌﻣﻟا وأ تﻻﻵا لﯾﻐﺷﺗ وأ ةرﺎﯾﺳﻟا ةدﺎﯾﻗ لﻔطﻠﻟ زوﺟﯾ ﻻ
ةددﺣﻣ ةرﺗﻔﻟ تﺎﺑوﻧﻟا نﻣ ﺎًﯾﻟﺎﺧ نﺎﻛ اذإ ﻻإ.
The extent of precautions depends on type, severity, and frequency of seizures. They may include:
•Side rails raised when child is sleeping or resting
•Side rails and other hard objects padded
•Waterproof mattress or pad on bed or crib
Appropriate precautions during potentially hazardous activities may include:
1.•Swimming with a companion
2.•Showers preferred; bathing only with close supervision
3.•Use of protective helmet and padding during bicycle riding, skateboarding, in-line skating
4.•Supervision during use of hazardous machinery or equipment
5.•Have child carry or wear medical identification.
6.•Alert other caregivers to need for any special precautions.
7.•Child may not drive or operate hazardous machinery or equipment unless seizure
free for designated period.
ﺎھرارﻛﺗو ﺎﮭﺗدﺷو تﺎﺑوﻧﻟا عوﻧ ﻰﻠﻋ تﺎطﺎﯾﺗﺣﻻا ىدﻣ دﻣﺗﻌﯾ .لﻣﺷﺗ دﻗ:
• ًﺎﺣﯾرﺗﺳﻣ وأ ًﺎﻣﺋﺎﻧ لﻔطﻟا نوﻛﯾ ﺎﻣدﻧﻋ ﺔﯾﺑﻧﺎﺟﻟا نﺎﺑﺿﻘﻟا ﻊﻓر مﺗﯾ
•ﺔﻧطﺑﻣ ىرﺧﻷا ﺔﺑﻠﺻﻟا ءﺎﯾﺷﻷاو ﺔﯾﺑﻧﺎﺟﻟا نﺎﺑﺿﻘﻟا
•لﺎﻔطﻷا رﯾرﺳ وأ رﯾرﺳﻟا ﻰﻠﻋ ءﺎﻣﻠﻟ ﺔﻣوﺎﻘﻣ ةدﺎﺳو وأ ﺔﺑﺗرﻣ
رطﺧ نوﻛﺗ نأ لﻣﺗﺣﯾ ﻲﺗﻟا ﺔطﺷﻧﻷا ءﺎﻧﺛأ ﺔﺑﺳﺎﻧﻣﻟا تﺎطﺎﯾﺗﺣﻻا لﻣﺷﺗ دﻗ ة
ﻲﻠﯾ ﺎﻣ:
1. •ﻖﻓارﻣ ﻊﻣ ﺔﺣﺎﺑﺳﻟا
2. •مﺎﻣﺣﺗﺳﻻا لﺿﻔﯾ .ﻖﯾﻗد فارﺷإ تﺣﺗ طﻘﻓ مﺎﻣﺣﺗﺳﻻا
3. • ،ﺞﻟزﺗﻟاو ،تﺎﺟاردﻟا بوﻛر ءﺎﻧﺛأ ةوﺷﺣﻟاو ﺔﯾﻗاوﻟا ةذوﺧﻟا مادﺧﺗﺳا
دﯾﻠﺟﻟا ﻰﻠﻋ ﺞﻟزﺗﻟاو
4.•Supervision ةرطﺧﻟا تادﻌﻣﻟا وأ تﻻﻵا مادﺧﺗﺳا ءﺎﻧﺛأ
5. •ﺔﯾﺑطﻟا ﺔﯾوﮭﻟا يدﺗرﯾ وأ لﻣﺣﯾ لﻔطﻟا لﻌﺟا.
6. • تﺎطﺎﯾﺗﺣا يأ ذﺎﺧﺗا ةرورﺿ ﻰﻟإ نﯾرﺧﻵا ﺔﯾﺎﻋرﻟا ﻲﻣدﻘﻣ ﮫﯾﺑﻧﺗ
ﺔﺻﺎﺧ.
7. • ةرطﺧﻟا تادﻌﻣﻟا وأ تﻻﻵا لﯾﻐﺷﺗ وأ ةرﺎﯾﺳﻟا ةدﺎﯾﻗ لﻔطﻠﻟ زوﺟﯾ ﻻ
ةددﺣﻣ ةرﺗﻔﻟ تﺎﺑوﻧﻟا نﻣ ﺎًﯾﻟﺎﺧ نﺎﻛ اذإ ﻻإ.
Febrile Seizures
•A febrile seizure is a seizure associated with a febrile illness in a child who does not have a
CNS infection. Febrile seizures are the single most common seizure type, occurring in 2% to
5% of children between the ages of 1 month and 5 years.
•There is evidence for both genetic and environmental causes for febrile seizures. Children
with a family history of febrile seizures are at increased risk for both a single febrile seizure
(10% to 46%) and for recurrent febrile seizures. Environmental factors that have been
implicated include viral illness and an age of younger than 18 months old .
Initial treatment consists of administering a benzodiazepine: IV lorazepam; IV or rectal
diazepam; or IV, buccal, or intranasal midazolam. The majority of children with febrile status
epilepticus will require administration of multiple antiepileptic medications for seizure control.
Parental education and emotional support are important interventions. Parents need
reassurance that children who have had febrile seizures but do not have underlying
developmental problems will perform as well as other children academically and behaviorally.
• ىودﻋ نﻣ ﻲﻧﺎﻌﯾ ﻻ لﻔط ىدﻟ يوﻣﺣ ضرﻣﺑ ﺔطﺑﺗرﻣ ﺔﺑوﻧ ﻲھ ﺔﯾوﻣﺣﻟا ﺔﺑوﻧﻟا
يزﻛرﻣﻟا ﻲﺑﺻﻌﻟا زﺎﮭﺟﻟا . ،ﺎًﻋوﯾﺷ تﺎﺑوﻧﻟا عاوﻧأ رﺛﻛأ ﻲھ ﺔﯾوﻣﺣﻟا تﺎﺑوﻧﻟا
ىدﻟ ثدﺣﺗو2 % ﻰﻟإ5 % دﺣاو رﮭﺷ نﯾﺑ مھرﺎﻣﻋأ حوارﺗﺗ نﯾذﻟا لﺎﻔطﻷا نﻣ
و5تاوﻧﺳ.
•ﺔﯾوﻣﺣﻟا تﺎﺑوﻧﻠﻟ ﺔﯾﺋﯾﺑو ﺔﯾﺛارو بﺎﺑﺳأ دوﺟو ﻰﻠﻋ ﺔﻟدأ كﺎﻧھ .نﻣ ﻲﻠﺋﺎﻋ ﺦﯾرﺎﺗ مﮭﯾدﻟ نﯾذﻟا لﺎﻔطﻷا
ةدﺣاو ﺔﯾوﻣﺣ ﺔﺑوﻧﺑ ﺔﺑﺎﺻﻺﻟ ﺔﺿرﻋ رﺛﻛأ نوﻧوﻛﯾ ﺔﯾوﻣﺣﻟا تﺎﺑوﻧﻟا)10 % ﻰﻟإ46 (% تﺎﺑوﻧﻠﻟو
ةررﻛﺗﻣﻟا ﺔﯾوﻣﺣﻟا . نﻣ لﻗأ رﻣﻋو ﻲﺳورﯾﻔﻟا ضرﻣﻟا ﺔطروﺗﻣﻟا ﺔﯾﺋﯾﺑﻟا لﻣاوﻌﻟا لﻣﺷﺗو18اًرﮭﺷ.
نﯾﺑﯾزﺎﯾدوزﻧﺑﻟا ءﺎطﻋإ نﻣ ﻲﻟوﻷا جﻼﻌﻟا نوﻛﺗﯾ : IV مﺎﺑﯾزاروﻟ .
مﯾﻘﺗﺳﻣﻟا وأ يدﯾروﻟا مﺎﺑﯾزﺎﯾدﻟا . نﻋ مﻻوزادﯾﻣﻟا وأ ،قدﺷﻟا ،دﯾروﻟا وأ
فﻧﻷا ﻖﯾرط . عرﺻﻟا ﺔﻟﺎﺣ نﻣ نوﻧﺎﻌﯾ نﯾذﻟا لﺎﻔطﻷا ﺔﯾﺑﻟﺎﻏ بﻠطﺗﯾﺳ
تﺎﺑوﻧﻟا ﻰﻠﻋ ةرطﯾﺳﻠﻟ عرﺻﻠﻟ ةدﺎﺿﻣ ةددﻌﺗﻣ ﺔﯾودأ ءﺎطﻋإ ﺔﯾوﻣﺣﻟا
ﺔﻣﮭﻣﻟا تﻼﺧدﺗﻟا نﻣ ﻲﻔطﺎﻌﻟا مﻋدﻟاو نﯾدﻟاوﻟا فﯾﻘﺛﺗ دﻌﯾ .ﺑﻵا جﺎﺗﺣﯾ ءﺎ
سﯾﻟ نﻛﻟو ﺔﯾوﻣﺣ تﺎﺑوﻧﺑ اوﺑﯾﺻأ نﯾذﻟا لﺎﻔطﻷا نﺄﺑ ﺔﻧﯾﻧﺄﻣطﻟا ﻰﻟإ
لﺛﻣ ﺎًﯾﻛوﻠﺳو ﺎًﯾﻣﯾدﺎﻛأ مھؤادأ نوﻛﯾ فوﺳ ﺔﻧﻣﺎﻛ ﺔﯾوﻣﻧﺗ لﻛﺎﺷﻣ مﮭﯾدﻟ
نﯾرﺧﻵا لﺎﻔطﻷا.
•A febrile seizure is a seizure associated with a febrile illness in a child who does not have a
CNS infection. Febrile seizures are the single most common seizure type, occurring in 2% to
5% of children between the ages of 1 month and 5 years.
•There is evidence for both genetic and environmental causes for febrile seizures. Children
with a family history of febrile seizures are at increased risk for both a single febrile seizure
(10% to 46%) and for recurrent febrile seizures. Environmental factors that have been
implicated include viral illness and an age of younger than 18 months old .
Initial treatment consists of administering a benzodiazepine: IV lorazepam; IV or rectal
diazepam; or IV, buccal, or intranasal midazolam. The majority of children with febrile status
epilepticus will require administration of multiple antiepileptic medications for seizure control.
Parental education and emotional support are important interventions. Parents need
reassurance that children who have had febrile seizures but do not have underlying
developmental problems will perform as well as other children academically and behaviorally.
• ىودﻋ نﻣ ﻲﻧﺎﻌﯾ ﻻ لﻔط ىدﻟ يوﻣﺣ ضرﻣﺑ ﺔطﺑﺗرﻣ ﺔﺑوﻧ ﻲھ ﺔﯾوﻣﺣﻟا ﺔﺑوﻧﻟا
يزﻛرﻣﻟا ﻲﺑﺻﻌﻟا زﺎﮭﺟﻟا . ،ﺎًﻋوﯾﺷ تﺎﺑوﻧﻟا عاوﻧأ رﺛﻛأ ﻲھ ﺔﯾوﻣﺣﻟا تﺎﺑوﻧﻟا
ىدﻟ ثدﺣﺗو2 % ﻰﻟإ5 % دﺣاو رﮭﺷ نﯾﺑ مھرﺎﻣﻋأ حوارﺗﺗ نﯾذﻟا لﺎﻔطﻷا نﻣ
و5تاوﻧﺳ.
•ﺔﯾوﻣﺣﻟا تﺎﺑوﻧﻠﻟ ﺔﯾﺋﯾﺑو ﺔﯾﺛارو بﺎﺑﺳأ دوﺟو ﻰﻠﻋ ﺔﻟدأ كﺎﻧھ .نﻣ ﻲﻠﺋﺎﻋ ﺦﯾرﺎﺗ مﮭﯾدﻟ نﯾذﻟا لﺎﻔطﻷا
ةدﺣاو ﺔﯾوﻣﺣ ﺔﺑوﻧﺑ ﺔﺑﺎﺻﻺﻟ ﺔﺿرﻋ رﺛﻛأ نوﻧوﻛﯾ ﺔﯾوﻣﺣﻟا تﺎﺑوﻧﻟا)10 % ﻰﻟإ46 (% تﺎﺑوﻧﻠﻟو
ةررﻛﺗﻣﻟا ﺔﯾوﻣﺣﻟا . نﻣ لﻗأ رﻣﻋو ﻲﺳورﯾﻔﻟا ضرﻣﻟا ﺔطروﺗﻣﻟا ﺔﯾﺋﯾﺑﻟا لﻣاوﻌﻟا لﻣﺷﺗو18اًرﮭﺷ.
نﯾﺑﯾزﺎﯾدوزﻧﺑﻟا ءﺎطﻋإ نﻣ ﻲﻟوﻷا جﻼﻌﻟا نوﻛﺗﯾ : IV مﺎﺑﯾزاروﻟ .
مﯾﻘﺗﺳﻣﻟا وأ يدﯾروﻟا مﺎﺑﯾزﺎﯾدﻟا . نﻋ مﻻوزادﯾﻣﻟا وأ ،قدﺷﻟا ،دﯾروﻟا وأ
فﻧﻷا ﻖﯾرط . عرﺻﻟا ﺔﻟﺎﺣ نﻣ نوﻧﺎﻌﯾ نﯾذﻟا لﺎﻔطﻷا ﺔﯾﺑﻟﺎﻏ بﻠطﺗﯾﺳ
تﺎﺑوﻧﻟا ﻰﻠﻋ ةرطﯾﺳﻠﻟ عرﺻﻠﻟ ةدﺎﺿﻣ ةددﻌﺗﻣ ﺔﯾودأ ءﺎطﻋإ ﺔﯾوﻣﺣﻟا
ﺔﻣﮭﻣﻟا تﻼﺧدﺗﻟا نﻣ ﻲﻔطﺎﻌﻟا مﻋدﻟاو نﯾدﻟاوﻟا فﯾﻘﺛﺗ دﻌﯾ .ﺑﻵا جﺎﺗﺣﯾ ءﺎ
سﯾﻟ نﻛﻟو ﺔﯾوﻣﺣ تﺎﺑوﻧﺑ اوﺑﯾﺻأ نﯾذﻟا لﺎﻔطﻷا نﺄﺑ ﺔﻧﯾﻧﺄﻣطﻟا ﻰﻟإ
لﺛﻣ ﺎًﯾﻛوﻠﺳو ﺎًﯾﻣﯾدﺎﻛأ مھؤادأ نوﻛﯾ فوﺳ ﺔﻧﻣﺎﻛ ﺔﯾوﻣﻧﺗ لﻛﺎﺷﻣ مﮭﯾدﻟ
نﯾرﺧﻵا لﺎﻔطﻷا.
Cerebral Malformation- Hydrocephalus
• Hydrocephalus is a condition caused by an imbalance in the
production and absorption of CSF in the ventricular system.
• The causes of hydrocephalus are varied, but the result is either (1) impaired
absorption of CSF within the subarachnoid space, obliteration of the subarachnoid
cisterns, or malfunction of the arachnoid villi (nonobstructive or communicating
hydrocephalus) or (2) obstruction to the flow of CSF through the ventricular system
(obstructive or noncommunicating hydrocephalus).
•In children younger than 12 years old, previously closed suture lines, especially
the sagittal suture, may become diastatic or opened. After 12 years old, the sutures
are fused and will not open.
جﺎﺗﻧإ ﻲﻓ لﻠﺧ نﻋ ﺔﻣﺟﺎﻧ ﺔﻟﺎﺣ وھ سأرﻟا ءﺎﻘﺳﺗﺳا
ﻲﻧﯾطﺑﻟا زﺎﮭﺟﻟا ﻲﻓ ﻲﻛوﺷﻟا ﻲﻏﺎﻣدﻟا لﺋﺎﺳﻟا صﺎﺻﺗﻣاو.
ﺎﻣإ ﻲھ ﺔﺟﯾﺗﻧﻟا نﻛﻟو ،سأرﻟا ءﺎﻘﺳﺗﺳا بﺎﺑﺳأ عوﻧﺗﺗ)1 (
تﺣﺗ زﯾﺣﻟا لﺧاد ﻲﻛوﺷﻟا ﻲﻏﺎﻣدﻟا لﺋﺎﺳﻟا صﺎﺻﺗﻣا فﻌﺿ
ﻓ لﻠﺧ وأ ،ﺔﯾﺗوﺑﻛﻧﻌﻟا تﺣﺗ ﺞﯾرﺎﮭﺻﻟا سﻣط وأ ،ﺔﯾﺗوﺑﻛﻧﻌﻟا ﻲ
ﺔﯾﺗوﺑﻛﻧﻌﻟا تﺎﺑﺎﻏزﻟا) وأ يدادﺳﻧﻻا رﯾﻏ سأرﻟا ءﺎﻘﺳﺗﺳا
لﺻﺗﻣﻟا ( وأ)2 ( ﻖﻓدﺗﻟا ﺔﻠﻗرﻋ CSF مﺎظﻧ لﻼﺧ نﻣ
نﯾطﺑﻟا)لﺻﺗﻣﻟا رﯾﻏ وأ يدادﺳﻧﻻا سأرﻟا ءﺎﻘﺳﺗﺳا(
نﻋ مھرﺎﻣﻋأ لﻘﺗ نﯾذﻟا لﺎﻔطﻷا ﻲﻓ12 طوطﺧ ﺢﺑﺻﺗ دﻗ ،ﺎًﻣﺎﻋ
ﺔﺣوﺗﻔﻣ وأ ﺔﯾطﺎﺳﺑﻧا ،ﻲﻣﮭﺳﻟا زردﻟا ﺔﺻﺎﺧو ،ﺎًﻘﺑﺎﺳ ﺔﻘﻠﻐﻣﻟا زرﻐﻟا .
رﻣﻋ دﻌﺑ12ﺢﺗﻔﻧﺗ ﻻو زرﻐﻟا ﺞﻣد مﺗﯾ ،ﺔﻧﺳ.
• Hydrocephalus is a condition caused by an imbalance in the
production and absorption of CSF in the ventricular system.
• The causes of hydrocephalus are varied, but the result is either (1) impaired
absorption of CSF within the subarachnoid space, obliteration of the subarachnoid
cisterns, or malfunction of the arachnoid villi (nonobstructive or communicating
hydrocephalus) or (2) obstruction to the flow of CSF through the ventricular system
(obstructive or noncommunicating hydrocephalus).
•In children younger than 12 years old, previously closed suture lines, especially
the sagittal suture, may become diastatic or opened. After 12 years old, the sutures
are fused and will not open.
جﺎﺗﻧإ ﻲﻓ لﻠﺧ نﻋ ﺔﻣﺟﺎﻧ ﺔﻟﺎﺣ وھ سأرﻟا ءﺎﻘﺳﺗﺳا
ﻲﻧﯾطﺑﻟا زﺎﮭﺟﻟا ﻲﻓ ﻲﻛوﺷﻟا ﻲﻏﺎﻣدﻟا لﺋﺎﺳﻟا صﺎﺻﺗﻣاو.
ﺎﻣإ ﻲھ ﺔﺟﯾﺗﻧﻟا نﻛﻟو ،سأرﻟا ءﺎﻘﺳﺗﺳا بﺎﺑﺳأ عوﻧﺗﺗ)1 (
تﺣﺗ زﯾﺣﻟا لﺧاد ﻲﻛوﺷﻟا ﻲﻏﺎﻣدﻟا لﺋﺎﺳﻟا صﺎﺻﺗﻣا فﻌﺿ
ﻓ لﻠﺧ وأ ،ﺔﯾﺗوﺑﻛﻧﻌﻟا تﺣﺗ ﺞﯾرﺎﮭﺻﻟا سﻣط وأ ،ﺔﯾﺗوﺑﻛﻧﻌﻟا ﻲ
ﺔﯾﺗوﺑﻛﻧﻌﻟا تﺎﺑﺎﻏزﻟا) وأ يدادﺳﻧﻻا رﯾﻏ سأرﻟا ءﺎﻘﺳﺗﺳا
لﺻﺗﻣﻟا ( وأ)2 ( ﻖﻓدﺗﻟا ﺔﻠﻗرﻋ CSF مﺎظﻧ لﻼﺧ نﻣ
نﯾطﺑﻟا)لﺻﺗﻣﻟا رﯾﻏ وأ يدادﺳﻧﻻا سأرﻟا ءﺎﻘﺳﺗﺳا(
نﻋ مھرﺎﻣﻋأ لﻘﺗ نﯾذﻟا لﺎﻔطﻷا ﻲﻓ12 طوطﺧ ﺢﺑﺻﺗ دﻗ ،ﺎًﻣﺎﻋ
ﺔﺣوﺗﻔﻣ وأ ﺔﯾطﺎﺳﺑﻧا ،ﻲﻣﮭﺳﻟا زردﻟا ﺔﺻﺎﺧو ،ﺎًﻘﺑﺎﺳ ﺔﻘﻠﻐﻣﻟا زرﻐﻟا .
رﻣﻋ دﻌﺑ12ﺢﺗﻔﻧﺗ ﻻو زرﻐﻟا ﺞﻣد مﺗﯾ ،ﺔﻧﺳ.
Causes
Most cases of hydrocephalus are a result of developmental malformations. Other
causes include neoplasms, CNS infections, and trauma. Developmental defects
(e.g., Chiari malformations, aqueduct stenosis, aqueduct gliosis, and atresia of the
foramina of Luschka and Magendie [Dandy-Walker syndrome]) account for most
cases of hydrocephalus from birth to 2 years old. Hydrocephalus is so often
associated with myelomeningocele that all such infants should be observed for its
development.
In some cases, there is a history of intrauterine infection, hemorrhage, and
neonatal meningoencephalitis.
In older children, hydrocephalus is most often a result of intracranial masses,
intracranial infections, hemorrhage, preexisting developmental defects (e.g.,
aqueduct stenosis, Chiari malformation), or trauma.
وﻣﻧﻟا ﻲﻓ تﺎھوﺷﺗﻟ ﺔﺟﯾﺗﻧ نوﻛﺗ سأرﻟا ءﺎﻘﺳﺗﺳا تﻻﺎﺣ مظﻌﻣ . ماروﻷا ىرﺧﻷا بﺎﺑﺳﻷا لﻣﺷﺗو
تﺎﻣدﺻﻟاو يزﻛرﻣﻟا ﻲﺑﺻﻌﻟا زﺎﮭﺟﻟا تﺎﺑﺎﮭﺗﻟاو . ﺔﯾﺋﺎﻣﻧﻟا بوﯾﻌﻟا لﺛﻣﺗ) تﺎھوﺷﺗﻟا لﺛﻣ
يدﻧﯾﺟﺎﻣو ﺎﻛﺷوﻟ ﻲﺑﻘﺛ ﻖﺗرو ،ةﺎﻧﻘﻟا قﺎﺑدو ،هﺎﯾﻣﻟا ةﺎﻧﻗ ﻖﯾﺿﺗو ،ﺔﯾرﺎﯾﺧﻟا] يدﻧاد ﺔﻣزﻼﺗﻣ
رﻛوو ([نﯾﻣﺎﻋ رﻣﻋ ﻰﺗﺣو ةدﻻوﻟا ذﻧﻣ سأرﻟا ءﺎﻘﺳﺗﺳا تﻻﺎﺣ مظﻌﻣ . ءﺎﻘﺳﺗﺳا طﺑﺗرﯾ ﺎﻣ ﺎًﺑﻟﺎﻏ
هروطﺗ لﺟأ نﻣ لﺎﻔطﻷا ءﻻؤھ ﻊﯾﻣﺟ ﺔظﺣﻼﻣ ﻲﻐﺑﻧﯾ اذﻟ ،ﺔﯾﺋﺎﺣﺳﻟا ﺔﯾوﻘﻧﻟا ﺔﻠﯾﻘﻟﺎﺑ سأرﻟا.
ﺎﯾﺎﺣﺳﻟا بﺎﮭﺗﻟاو ،فﯾزﻧﻟاو ،مﺣرﻟا لﺧاد ىودﻌﻟا نﻣ ﺦﯾرﺎﺗ كﺎﻧھ نوﻛﯾ ،تﻻﺎﺣﻟا ضﻌﺑ ﻲﻓ
يدﯾﻟوﻟا غﺎﻣدﻟاو.
ﺑﺎﮭﺗﻟا وأ ،ﺔﻣﺟﻣﺟﻟا لﺧاد لﺗﻛﻟ ﺔﺟﯾﺗﻧ ﺎًﺑﻟﺎﻏ سأرﻟا ءﺎﻘﺳﺗﺳا نوﻛﯾ ،ﺎًﻧﺳ رﺑﻛﻷا لﺎﻔطﻷا ﻲﻓ تﺎ
ﺎًﻘﺑﺳﻣ ةدوﺟوﻣ وﻣﻧ بوﯾﻋ وأ ،فﯾزﻧ وأ ،ﺔﻣﺟﻣﺟﻟا لﺧاد) هوﺷﺗ وأ ،هﺎﯾﻣﻟا ةﺎﻧﻗ ﻖﯾﺿﺗ لﺛﻣ
يرﺎﯾﺧ(ﺔﻣدﺻ وأ ،.
Most cases of hydrocephalus are a result of developmental malformations. Other
causes include neoplasms, CNS infections, and trauma. Developmental defects
(e.g., Chiari malformations, aqueduct stenosis, aqueduct gliosis, and atresia of the
foramina of Luschka and Magendie [Dandy-Walker syndrome]) account for most
cases of hydrocephalus from birth to 2 years old. Hydrocephalus is so often
associated with myelomeningocele that all such infants should be observed for its
development.
In some cases, there is a history of intrauterine infection, hemorrhage, and
neonatal meningoencephalitis.
In older children, hydrocephalus is most often a result of intracranial masses,
intracranial infections, hemorrhage, preexisting developmental defects (e.g.,
aqueduct stenosis, Chiari malformation), or trauma.
وﻣﻧﻟا ﻲﻓ تﺎھوﺷﺗﻟ ﺔﺟﯾﺗﻧ نوﻛﺗ سأرﻟا ءﺎﻘﺳﺗﺳا تﻻﺎﺣ مظﻌﻣ . ماروﻷا ىرﺧﻷا بﺎﺑﺳﻷا لﻣﺷﺗو
تﺎﻣدﺻﻟاو يزﻛرﻣﻟا ﻲﺑﺻﻌﻟا زﺎﮭﺟﻟا تﺎﺑﺎﮭﺗﻟاو . ﺔﯾﺋﺎﻣﻧﻟا بوﯾﻌﻟا لﺛﻣﺗ) تﺎھوﺷﺗﻟا لﺛﻣ
يدﻧﯾﺟﺎﻣو ﺎﻛﺷوﻟ ﻲﺑﻘﺛ ﻖﺗرو ،ةﺎﻧﻘﻟا قﺎﺑدو ،هﺎﯾﻣﻟا ةﺎﻧﻗ ﻖﯾﺿﺗو ،ﺔﯾرﺎﯾﺧﻟا] يدﻧاد ﺔﻣزﻼﺗﻣ
رﻛوو ([نﯾﻣﺎﻋ رﻣﻋ ﻰﺗﺣو ةدﻻوﻟا ذﻧﻣ سأرﻟا ءﺎﻘﺳﺗﺳا تﻻﺎﺣ مظﻌﻣ . ءﺎﻘﺳﺗﺳا طﺑﺗرﯾ ﺎﻣ ﺎًﺑﻟﺎﻏ
هروطﺗ لﺟأ نﻣ لﺎﻔطﻷا ءﻻؤھ ﻊﯾﻣﺟ ﺔظﺣﻼﻣ ﻲﻐﺑﻧﯾ اذﻟ ،ﺔﯾﺋﺎﺣﺳﻟا ﺔﯾوﻘﻧﻟا ﺔﻠﯾﻘﻟﺎﺑ سأرﻟا.
ﺎﯾﺎﺣﺳﻟا بﺎﮭﺗﻟاو ،فﯾزﻧﻟاو ،مﺣرﻟا لﺧاد ىودﻌﻟا نﻣ ﺦﯾرﺎﺗ كﺎﻧھ نوﻛﯾ ،تﻻﺎﺣﻟا ضﻌﺑ ﻲﻓ
يدﯾﻟوﻟا غﺎﻣدﻟاو.
ﺑﺎﮭﺗﻟا وأ ،ﺔﻣﺟﻣﺟﻟا لﺧاد لﺗﻛﻟ ﺔﺟﯾﺗﻧ ﺎًﺑﻟﺎﻏ سأرﻟا ءﺎﻘﺳﺗﺳا نوﻛﯾ ،ﺎًﻧﺳ رﺑﻛﻷا لﺎﻔطﻷا ﻲﻓ تﺎ
ﺎًﻘﺑﺳﻣ ةدوﺟوﻣ وﻣﻧ بوﯾﻋ وأ ،فﯾزﻧ وأ ،ﺔﻣﺟﻣﺟﻟا لﺧاد) هوﺷﺗ وأ ،هﺎﯾﻣﻟا ةﺎﻧﻗ ﻖﯾﺿﺗ لﺛﻣ
يرﺎﯾﺧ(ﺔﻣدﺻ وأ ،.
Clinical Manifestations
•In infancy, before closure of the cranial sutures, head enlargement (increasing occipitofrontal
circumference) is the predominant sign, but in older infants and children, the lesions responsible
for hydrocephalus produce other neurologic signs through pressure on adjacent structures.
•In infants with hydrocephalus, the head grows at an abnormal rate, although the first signs may
be bulging fontanels. The anterior fontanel is tense, often bulging and non-pulsatile. Scalp veins
are dilated, especially when the infant cries. With the increase in intracranial volume, skull bones
become thin and the sutures become palpably separated to produce a cracked-pot sound
(Macewen sign) on percussion of the skull. In severe cases, infants display frontal protrusion
(frontal bossing) with depressed eyes and the eyes may be rotated downward (setting-sun sign).
Pupils are sluggish, with unequal responses to light.
•The signs and symptoms in early to late childhood are primarily those associated with space-
occupying lesions (e.g., headaches on awakening with improvement after emesis or being in an
upright position, strabismus, ataxia).
• سأرﻟا مﺧﺿﺗ نوﻛﯾ ،ﺔﻣﺟﻣﺟﻟا طوﯾﺧ قﻼﻏإ لﺑﻗ ،ﺔﻟوﻔطﻟا ﺔﻠﺣرﻣ ﻲﻓ
)ﻲﮭﺑﺟﻟا ﻲﻟاذﻘﻟا طﯾﺣﻣﻟا ةدﺎﯾز ( ﻊﺿرﻟا دﻧﻋ نﻛﻟو ،ةدﺋﺎﺳﻟا ﺔﻣﻼﻌﻟا وھ
سأرﻟا ءﺎﻘﺳﺗﺳا نﻋ ﺔﻟوؤﺳﻣﻟا تﺎﻓﻵا ﺞﺗﻧﺗ ،ﺎًﻧﺳ رﺑﻛﻷا لﺎﻔطﻷاو
ةروﺎﺟﻣﻟا لﻛﺎﯾﮭﻟا ﻰﻠﻋ طﻐﺿﻟا لﻼﺧ نﻣ ىرﺧأ ﺔﯾﺑﺻﻋ تﺎﻣﻼﻋ.
• تﺎﻣﻼﻌﻟا نأ نﻣ مﻏرﻟا ﻰﻠﻋ ،ﻲﻌﯾﺑط رﯾﻏ لدﻌﻣﺑ سأرﻟا وﻣﻧﯾ ،سأرﻟا ءﺎﻘﺳﺗﺳﺎﺑ نﯾﺑﺎﺻﻣﻟا ﻊﺿرﻟا دﻧﻋ
خوﻓﺎﯾﻟا خﺎﻔﺗﻧا نوﻛﺗ دﻗ ﻰﻟوﻷا .ضﺑﺎﻧ رﯾﻏو ﺎًﺧﻔﺗﻧﻣ نوﻛﯾ ﺎﻣ ﺎًﺑﻟﺎﻏو ،رﺗوﺗﻣ ﻲﻣﺎﻣﻷا خوﻓﺎﯾﻟا .وﺗﺗ ةدروأ ﻊﺳ
ﻊﯾﺿرﻟا ﻲﻛﺑﯾ ﺎﻣدﻧﻋ ﺔﺻﺎﺧ ،سأرﻟا ةورﻓ . ﺔﻘﯾﻗر ﺔﻣﺟﻣﺟﻟا مﺎظﻋ ﺢﺑﺻﺗ ،ﺔﻣﺟﻣﺟﻟا لﺧاد مﺟﺣﻟا ةدﺎﯾز ﻊﻣ
عدﺻﺗﻣ ءﺎﻋو توﺻ رادﺻﻹ ﺢﺿاو لﻛﺷﺑ زرﻐﻟا لﺻﻔﻧﺗو)نﯾوﯾﺳﺎﻣ ﺔﻣﻼﻋ (ﺔﻣﺟﻣﺟﻟا عرﻗ دﻧﻋ . ﻲﻓ
ﺎًﯾﻣﺎﻣأ اًءوﺗﻧ ﻊﺿرﻟا رﮭظُﯾ ،ةدﯾدﺷﻟا تﻻﺎﺣﻟا)ﻲﻣﺎﻣأ طﻠﺳﺗ (ﻷا وﺣﻧ نوﯾﻌﻟا رودﺗ دﻗو ﺔﺑﺋﺗﻛﻣ نوﯾﻋ ﻊﻣ لﻔﺳ
)سﻣﺷﻟا بورﻏ ﺔﻣﻼﻋ .(ءوﺿﻠﻟ ﺔﯾوﺎﺳﺗﻣ رﯾﻏ تﺎﺑﺎﺟﺗﺳا ﻊﻣ ،نﯾﺋﯾطﺑ ذﯾﻣﻼﺗﻟا نوﻛﯾ.
- ﻰﻟإ ةرﻛﺑﻣﻟا ﺔﻟوﻔطﻟا ﺔﻠﺣرﻣ ﻲﻓ ضارﻋﻷاو تﺎﻣﻼﻌﻟا
ﺷﺗ ﻲﺗﻟا تﺎﻓﻵﺎﺑ ﺔطﺑﺗرﻣﻟا كﻠﺗ لوﻷا مﺎﻘﻣﻟا ﻲﻓ ﻲھ ةرﺧﺄﺗﻣﻟا لﻐ
ﺔﺣﺎﺳﻣ) نﺳﺣﺗ ﻊﻣ ظﺎﻘﯾﺗﺳﻻا دﻧﻋ عادﺻﻟا ،لﺎﺛﻣﻟا لﯾﺑﺳ ﻰﻠﻋ
ﺢﻧرﻟاو ،لوﺣﻟاو ،مﯾﻘﺗﺳﻣ ﻊﺿو ﻲﻓ ءﺎﻘﺑﻟا وأ ؤﯾﻘﺗﻟا دﻌﺑ.(
•In infancy, before closure of the cranial sutures, head enlargement (increasing occipitofrontal
circumference) is the predominant sign, but in older infants and children, the lesions responsible
for hydrocephalus produce other neurologic signs through pressure on adjacent structures.
•In infants with hydrocephalus, the head grows at an abnormal rate, although the first signs may
be bulging fontanels. The anterior fontanel is tense, often bulging and non-pulsatile. Scalp veins
are dilated, especially when the infant cries. With the increase in intracranial volume, skull bones
become thin and the sutures become palpably separated to produce a cracked-pot sound
(Macewen sign) on percussion of the skull. In severe cases, infants display frontal protrusion
(frontal bossing) with depressed eyes and the eyes may be rotated downward (setting-sun sign).
Pupils are sluggish, with unequal responses to light.
•The signs and symptoms in early to late childhood are primarily those associated with space-
occupying lesions (e.g., headaches on awakening with improvement after emesis or being in an
upright position, strabismus, ataxia).
• سأرﻟا مﺧﺿﺗ نوﻛﯾ ،ﺔﻣﺟﻣﺟﻟا طوﯾﺧ قﻼﻏإ لﺑﻗ ،ﺔﻟوﻔطﻟا ﺔﻠﺣرﻣ ﻲﻓ
)ﻲﮭﺑﺟﻟا ﻲﻟاذﻘﻟا طﯾﺣﻣﻟا ةدﺎﯾز ( ﻊﺿرﻟا دﻧﻋ نﻛﻟو ،ةدﺋﺎﺳﻟا ﺔﻣﻼﻌﻟا وھ
سأرﻟا ءﺎﻘﺳﺗﺳا نﻋ ﺔﻟوؤﺳﻣﻟا تﺎﻓﻵا ﺞﺗﻧﺗ ،ﺎًﻧﺳ رﺑﻛﻷا لﺎﻔطﻷاو
ةروﺎﺟﻣﻟا لﻛﺎﯾﮭﻟا ﻰﻠﻋ طﻐﺿﻟا لﻼﺧ نﻣ ىرﺧأ ﺔﯾﺑﺻﻋ تﺎﻣﻼﻋ.
• تﺎﻣﻼﻌﻟا نأ نﻣ مﻏرﻟا ﻰﻠﻋ ،ﻲﻌﯾﺑط رﯾﻏ لدﻌﻣﺑ سأرﻟا وﻣﻧﯾ ،سأرﻟا ءﺎﻘﺳﺗﺳﺎﺑ نﯾﺑﺎﺻﻣﻟا ﻊﺿرﻟا دﻧﻋ
خوﻓﺎﯾﻟا خﺎﻔﺗﻧا نوﻛﺗ دﻗ ﻰﻟوﻷا .ضﺑﺎﻧ رﯾﻏو ﺎًﺧﻔﺗﻧﻣ نوﻛﯾ ﺎﻣ ﺎًﺑﻟﺎﻏو ،رﺗوﺗﻣ ﻲﻣﺎﻣﻷا خوﻓﺎﯾﻟا .وﺗﺗ ةدروأ ﻊﺳ
ﻊﯾﺿرﻟا ﻲﻛﺑﯾ ﺎﻣدﻧﻋ ﺔﺻﺎﺧ ،سأرﻟا ةورﻓ . ﺔﻘﯾﻗر ﺔﻣﺟﻣﺟﻟا مﺎظﻋ ﺢﺑﺻﺗ ،ﺔﻣﺟﻣﺟﻟا لﺧاد مﺟﺣﻟا ةدﺎﯾز ﻊﻣ
عدﺻﺗﻣ ءﺎﻋو توﺻ رادﺻﻹ ﺢﺿاو لﻛﺷﺑ زرﻐﻟا لﺻﻔﻧﺗو)نﯾوﯾﺳﺎﻣ ﺔﻣﻼﻋ (ﺔﻣﺟﻣﺟﻟا عرﻗ دﻧﻋ . ﻲﻓ
ﺎًﯾﻣﺎﻣأ اًءوﺗﻧ ﻊﺿرﻟا رﮭظُﯾ ،ةدﯾدﺷﻟا تﻻﺎﺣﻟا)ﻲﻣﺎﻣأ طﻠﺳﺗ (ﻷا وﺣﻧ نوﯾﻌﻟا رودﺗ دﻗو ﺔﺑﺋﺗﻛﻣ نوﯾﻋ ﻊﻣ لﻔﺳ
)سﻣﺷﻟا بورﻏ ﺔﻣﻼﻋ .(ءوﺿﻠﻟ ﺔﯾوﺎﺳﺗﻣ رﯾﻏ تﺎﺑﺎﺟﺗﺳا ﻊﻣ ،نﯾﺋﯾطﺑ ذﯾﻣﻼﺗﻟا نوﻛﯾ.
- ﻰﻟإ ةرﻛﺑﻣﻟا ﺔﻟوﻔطﻟا ﺔﻠﺣرﻣ ﻲﻓ ضارﻋﻷاو تﺎﻣﻼﻌﻟا
ﺷﺗ ﻲﺗﻟا تﺎﻓﻵﺎﺑ ﺔطﺑﺗرﻣﻟا كﻠﺗ لوﻷا مﺎﻘﻣﻟا ﻲﻓ ﻲھ ةرﺧﺄﺗﻣﻟا لﻐ
ﺔﺣﺎﺳﻣ) نﺳﺣﺗ ﻊﻣ ظﺎﻘﯾﺗﺳﻻا دﻧﻋ عادﺻﻟا ،لﺎﺛﻣﻟا لﯾﺑﺳ ﻰﻠﻋ
ﺢﻧرﻟاو ،لوﺣﻟاو ،مﯾﻘﺗﺳﻣ ﻊﺿو ﻲﻓ ءﺎﻘﺑﻟا وأ ؤﯾﻘﺗﻟا دﻌﺑ.(
Diagnostic Evaluation
In evaluation of a preterm infant, specially adapted head circumference charts are
consulted to distinguish abnormal head growth from normal rapid head growth. The
primary diagnostic tools to detect hydrocephalus in older infants and children are CT
and MRI. In neonates, echoencephalography is useful in comparing the ratio of lateral
ventricle to cortex.
Therapeutic Management
•The treatment of hydrocephalus is directed toward relief of ventricular pressure,
treatment of the cause of the ventriculomegaly, treatment of associated
complications, and management of problems related to the effect of the disorder on
psychomotor development.
•The treatment is, with few exceptions, surgical. This is accomplished by direct removal
of an obstruction (e.g., a tumor or hematoma). Most children require placement of a
shunt that provides primary drainage of the CSF from the ventricles to an extracranial
compartment, usually the peritoneum (ventriculoperitoneal [VP] shunt)
ﺑ زﯾﯾﻣﺗﻠﻟ ﺎًﺻﯾﺻﺧ ﺔﻔﱠﯾﻛُﻣﻟا سأرﻟا طﯾﺣﻣ تﺎططﺧﻣ ةرﺎﺷﺗﺳا مﺗﯾ ،رِﺳﺗﺑﻣﻟا ﻊﯾﺿرﻟا مﯾﯾﻘﺗ دﻧﻋ سأرﻟا وﻣﻧ نﯾ
ﻲﻌﯾﺑطﻟا ﻊﯾرﺳﻟا سأرﻟا وﻣﻧو ﻲﻌﯾﺑطﻟا رﯾﻏ . دﻧﻋ سأرﻟا ءﺎﻘﺳﺗﺳا نﻋ فﺷﻛﻠﻟ ﺔﯾﻟوﻷا صﯾﺧﺷﺗﻟا تاودأ
ﻲﺳﯾطﺎﻧﻐﻣﻟا نﯾﻧرﻟﺎﺑ رﯾوﺻﺗﻟاو ﻲﻌطﻘﻣﻟا رﯾوﺻﺗﻟا ﻲھ ﺎًﻧﺳ رﺑﻛﻷا لﺎﻔطﻷاو ﻊﺿرﻟا .ﻛﯾ ،نادﻟوﻟا دﻧﻋ نو
ةرﺷﻘﻟا ﻰﻟإ ﻲﺑﻧﺎﺟﻟا نﯾطﺑﻟا ﺔﺑﺳﻧ ﺔﻧرﺎﻘﻣ ﻲﻓ اًدﯾﻔﻣ غﺎﻣدﻟا ىدﺻ طﯾطﺧﺗ.
• جﻼﻋو ،نﯾطﺑﻟا مﺧﺿﺗ بﺑﺳ جﻼﻋو ،ﻲﻧﯾطﺑﻟا طﻐﺿﻟا فﯾﻔﺧﺗ وﺣﻧ سأرﻟا ءﺎﻘﺳﺗﺳا جﻼﻋ ﮫﯾﺟوﺗ مﺗﯾ
ﻲﻛرﺣﻟا ﻲﺳﻔﻧﻟا روطﺗﻟا ﻰﻠﻋ بارطﺿﻻا رﯾﺛﺄﺗﺑ ﺔﻘﻠﻌﺗﻣﻟا لﻛﺎﺷﻣﻟا ةرادإو ،ﮫﺑ ﺔطﺑﺗرﻣﻟا تﺎﻔﻋﺎﺿﻣﻟا.
•ﺎًﯾﺣارﺟ ،تاءﺎﻧﺛﺗﺳﻻا ضﻌﺑ ﻊﻣ ،جﻼﻌﻟا نوﻛﯾ . ﻖﺋﺎﻌﻠﻟ ةرﺷﺎﺑﻣﻟا ﺔﻟازﻹا ﻖﯾرط نﻋ كﻟذ ﻖﯾﻘﺣﺗ مﺗﯾو)ﻋ ﻰﻠ
يوﻣد مرو وأ مرو ،لﺎﺛﻣﻟا لﯾﺑﺳ .(لﺋﺎﺳﻠﻟ ﻲﻟوﻷا فﯾرﺻﺗﻟا رﻓوﺗ ﺔﻠﯾوﺣﺗ ﻊﺿو ﻰﻟإ لﺎﻔطﻷا مظﻌﻣ جﺎﺗﺣﯾ
قﺎﻔﺻﻟا نوﻛﺗ ﺎﻣ ةدﺎﻋو ،فﺣﻘﻟا جرﺎﺧ ةرﺟﺣ ﻰﻟإ نﯾﻧﯾطﺑﻟا نﻣ ﻲﻛوﺷﻟا ﻲﻏﺎﻣدﻟا)ﻲﻗﺎﻔﺻﻟا نﯾطﺑﻟا ﺔﻠﯾوﺣﺗ
]VP])
In evaluation of a preterm infant, specially adapted head circumference charts are
consulted to distinguish abnormal head growth from normal rapid head growth. The
primary diagnostic tools to detect hydrocephalus in older infants and children are CT
and MRI. In neonates, echoencephalography is useful in comparing the ratio of lateral
ventricle to cortex.
Therapeutic Management
•The treatment of hydrocephalus is directed toward relief of ventricular pressure,
treatment of the cause of the ventriculomegaly, treatment of associated
complications, and management of problems related to the effect of the disorder on
psychomotor development.
•The treatment is, with few exceptions, surgical. This is accomplished by direct removal
of an obstruction (e.g., a tumor or hematoma). Most children require placement of a
shunt that provides primary drainage of the CSF from the ventricles to an extracranial
compartment, usually the peritoneum (ventriculoperitoneal [VP] shunt)
ﺑ زﯾﯾﻣﺗﻠﻟ ﺎًﺻﯾﺻﺧ ﺔﻔﱠﯾﻛُﻣﻟا سأرﻟا طﯾﺣﻣ تﺎططﺧﻣ ةرﺎﺷﺗﺳا مﺗﯾ ،رِﺳﺗﺑﻣﻟا ﻊﯾﺿرﻟا مﯾﯾﻘﺗ دﻧﻋ سأرﻟا وﻣﻧ نﯾ
ﻲﻌﯾﺑطﻟا ﻊﯾرﺳﻟا سأرﻟا وﻣﻧو ﻲﻌﯾﺑطﻟا رﯾﻏ . دﻧﻋ سأرﻟا ءﺎﻘﺳﺗﺳا نﻋ فﺷﻛﻠﻟ ﺔﯾﻟوﻷا صﯾﺧﺷﺗﻟا تاودأ
ﻲﺳﯾطﺎﻧﻐﻣﻟا نﯾﻧرﻟﺎﺑ رﯾوﺻﺗﻟاو ﻲﻌطﻘﻣﻟا رﯾوﺻﺗﻟا ﻲھ ﺎًﻧﺳ رﺑﻛﻷا لﺎﻔطﻷاو ﻊﺿرﻟا .ﻛﯾ ،نادﻟوﻟا دﻧﻋ نو
ةرﺷﻘﻟا ﻰﻟإ ﻲﺑﻧﺎﺟﻟا نﯾطﺑﻟا ﺔﺑﺳﻧ ﺔﻧرﺎﻘﻣ ﻲﻓ اًدﯾﻔﻣ غﺎﻣدﻟا ىدﺻ طﯾطﺧﺗ.
• جﻼﻋو ،نﯾطﺑﻟا مﺧﺿﺗ بﺑﺳ جﻼﻋو ،ﻲﻧﯾطﺑﻟا طﻐﺿﻟا فﯾﻔﺧﺗ وﺣﻧ سأرﻟا ءﺎﻘﺳﺗﺳا جﻼﻋ ﮫﯾﺟوﺗ مﺗﯾ
ﻲﻛرﺣﻟا ﻲﺳﻔﻧﻟا روطﺗﻟا ﻰﻠﻋ بارطﺿﻻا رﯾﺛﺄﺗﺑ ﺔﻘﻠﻌﺗﻣﻟا لﻛﺎﺷﻣﻟا ةرادإو ،ﮫﺑ ﺔطﺑﺗرﻣﻟا تﺎﻔﻋﺎﺿﻣﻟا.
•ﺎًﯾﺣارﺟ ،تاءﺎﻧﺛﺗﺳﻻا ضﻌﺑ ﻊﻣ ،جﻼﻌﻟا نوﻛﯾ . ﻖﺋﺎﻌﻠﻟ ةرﺷﺎﺑﻣﻟا ﺔﻟازﻹا ﻖﯾرط نﻋ كﻟذ ﻖﯾﻘﺣﺗ مﺗﯾو)ﻋ ﻰﻠ
يوﻣد مرو وأ مرو ،لﺎﺛﻣﻟا لﯾﺑﺳ .(لﺋﺎﺳﻠﻟ ﻲﻟوﻷا فﯾرﺻﺗﻟا رﻓوﺗ ﺔﻠﯾوﺣﺗ ﻊﺿو ﻰﻟإ لﺎﻔطﻷا مظﻌﻣ جﺎﺗﺣﯾ
قﺎﻔﺻﻟا نوﻛﺗ ﺎﻣ ةدﺎﻋو ،فﺣﻘﻟا جرﺎﺧ ةرﺟﺣ ﻰﻟإ نﯾﻧﯾطﺑﻟا نﻣ ﻲﻛوﺷﻟا ﻲﻏﺎﻣدﻟا)ﻲﻗﺎﻔﺻﻟا نﯾطﺑﻟا ﺔﻠﯾوﺣﺗ
]VP])
Prognosis
• The prognosis of children with treated hydrocephalus depends largely
on the cause of the dilated ventricles before shunt placement and the
amount of irreversible brain damage before shunting
• Surgically treated hydrocephalus in patients with little or no evidence
of irreversible brain damage has a survival rate of about 80%, with most
deaths occurring within the first year of treatment.
• Those with poor outcomes include children shunted for post
hemorrhagic hydrocephalus or meningitis. Most children who require
shunting must depend on the shunt for the remainder of their life.
بﺑﺳ ﻰﻠﻋ رﯾﺑﻛ دﺣ ﻰﻟإ ﺞﻟﺎﻌﻣﻟا سأرﻟا ءﺎﻘﺳﺗﺳا نﻣ نوﻧﺎﻌﯾ نﯾذﻟا لﺎﻔطﻷا صﯾﺧﺷﺗ دﻣﺗﻌﯾ
ﻠﯾوﺣﺗﻟا لﺑﻗ ﮫﺟﻼﻋ نﻛﻣﯾ ﻻ يذﻟا غﺎﻣدﻟا فﻠﺗ رادﻘﻣو ﺔﻠﯾوﺣﺗﻟا ﻊﺿو لﺑﻗ تﺎﻧﯾطﺑﻟا ﻊﺳوﺗﺔ
سأرﻟا ءﺎﻘﺳﺗﺳا نﻣ نوﻧﺎﻌﯾ نﯾذﻟا ﻰﺿرﻣﻟا دﻧﻋ ةﺎﯾﺣﻟا دﯾﻗ ﻰﻠﻋ ءﺎﻘﺑﻟا لدﻌﻣ ﻎﻠﺑﯾ
نﻛﻣﯾ ﻻ غﺎﻣدﻟا ﻲﻓ فﻠﺗ ﻰﻠﻋ ﺔﻣودﻌﻣ وأ ﺔﻠﯾﻠﻗ ﺔﻟدأ مﮭﯾدﻟ نﯾذﻟاو ،ﺎًﯾﺣارﺟ ﺞﻟﺎﻌﻣﻟا
ﻲﻟاوﺣ ،ﮫﺟﻼﻋ80%جﻼﻌﻟا نﻣ ﻰﻟوﻷا ﺔﻧﺳﻟا لﻼﺧ تﺎﯾﻓوﻟا مظﻌﻣ ثدﺣﺗو ،.
ﺑﺳﺑ مﮭﻠﯾوﺣﺗ مﺗ نﯾذﻟا لﺎﻔطﻷا نوﻠﻣﺷﯾ ﺔﺋﯾﺳ ﺞﺋﺎﺗﻧ نﻣ نوﻧﺎﻌﯾ نﯾذﻟا كﺋﻟوأ ب
ﺎﯾﺎﺣﺳﻟا بﺎﮭﺗﻟا وأ ﻲﻓزﻧﻟا سأرﻟا ءﺎﻘﺳﺗﺳا . نﯾذﻟا لﺎﻔطﻷا مظﻌﻣ دﻣﺗﻌﯾ نأ بﺟﯾ
مﮭﺗﺎﯾﺣ ﺔﯾﻘﺑﻟ ﺔﻠﯾوﺣﺗﻟا ﻰﻠﻋ ﺔﻠﯾوﺣﺗﻟا ﻰﻟإ نوﺟﺎﺗﺣﯾ.
• The prognosis of children with treated hydrocephalus depends largely
on the cause of the dilated ventricles before shunt placement and the
amount of irreversible brain damage before shunting
• Surgically treated hydrocephalus in patients with little or no evidence
of irreversible brain damage has a survival rate of about 80%, with most
deaths occurring within the first year of treatment.
• Those with poor outcomes include children shunted for post
hemorrhagic hydrocephalus or meningitis. Most children who require
shunting must depend on the shunt for the remainder of their life.
بﺑﺳ ﻰﻠﻋ رﯾﺑﻛ دﺣ ﻰﻟإ ﺞﻟﺎﻌﻣﻟا سأرﻟا ءﺎﻘﺳﺗﺳا نﻣ نوﻧﺎﻌﯾ نﯾذﻟا لﺎﻔطﻷا صﯾﺧﺷﺗ دﻣﺗﻌﯾ
ﻠﯾوﺣﺗﻟا لﺑﻗ ﮫﺟﻼﻋ نﻛﻣﯾ ﻻ يذﻟا غﺎﻣدﻟا فﻠﺗ رادﻘﻣو ﺔﻠﯾوﺣﺗﻟا ﻊﺿو لﺑﻗ تﺎﻧﯾطﺑﻟا ﻊﺳوﺗﺔ
سأرﻟا ءﺎﻘﺳﺗﺳا نﻣ نوﻧﺎﻌﯾ نﯾذﻟا ﻰﺿرﻣﻟا دﻧﻋ ةﺎﯾﺣﻟا دﯾﻗ ﻰﻠﻋ ءﺎﻘﺑﻟا لدﻌﻣ ﻎﻠﺑﯾ
نﻛﻣﯾ ﻻ غﺎﻣدﻟا ﻲﻓ فﻠﺗ ﻰﻠﻋ ﺔﻣودﻌﻣ وأ ﺔﻠﯾﻠﻗ ﺔﻟدأ مﮭﯾدﻟ نﯾذﻟاو ،ﺎًﯾﺣارﺟ ﺞﻟﺎﻌﻣﻟا
ﻲﻟاوﺣ ،ﮫﺟﻼﻋ80%جﻼﻌﻟا نﻣ ﻰﻟوﻷا ﺔﻧﺳﻟا لﻼﺧ تﺎﯾﻓوﻟا مظﻌﻣ ثدﺣﺗو ،.
ﺑﺳﺑ مﮭﻠﯾوﺣﺗ مﺗ نﯾذﻟا لﺎﻔطﻷا نوﻠﻣﺷﯾ ﺔﺋﯾﺳ ﺞﺋﺎﺗﻧ نﻣ نوﻧﺎﻌﯾ نﯾذﻟا كﺋﻟوأ ب
ﺎﯾﺎﺣﺳﻟا بﺎﮭﺗﻟا وأ ﻲﻓزﻧﻟا سأرﻟا ءﺎﻘﺳﺗﺳا . نﯾذﻟا لﺎﻔطﻷا مظﻌﻣ دﻣﺗﻌﯾ نأ بﺟﯾ
مﮭﺗﺎﯾﺣ ﺔﯾﻘﺑﻟ ﺔﻠﯾوﺣﺗﻟا ﻰﻠﻋ ﺔﻠﯾوﺣﺗﻟا ﻰﻟإ نوﺟﺎﺗﺣﯾ.
Nursing Care Management
•An infant with suspected or confirmed hydrocephalus is observed carefully for signs of increasing
ventricular size and increasing ICP. In infants, the head is measured daily (frontooccipital circumference).
Fontanels and suture lines are palpated for size, signs of bulging, tenseness, and separation.
•Prepare the child for diagnostic tests such as MRI or CT scan and for assisting with procedures such as a
ventricular tap. Sedation is required because the child must remain absolutely still during diagnostic testing.
Postoperative Care
•In addition to routine postoperative care and observation, the infant or child is positioned carefully on the
unoperated side to prevent pressure on the shunt valve. The child remains flat to help avert complications
resulting from too rapid reduction of intracranial fluid. The surgeon indicates the position to be maintained
and the extent of activity allowed.
•Observation is continued for signs of increased ICP, which indicates obstruction of the shunt. Neurologic
assessment includes pupil dilation (pressure causes compression or stretching of the oculomotor nerve,
producing dilation on the same side as the pressure) and blood pressure (hypoxia to the brainstem causes
variability in these vital signs). incision site for leakage, and test any suspected drainage for glucose
•Family support
•ﯾﺎﻧﻌﺑ دﻛؤﻣﻟا وأ ﮫﺑ ﮫﺑﺗﺷﻣﻟا سأرﻟا ءﺎﻘﺳﺗﺳﺎﺑ بﺎﺻﻣﻟا ﻊﯾﺿرﻟا ﺔظﺣﻼﻣ مﺗﺗ ﺔ
ﺔﯾﻟودﻟا تﺎﻧرﺎﻘﻣﻟا ﺞﻣﺎﻧرﺑ ةدﺎﯾزو نﯾطﺑﻟا مﺟﺣ ةدﺎﯾز تﺎﻣﻼﻋ نﻋ ﺎًﺛﺣﺑ . دﻧﻋ
ﺎًﯾﻣوﯾ سأرﻟا سﺎﯾﻗ مﺗﯾ ،ﻊﺿرﻟا)ﻲﻟاذﻘﻟا ﻲﮭﺑﺟﻟا طﯾﺣﻣ .(وﻓﺎﯾﻟا سﺳﺣﺗ مﺗﯾ خ
لﺎﺻﻔﻧﻻاو دﺷﻟاو خﺎﻔﺗﻧﻻا تﺎﻣﻼﻋو مﺟﺣﻟا ﺔﻓرﻌﻣﻟ ﺔطﺎﯾﺧﻟا طوطﺧو.
•ﻓ ةدﻋﺎﺳﻣﻠﻟو ﺔﯾﻌطﻘﻣﻟا ﺔﻌﺷﻷا وأ ﻲﺳﯾطﺎﻧﻐﻣﻟا نﯾﻧرﻟﺎﺑ رﯾوﺻﺗﻟا لﺛﻣ ﺔﯾﺻﯾﺧﺷﺗﻟا تارﺎﺑﺗﺧﻼﻟ لﻔطﻟا دادﻋإ ﻲ
ﻲﻧﯾطﺑﻟا لزﺑﻟا لﺛﻣ تاءارﺟإ .ﯾﺧﺷﺗﻟا رﺎﺑﺗﺧﻻا ءﺎﻧﺛأ ﺎًﻣﺎﻣﺗ ﺎًﻧﻛﺎﺳ لظﯾ نأ بﺟﯾ لﻔطﻟا نﻷ بوﻠطﻣ رﯾدﺧﺗﻟاﻲﺻ.
• وأ ﻊﯾﺿرﻟا ﻊﺿو مﺗﯾ ،ﺔﯾﺣارﺟﻟا ﺔﯾﻠﻣﻌﻟا دﻌﺑ ﺔﯾﻧﯾﺗورﻟا ﺔﺑﻗارﻣﻟاو ﺔﯾﺎﻋرﻟا ﻰﻟإ ﺔﻓﺎﺿﻹﺎﺑ
ﺔﻠﯾوﺣﺗﻟا مﺎﻣﺻ ﻰﻠﻋ طﻐﺿﻟا ﻊﻧﻣﻟ ﺔﺣارﺟﻠﻟ ﻊﺿﺎﺧﻟا رﯾﻏ بﻧﺎﺟﻟا ﻰﻠﻋ ﺔﯾﺎﻧﻌﺑ لﻔطﻟا . ﻰﻘﺑﯾ
ﺋﺎﺳﻠﻟ اًدﺟ ﻊﯾرﺳﻟا ضﯾﻔﺧﺗﻟا نﻋ ﺔﺟﺗﺎﻧﻟا تﺎﻔﻋﺎﺿﻣﻟا بﻧﺟﺗ ﻲﻓ ةدﻋﺎﺳﻣﻠﻟ ﺎًﺣطﺳﻣ لﻔطﻟا لﺧاد ل
ﺔﻣﺟﻣﺟﻟا .ﮫﺑ حوﻣﺳﻣﻟا طﺎﺷﻧﻟا ىدﻣو ﺎﮭﯾﻠﻋ ظﺎﻔﺣﻟا بﺟﯾ ﻲﺗﻟا ﺔﯾﻌﺿوﻟا ﻰﻟإ حارﺟﻟا رﯾﺷﯾ.
• دادﺳﻧا ﻰﻠﻋ لدﯾ ﺎﻣﻣ ،ﺔﯾﻟودﻟا تﺎﻧرﺎﻘﻣﻟا ﺞﻣﺎﻧرﺑ ةدﺎﯾز تﺎﻣﻼﻌﻟ ﺔظﺣﻼﻣﻟا رﻣﺗﺳﺗ
ﺔﻠﯾوﺣﺗﻟا . نﯾﻌﻟا ﺔﻗدﺣ ﻊﺳوﺗ ﻲﺑﺻﻌﻟا مﯾﯾﻘﺗﻟا لﻣﺷﯾ)ﺗ وأ ﺎًطﻐﺿ طﻐﺿﻟا بﺑﺳﯾ اًددﻣ
طﻐﺿﻟا بﻧﺎﺟ سﻔﻧ ﻲﻓ ددﻣﺗ ﻰﻟإ يدؤﯾ ﺎﻣﻣ ،نﯾﻌﻠﻟ ﻲﻛرﺣﻟا بﺻﻌﻠﻟ ( مدﻟا طﻐﺿو
)ﺔﯾوﯾﺣﻟا تﺎﻣﻼﻌﻟا هذھ ﻲﻓ ﺎًﻧﯾﺎﺑﺗ بﺑﺳﯾ غﺎﻣدﻟا عذﺟ ﻲﻓ ﺔﺟﺳﻛﻷا صﻘﻧ .(ﻖﺷﻟا ﻊﻗوﻣ
زوﻛوﻠﺟﻠﻟ ﮫﺑ ﮫﺑﺗﺷﻣ فﯾرﺻﺗ يأ رﺎﺑﺗﺧاو ،برﺳﺗﻟا نﻋ ﺎًﺛﺣﺑ
•يرﺳﻷا مﻋدﻟا
•An infant with suspected or confirmed hydrocephalus is observed carefully for signs of increasing
ventricular size and increasing ICP. In infants, the head is measured daily (frontooccipital circumference).
Fontanels and suture lines are palpated for size, signs of bulging, tenseness, and separation.
•Prepare the child for diagnostic tests such as MRI or CT scan and for assisting with procedures such as a
ventricular tap. Sedation is required because the child must remain absolutely still during diagnostic testing.
Postoperative Care
•In addition to routine postoperative care and observation, the infant or child is positioned carefully on the
unoperated side to prevent pressure on the shunt valve. The child remains flat to help avert complications
resulting from too rapid reduction of intracranial fluid. The surgeon indicates the position to be maintained
and the extent of activity allowed.
•Observation is continued for signs of increased ICP, which indicates obstruction of the shunt. Neurologic
assessment includes pupil dilation (pressure causes compression or stretching of the oculomotor nerve,
producing dilation on the same side as the pressure) and blood pressure (hypoxia to the brainstem causes
variability in these vital signs). incision site for leakage, and test any suspected drainage for glucose
•Family support
•ﯾﺎﻧﻌﺑ دﻛؤﻣﻟا وأ ﮫﺑ ﮫﺑﺗﺷﻣﻟا سأرﻟا ءﺎﻘﺳﺗﺳﺎﺑ بﺎﺻﻣﻟا ﻊﯾﺿرﻟا ﺔظﺣﻼﻣ مﺗﺗ ﺔ
ﺔﯾﻟودﻟا تﺎﻧرﺎﻘﻣﻟا ﺞﻣﺎﻧرﺑ ةدﺎﯾزو نﯾطﺑﻟا مﺟﺣ ةدﺎﯾز تﺎﻣﻼﻋ نﻋ ﺎًﺛﺣﺑ . دﻧﻋ
ﺎًﯾﻣوﯾ سأرﻟا سﺎﯾﻗ مﺗﯾ ،ﻊﺿرﻟا)ﻲﻟاذﻘﻟا ﻲﮭﺑﺟﻟا طﯾﺣﻣ .(وﻓﺎﯾﻟا سﺳﺣﺗ مﺗﯾ خ
لﺎﺻﻔﻧﻻاو دﺷﻟاو خﺎﻔﺗﻧﻻا تﺎﻣﻼﻋو مﺟﺣﻟا ﺔﻓرﻌﻣﻟ ﺔطﺎﯾﺧﻟا طوطﺧو.
•ﻓ ةدﻋﺎﺳﻣﻠﻟو ﺔﯾﻌطﻘﻣﻟا ﺔﻌﺷﻷا وأ ﻲﺳﯾطﺎﻧﻐﻣﻟا نﯾﻧرﻟﺎﺑ رﯾوﺻﺗﻟا لﺛﻣ ﺔﯾﺻﯾﺧﺷﺗﻟا تارﺎﺑﺗﺧﻼﻟ لﻔطﻟا دادﻋإ ﻲ
ﻲﻧﯾطﺑﻟا لزﺑﻟا لﺛﻣ تاءارﺟإ .ﯾﺧﺷﺗﻟا رﺎﺑﺗﺧﻻا ءﺎﻧﺛأ ﺎًﻣﺎﻣﺗ ﺎًﻧﻛﺎﺳ لظﯾ نأ بﺟﯾ لﻔطﻟا نﻷ بوﻠطﻣ رﯾدﺧﺗﻟاﻲﺻ.
• وأ ﻊﯾﺿرﻟا ﻊﺿو مﺗﯾ ،ﺔﯾﺣارﺟﻟا ﺔﯾﻠﻣﻌﻟا دﻌﺑ ﺔﯾﻧﯾﺗورﻟا ﺔﺑﻗارﻣﻟاو ﺔﯾﺎﻋرﻟا ﻰﻟإ ﺔﻓﺎﺿﻹﺎﺑ
ﺔﻠﯾوﺣﺗﻟا مﺎﻣﺻ ﻰﻠﻋ طﻐﺿﻟا ﻊﻧﻣﻟ ﺔﺣارﺟﻠﻟ ﻊﺿﺎﺧﻟا رﯾﻏ بﻧﺎﺟﻟا ﻰﻠﻋ ﺔﯾﺎﻧﻌﺑ لﻔطﻟا . ﻰﻘﺑﯾ
ﺋﺎﺳﻠﻟ اًدﺟ ﻊﯾرﺳﻟا ضﯾﻔﺧﺗﻟا نﻋ ﺔﺟﺗﺎﻧﻟا تﺎﻔﻋﺎﺿﻣﻟا بﻧﺟﺗ ﻲﻓ ةدﻋﺎﺳﻣﻠﻟ ﺎًﺣطﺳﻣ لﻔطﻟا لﺧاد ل
ﺔﻣﺟﻣﺟﻟا .ﮫﺑ حوﻣﺳﻣﻟا طﺎﺷﻧﻟا ىدﻣو ﺎﮭﯾﻠﻋ ظﺎﻔﺣﻟا بﺟﯾ ﻲﺗﻟا ﺔﯾﻌﺿوﻟا ﻰﻟإ حارﺟﻟا رﯾﺷﯾ.
• دادﺳﻧا ﻰﻠﻋ لدﯾ ﺎﻣﻣ ،ﺔﯾﻟودﻟا تﺎﻧرﺎﻘﻣﻟا ﺞﻣﺎﻧرﺑ ةدﺎﯾز تﺎﻣﻼﻌﻟ ﺔظﺣﻼﻣﻟا رﻣﺗﺳﺗ
ﺔﻠﯾوﺣﺗﻟا . نﯾﻌﻟا ﺔﻗدﺣ ﻊﺳوﺗ ﻲﺑﺻﻌﻟا مﯾﯾﻘﺗﻟا لﻣﺷﯾ)ﺗ وأ ﺎًطﻐﺿ طﻐﺿﻟا بﺑﺳﯾ اًددﻣ
طﻐﺿﻟا بﻧﺎﺟ سﻔﻧ ﻲﻓ ددﻣﺗ ﻰﻟإ يدؤﯾ ﺎﻣﻣ ،نﯾﻌﻠﻟ ﻲﻛرﺣﻟا بﺻﻌﻠﻟ ( مدﻟا طﻐﺿو
)ﺔﯾوﯾﺣﻟا تﺎﻣﻼﻌﻟا هذھ ﻲﻓ ﺎًﻧﯾﺎﺑﺗ بﺑﺳﯾ غﺎﻣدﻟا عذﺟ ﻲﻓ ﺔﺟﺳﻛﻷا صﻘﻧ .(ﻖﺷﻟا ﻊﻗوﻣ
زوﻛوﻠﺟﻠﻟ ﮫﺑ ﮫﺑﺗﺷﻣ فﯾرﺻﺗ يأ رﺎﺑﺗﺧاو ،برﺳﺗﻟا نﻋ ﺎًﺛﺣﺑ
•يرﺳﻷا مﻋدﻟا
CEREBRAL PALSY
• Cerebral palsy (CP) has been
defined as a “group of permanent
disorders of the development of
movement and posture, causing
activity limitation, that are
attributed to non-progressive
disturbances that occurred in the
developing fetal or infant brain
ﻲﻏﺎﻣدﻟا لﻠﺷﻟا فﯾرﻌﺗ مﺗ () ﮫﻧأ ﻰﻠﻋ" ﺔﻣﺋادﻟا تﺎﺑارطﺿﻻا نﻣ ﺔﻋوﻣﺟﻣ
ﻰﻟإ ىزﻌﺗ ﻲﺗﻟاو ،طﺎﺷﻧﻟا دﯾﯾﻘﺗ بﺑﺳﯾ ﺎﻣﻣ ،ﺔﯾﻌﺿوﻟاو ﺔﻛرﺣﻟا روطﺗ ﻲﻓ
ﻲﻣﺎﻧﻟا ﻊﯾﺿرﻟا وأ نﯾﻧﺟﻟا غﺎﻣد ﻲﻓ ثدﺣﺗ ﺔﯾﻣدﻘﺗ رﯾﻏ تﺎﺑارطﺿا.
• Cerebral palsy (CP) has been
defined as a “group of permanent
disorders of the development of
movement and posture, causing
activity limitation, that are
attributed to non-progressive
disturbances that occurred in the
developing fetal or infant brain
ﻲﻏﺎﻣدﻟا لﻠﺷﻟا فﯾرﻌﺗ مﺗ () ﮫﻧأ ﻰﻠﻋ" ﺔﻣﺋادﻟا تﺎﺑارطﺿﻻا نﻣ ﺔﻋوﻣﺟﻣ
ﻰﻟإ ىزﻌﺗ ﻲﺗﻟاو ،طﺎﺷﻧﻟا دﯾﯾﻘﺗ بﺑﺳﯾ ﺎﻣﻣ ،ﺔﯾﻌﺿوﻟاو ﺔﻛرﺣﻟا روطﺗ ﻲﻓ
ﻲﻣﺎﻧﻟا ﻊﯾﺿرﻟا وأ نﯾﻧﺟﻟا غﺎﻣد ﻲﻓ ثدﺣﺗ ﺔﯾﻣدﻘﺗ رﯾﻏ تﺎﺑارطﺿا.
Pathophysiology
•In some cases, there are gross malformations of the brain. In others, there may be
evidence of vascular occlusion, atrophy, loss of neurons, and laminar degeneration that
produce narrower gyri, wider sulci, and low brain weight.
•In some cases, the manifestations or etiology is related to anatomic areas. For example,
CP associated with preterm birth is usually spastic diplegia caused by hypoxic infarction or
hemorrhage with periventricular leukomalacia in the area adjacent to the lateral
ventricles. The athetoid (extrapyramidal) type of CP is most likely to be associated with
birth asphyxia but can also be caused by kernicterus and metabolic genetic disorders
•Hemiplegic (hemiparetic) CP is often associated with a focal cerebral infarction (stroke)
secondary to an intrauterine or perinatal thromboembolism. Cerebral hypoplasia and
sometimes severe neonatal hypoglycemia are related to ataxic CP. Generalized cortical and
cerebral atrophy often cause severe quadriparesis with cognitive impairment and
microcephaly.
•غﺎﻣدﻟا ﻲﻓ ﺔﻣﯾﺳﺟ تﺎھوﺷﺗ ثدﺣﺗ ،تﻻﺎﺣﻟا ضﻌﺑ ﻲﻓ . ﻲﻓو
،ﺔﯾوﻣدﻟا ﺔﯾﻋوﻷا دادﺳﻧا ﻰﻠﻋ لﯾﻟد كﺎﻧھ نوﻛﯾ دﻗ ،ىرﺧأ تﻻﺎﺣ
دؤﯾ يذﻟا ﻲﺣﻔﺻﻟا سﻛﻧﺗﻟاو ،ﺔﯾﺑﺻﻌﻟا ﺎﯾﻼﺧﻟا نادﻘﻓو ،روﻣﺿﻟاو ي
غﺎﻣدﻟا نزو ضﺎﻔﺧﻧاو ،ﻊﺳوأ مﻼﺗأو ،ﻖﯾﺿأ فﯾﻓﻼﺗ ﻰﻟإ.
• ﻖطﺎﻧﻣﻟﺎﺑ ﺔطﺑﺗرﻣ تﺎﺑﺑﺳﻣﻟا وأ رھﺎظﻣﻟا نوﻛﺗ ،تﻻﺎﺣﻟا ضﻌﺑ ﻲﻓ
ﺔﯾﺣﯾرﺷﺗﻟا .ﺎﻋ ةرﻛﺑﻣﻟا ةدﻻوﻟﺎﺑ طﺑﺗرﻣﻟا ﻲﻏﺎﻣدﻟا لﻠﺷﻟا ،لﺎﺛﻣﻟا لﯾﺑﺳ ﻰﻠﻋ ﺎﻣ ةد
ﺗ ﻊﻣ فزﻧ وأ ﺔﺟﺳﻛﻷا صﻘﻧ ءﺎﺷﺗﺣا نﻋ ﺎًﻣﺟﺎﻧ ﺎًﯾﺟﻧﺷﺗ ﺎًﺟودزﻣ ًﻼﻠﺷ نوﻛﯾ نﯾﻠ
ﺔﯾﺑﻧﺎﺟﻟا تﺎﻧﯾطﺑﻠﻟ ةروﺎﺟﻣﻟا ﺔﻘطﻧﻣﻟا ﻲﻓ تﺎﻧﯾطﺑﻟا لوﺣ ءﺎﺿﯾﺑ .أ ﺢﺟرﻣﻟا نﻣ ن
ﻲﻌَﻧُﻛﻟا عوﻧﻟا نوﻛﯾ)ﻲﻣرﮭﻟا جرﺎﺧ ( قﺎﻧﺗﺧﻻﺎﺑ ﺎًطﺑﺗرﻣ ﻲﻏﺎﻣدﻟا لﻠﺷﻟا نﻣ
ﺎﺑارطﺿﻻاو يووﻧﻟا نﺎﻗرﯾﻟا نﻋ ﺎًﻣﺟﺎﻧ نوﻛﯾ نأ ﺎًﺿﯾأ نﻛﻣﯾ نﻛﻟو ،يدﻻوﻟا ت
ﺔﯾﺿﯾﻷا ﺔﯾﺛاروﻟا
• ﻲﻔﺻﻧﻟا لﻠﺷﻟا طﺑﺗرﯾ ﺎﻣ ﺎًﺑﻟﺎﻏ)ﻲﺟرﻔﻟا ( يرؤﺑﻟا ﻲﻏﺎﻣدﻟا ءﺎﺷﺗﺣﻻﺎﺑ)ﻟا ﺔﺗﻛﺳ
ﺔﯾﻏﺎﻣدﻟا ( ﺔطﯾﺣﻣﻟا ةرﺗﻔﻟا ﻲﻓ وأ مﺣرﻟا لﺧاد ﺔﯾوﻣدﻟا تﺎطﻠﺟﻠﻟ يوﻧﺎﺛﻟا
ةدﻻوﻟﺎﺑ .ﻔطﻷا دﻧﻋ مدﻟا ﻲﻓ رﻛﺳﻟا صﻘﻧ ﺎًﻧﺎﯾﺣأو غﺎﻣدﻟا ﺞﺳﻧﺗ صﻘﻧ طﺑﺗرﯾ لﺎ
ﺢﻧرﻟا ﻲﻏﺎﻣدﻟا لﻠﺷﻟﺎﺑ ةدﻻوﻟا ﻲﺛﯾدﺣ . يرﺷﻘﻟا روﻣﺿﻟا بﺑﺳﯾ ﺎﻣ ﺎًﺑﻟﺎﻏ
سأرﻟا رﻐﺻو ﻲﻛاردإ فﻌﺿ ﻊﻣ اًدﯾدﺷ ﺎًﯾﻋﺎﺑر ًﻻزﺧ مﻣﻌﻣﻟا ﻲﻏﺎﻣدﻟاو.
•In some cases, there are gross malformations of the brain. In others, there may be
evidence of vascular occlusion, atrophy, loss of neurons, and laminar degeneration that
produce narrower gyri, wider sulci, and low brain weight.
•In some cases, the manifestations or etiology is related to anatomic areas. For example,
CP associated with preterm birth is usually spastic diplegia caused by hypoxic infarction or
hemorrhage with periventricular leukomalacia in the area adjacent to the lateral
ventricles. The athetoid (extrapyramidal) type of CP is most likely to be associated with
birth asphyxia but can also be caused by kernicterus and metabolic genetic disorders
•Hemiplegic (hemiparetic) CP is often associated with a focal cerebral infarction (stroke)
secondary to an intrauterine or perinatal thromboembolism. Cerebral hypoplasia and
sometimes severe neonatal hypoglycemia are related to ataxic CP. Generalized cortical and
cerebral atrophy often cause severe quadriparesis with cognitive impairment and
microcephaly.
•غﺎﻣدﻟا ﻲﻓ ﺔﻣﯾﺳﺟ تﺎھوﺷﺗ ثدﺣﺗ ،تﻻﺎﺣﻟا ضﻌﺑ ﻲﻓ . ﻲﻓو
،ﺔﯾوﻣدﻟا ﺔﯾﻋوﻷا دادﺳﻧا ﻰﻠﻋ لﯾﻟد كﺎﻧھ نوﻛﯾ دﻗ ،ىرﺧأ تﻻﺎﺣ
دؤﯾ يذﻟا ﻲﺣﻔﺻﻟا سﻛﻧﺗﻟاو ،ﺔﯾﺑﺻﻌﻟا ﺎﯾﻼﺧﻟا نادﻘﻓو ،روﻣﺿﻟاو ي
غﺎﻣدﻟا نزو ضﺎﻔﺧﻧاو ،ﻊﺳوأ مﻼﺗأو ،ﻖﯾﺿأ فﯾﻓﻼﺗ ﻰﻟإ.
• ﻖطﺎﻧﻣﻟﺎﺑ ﺔطﺑﺗرﻣ تﺎﺑﺑﺳﻣﻟا وأ رھﺎظﻣﻟا نوﻛﺗ ،تﻻﺎﺣﻟا ضﻌﺑ ﻲﻓ
ﺔﯾﺣﯾرﺷﺗﻟا .ﺎﻋ ةرﻛﺑﻣﻟا ةدﻻوﻟﺎﺑ طﺑﺗرﻣﻟا ﻲﻏﺎﻣدﻟا لﻠﺷﻟا ،لﺎﺛﻣﻟا لﯾﺑﺳ ﻰﻠﻋ ﺎﻣ ةد
ﺗ ﻊﻣ فزﻧ وأ ﺔﺟﺳﻛﻷا صﻘﻧ ءﺎﺷﺗﺣا نﻋ ﺎًﻣﺟﺎﻧ ﺎًﯾﺟﻧﺷﺗ ﺎًﺟودزﻣ ًﻼﻠﺷ نوﻛﯾ نﯾﻠ
ﺔﯾﺑﻧﺎﺟﻟا تﺎﻧﯾطﺑﻠﻟ ةروﺎﺟﻣﻟا ﺔﻘطﻧﻣﻟا ﻲﻓ تﺎﻧﯾطﺑﻟا لوﺣ ءﺎﺿﯾﺑ .أ ﺢﺟرﻣﻟا نﻣ ن
ﻲﻌَﻧُﻛﻟا عوﻧﻟا نوﻛﯾ)ﻲﻣرﮭﻟا جرﺎﺧ ( قﺎﻧﺗﺧﻻﺎﺑ ﺎًطﺑﺗرﻣ ﻲﻏﺎﻣدﻟا لﻠﺷﻟا نﻣ
ﺎﺑارطﺿﻻاو يووﻧﻟا نﺎﻗرﯾﻟا نﻋ ﺎًﻣﺟﺎﻧ نوﻛﯾ نأ ﺎًﺿﯾأ نﻛﻣﯾ نﻛﻟو ،يدﻻوﻟا ت
ﺔﯾﺿﯾﻷا ﺔﯾﺛاروﻟا
• ﻲﻔﺻﻧﻟا لﻠﺷﻟا طﺑﺗرﯾ ﺎﻣ ﺎًﺑﻟﺎﻏ)ﻲﺟرﻔﻟا ( يرؤﺑﻟا ﻲﻏﺎﻣدﻟا ءﺎﺷﺗﺣﻻﺎﺑ)ﻟا ﺔﺗﻛﺳ
ﺔﯾﻏﺎﻣدﻟا ( ﺔطﯾﺣﻣﻟا ةرﺗﻔﻟا ﻲﻓ وأ مﺣرﻟا لﺧاد ﺔﯾوﻣدﻟا تﺎطﻠﺟﻠﻟ يوﻧﺎﺛﻟا
ةدﻻوﻟﺎﺑ .ﻔطﻷا دﻧﻋ مدﻟا ﻲﻓ رﻛﺳﻟا صﻘﻧ ﺎًﻧﺎﯾﺣأو غﺎﻣدﻟا ﺞﺳﻧﺗ صﻘﻧ طﺑﺗرﯾ لﺎ
ﺢﻧرﻟا ﻲﻏﺎﻣدﻟا لﻠﺷﻟﺎﺑ ةدﻻوﻟا ﻲﺛﯾدﺣ . يرﺷﻘﻟا روﻣﺿﻟا بﺑﺳﯾ ﺎﻣ ﺎًﺑﻟﺎﻏ
سأرﻟا رﻐﺻو ﻲﻛاردإ فﻌﺿ ﻊﻣ اًدﯾدﺷ ﺎًﯾﻋﺎﺑر ًﻻزﺧ مﻣﻌﻣﻟا ﻲﻏﺎﻣدﻟاو.
Diagnostic Evaluation
The neurologic examination and
history are the primary modalities for
diagnosis. Neuroimaging of the child
with suspected brain abnormality and
CP is now recommended for diagnostic
assessment, with MRI being a strong
predictor of CP. Metabolic and genetic
testing is recommended if no
structural abnormality is identified by
neuroimaging
صﯾﺧﺷﺗﻠﻟ ﺔﯾﺳﺎﺳﻷا ﻖﺋارطﻟا ﺎﻣھ ﺦﯾرﺎﺗﻟاو ﻲﺑﺻﻌﻟا صﺣﻔﻟا .ﺑﺻﻋ رﯾوﺻﺗ ءارﺟﺈﺑ نﻵا ﻰﺻوﯾ ﻲ
ﺗﻌﯾ ثﯾﺣ ،ﻲﺻﯾﺧﺷﺗﻟا مﯾﯾﻘﺗﻟا لﺟأ نﻣ ﻲﻏﺎﻣدﻟا لﻠﺷﻟاو ﮫﻏﺎﻣد ﻲﻓ لﻠﺧ دوﺟو ﻲﻓ ﮫﺑﺗﺷﻣﻟا لﻔطﻠﻟ رﺑ
ﻲﻏﺎﻣدﻟا لﻠﺷﻟﺎﺑ ﺔﺑﺎﺻﻹا ﻰﻠﻋ ﺎًﯾوﻗ اًرﺷؤﻣ ﻲﺳﯾطﺎﻧﻐﻣﻟا نﯾﻧرﻟﺎﺑ رﯾوﺻﺗﻟا .ﺗﺧا ءارﺟﺈﺑ ﻰﺻوﯾ تارﺎﺑ
ﻲﺑﺻﻌﻟا رﯾوﺻﺗﻟا ﻖﯾرط نﻋ ﻲﻠﻛﯾھ لﻠﺧ يأ دﯾدﺣﺗ مﺗﯾ مﻟ اذإ ﻲﻧﯾﺟﻟاو ﻲﺋاذﻐﻟا لﯾﺛﻣﺗﻟا
The neurologic examination and
history are the primary modalities for
diagnosis. Neuroimaging of the child
with suspected brain abnormality and
CP is now recommended for diagnostic
assessment, with MRI being a strong
predictor of CP. Metabolic and genetic
testing is recommended if no
structural abnormality is identified by
neuroimaging
صﯾﺧﺷﺗﻠﻟ ﺔﯾﺳﺎﺳﻷا ﻖﺋارطﻟا ﺎﻣھ ﺦﯾرﺎﺗﻟاو ﻲﺑﺻﻌﻟا صﺣﻔﻟا .ﺑﺻﻋ رﯾوﺻﺗ ءارﺟﺈﺑ نﻵا ﻰﺻوﯾ ﻲ
ﺗﻌﯾ ثﯾﺣ ،ﻲﺻﯾﺧﺷﺗﻟا مﯾﯾﻘﺗﻟا لﺟأ نﻣ ﻲﻏﺎﻣدﻟا لﻠﺷﻟاو ﮫﻏﺎﻣد ﻲﻓ لﻠﺧ دوﺟو ﻲﻓ ﮫﺑﺗﺷﻣﻟا لﻔطﻠﻟ رﺑ
ﻲﻏﺎﻣدﻟا لﻠﺷﻟﺎﺑ ﺔﺑﺎﺻﻹا ﻰﻠﻋ ﺎًﯾوﻗ اًرﺷؤﻣ ﻲﺳﯾطﺎﻧﻐﻣﻟا نﯾﻧرﻟﺎﺑ رﯾوﺻﺗﻟا .ﺗﺧا ءارﺟﺈﺑ ﻰﺻوﯾ تارﺎﺑ
ﻲﺑﺻﻌﻟا رﯾوﺻﺗﻟا ﻖﯾرط نﻋ ﻲﻠﻛﯾھ لﻠﺧ يأ دﯾدﺣﺗ مﺗﯾ مﻟ اذإ ﻲﻧﯾﺟﻟاو ﻲﺋاذﻐﻟا لﯾﺛﻣﺗﻟا
Nursing Care Management
Nursing assessment includes risk identification of infants with etiologic
factors that are associated with CP. Ongoing assessment of infants for
abnormal muscle tone, inability to achieve developmental milestones,
and persistence of neonatal reflexes alert the nurse to investigate further.
•Reinforce Therapeutic Plan and Assist in Normalization
•Address health maintenance needs
•Support the family
•Care of the hospitalised child
لﻣاوﻌﻟا نﻣ نوﻧﺎﻌﯾ نﯾذﻟا ﻊﺿرﻟا دﻧﻋ رطﺎﺧﻣﻟا دﯾدﺣﺗ ضﯾرﻣﺗﻟا مﯾﯾﻘﺗ لﻣﺷﯾ
ﻲﻏﺎﻣدﻟا لﻠﺷﻟﺎﺑ ﺔطﺑﺗرﻣﻟا ﺔﺑﺑﺳﻣﻟا .ﻋ ﺎًﺛﺣﺑ ﻊﺿرﻠﻟ رﻣﺗﺳﻣﻟا مﯾﯾﻘﺗﻟا نإ ةوﻗ ن
رارﻣﺗﺳاو ،وﻣﻧﻟا مﻟﺎﻌﻣ ﻖﯾﻘﺣﺗ ﻰﻠﻋ ةردﻘﻟا مدﻋو ،ﺔﯾﻌﯾﺑطﻟا رﯾﻏ تﻼﺿﻌﻟا
ﻖﯾﻘﺣﺗﻟا نﻣ دﯾزﻣ ءارﺟإ ﻰﻟإ ﺔﺿرﻣﻣﻟا ﮫﺑﻧﯾ ﺔﯾدﯾﻟوﻟا لﻌﻔﻟا دودر.
•ﻊﯾﺑطﺗﻟا ﻲﻓ ةدﻋﺎﺳﻣﻟاو ﺔﯾﺟﻼﻌﻟا ﺔطﺧﻟا زﯾزﻌﺗ
•ﺔﯾﺣﺻﻟا ﺔﻧﺎﯾﺻﻟا تﺎﺟﺎﯾﺗﺣا ﺔﺟﻟﺎﻌﻣ
•ةرﺳﻷا مﻋد
•ﻰﻔﺷﺗﺳﻣﻟا ﻲﻓ لﻔطﻟا ﺔﯾﺎﻋر
Nursing assessment includes risk identification of infants with etiologic
factors that are associated with CP. Ongoing assessment of infants for
abnormal muscle tone, inability to achieve developmental milestones,
and persistence of neonatal reflexes alert the nurse to investigate further.
•Reinforce Therapeutic Plan and Assist in Normalization
•Address health maintenance needs
•Support the family
•Care of the hospitalised child
لﻣاوﻌﻟا نﻣ نوﻧﺎﻌﯾ نﯾذﻟا ﻊﺿرﻟا دﻧﻋ رطﺎﺧﻣﻟا دﯾدﺣﺗ ضﯾرﻣﺗﻟا مﯾﯾﻘﺗ لﻣﺷﯾ
ﻲﻏﺎﻣدﻟا لﻠﺷﻟﺎﺑ ﺔطﺑﺗرﻣﻟا ﺔﺑﺑﺳﻣﻟا .ﻋ ﺎًﺛﺣﺑ ﻊﺿرﻠﻟ رﻣﺗﺳﻣﻟا مﯾﯾﻘﺗﻟا نإ ةوﻗ ن
رارﻣﺗﺳاو ،وﻣﻧﻟا مﻟﺎﻌﻣ ﻖﯾﻘﺣﺗ ﻰﻠﻋ ةردﻘﻟا مدﻋو ،ﺔﯾﻌﯾﺑطﻟا رﯾﻏ تﻼﺿﻌﻟا
ﻖﯾﻘﺣﺗﻟا نﻣ دﯾزﻣ ءارﺟإ ﻰﻟإ ﺔﺿرﻣﻣﻟا ﮫﺑﻧﯾ ﺔﯾدﯾﻟوﻟا لﻌﻔﻟا دودر.
•ﻊﯾﺑطﺗﻟا ﻲﻓ ةدﻋﺎﺳﻣﻟاو ﺔﯾﺟﻼﻌﻟا ﺔطﺧﻟا زﯾزﻌﺗ
•ﺔﯾﺣﺻﻟا ﺔﻧﺎﯾﺻﻟا تﺎﺟﺎﯾﺗﺣا ﺔﺟﻟﺎﻌﻣ
•ةرﺳﻷا مﻋد
•ﻰﻔﺷﺗﺳﻣﻟا ﻲﻓ لﻔطﻟا ﺔﯾﺎﻋر
SPINAL MUSCULAR ATROPHY TYPE 1
(WERDNIG-HOFFMANN DISEASE)
• Spinal muscular atrophy (SMA) type 1 (Werdnig-Hoffmann disease) is a
disorder characterized by progressive weakness and wasting of skeletal
muscles caused by degeneration of anterior horn cells.
• It is inherited as an autosomal recessive trait and is the most common
paralytic form of the floppy infant syndrome (congenital hypotonia).
The sites of the pathologic condition are the anterior horn cells of the
spinal cord and the motor nuclei of the brainstem, but the primary
effect is atrophy of skeletal muscles.
ﻲﻛوﺷﻟا تﻼﺿﻌﻟا روﻣﺿ () عوﻧﻟا1)نﺎﻣﻓوھ ﺞﯾﻧدرﯾو ضرﻣ ( زﯾﻣﺗﯾ بارطﺿا وھ
ﻲﻣﺎﻣﻷا نرﻘﻟا ﺎﯾﻼﺧ سﻛﻧﺗ نﻋ مﺟﺎﻧﻟا ﺔﯾﻠﻛﯾﮭﻟا تﻼﺿﻌﻟا لازھو ﻲﺟﯾردﺗﻟا فﻌﺿﻟﺎﺑ.
نرﻣﻟا ﻊﯾﺿرﻟا ﺔﻣزﻼﺗﻣﻟ ﺎًﻋوﯾﺷ رﺛﻛﻷا ﻲﻠﻠﺷﻟا لﻛﺷﻟا وھو ﺔﯾﺣﻧﺗﻣ ﺔﯾﻣﺳﺟ ﺔﻔﺻﻛ ﮫﺛﯾروﺗ مﺗﯾ)ﻘﻧ ص
ﻲﻘﻠﺧﻟا رﺗوﺗﻟا .( عذﺟﻟ ﺔﯾﻛرﺣﻟا ةاوﻧﻟاو ﻲﻛوﺷﻟا لﺑﺣﻠﻟ ﻲﻣﺎﻣﻷا نرﻘﻟا ﺎﯾﻼﺧ ﻲھ ﺔﯾﺿرﻣﻟا ﺔﻟﺎﺣﻟا ﻊﻗاوﻣ
ﺔﯾﻠﻛﯾﮭﻟا تﻼﺿﻌﻟا روﻣﺿ وھ ﻲﺳﺎﺳﻷا رﯾﺛﺄﺗﻟا نﻛﻟو ،غﺎﻣدﻟا.
(WERDNIG-HOFFMANN DISEASE)
• Spinal muscular atrophy (SMA) type 1 (Werdnig-Hoffmann disease) is a
disorder characterized by progressive weakness and wasting of skeletal
muscles caused by degeneration of anterior horn cells.
• It is inherited as an autosomal recessive trait and is the most common
paralytic form of the floppy infant syndrome (congenital hypotonia).
The sites of the pathologic condition are the anterior horn cells of the
spinal cord and the motor nuclei of the brainstem, but the primary
effect is atrophy of skeletal muscles.
ﻲﻛوﺷﻟا تﻼﺿﻌﻟا روﻣﺿ () عوﻧﻟا1)نﺎﻣﻓوھ ﺞﯾﻧدرﯾو ضرﻣ ( زﯾﻣﺗﯾ بارطﺿا وھ
ﻲﻣﺎﻣﻷا نرﻘﻟا ﺎﯾﻼﺧ سﻛﻧﺗ نﻋ مﺟﺎﻧﻟا ﺔﯾﻠﻛﯾﮭﻟا تﻼﺿﻌﻟا لازھو ﻲﺟﯾردﺗﻟا فﻌﺿﻟﺎﺑ.
نرﻣﻟا ﻊﯾﺿرﻟا ﺔﻣزﻼﺗﻣﻟ ﺎًﻋوﯾﺷ رﺛﻛﻷا ﻲﻠﻠﺷﻟا لﻛﺷﻟا وھو ﺔﯾﺣﻧﺗﻣ ﺔﯾﻣﺳﺟ ﺔﻔﺻﻛ ﮫﺛﯾروﺗ مﺗﯾ)ﻘﻧ ص
ﻲﻘﻠﺧﻟا رﺗوﺗﻟا .( عذﺟﻟ ﺔﯾﻛرﺣﻟا ةاوﻧﻟاو ﻲﻛوﺷﻟا لﺑﺣﻠﻟ ﻲﻣﺎﻣﻷا نرﻘﻟا ﺎﯾﻼﺧ ﻲھ ﺔﯾﺿرﻣﻟا ﺔﻟﺎﺣﻟا ﻊﻗاوﻣ
ﺔﯾﻠﻛﯾﮭﻟا تﻼﺿﻌﻟا روﻣﺿ وھ ﻲﺳﺎﺳﻷا رﯾﺛﺄﺗﻟا نﻛﻟو ،غﺎﻣدﻟا.
Diagnostic Evaluation
The diagnosis is based on the molecular genetic marker for the (SMN) (survival motor neuron) gene.
Prenatal diagnosis may be made by genetic analysis of circulating fetal cells in maternal blood or circulating
fetal cells in amniotic fluid. Further diagnostic studies include muscle electromyography (EMG), however,
the genetic analysis has become the gold standard for diagnosis of the condition.
Therapeutic Management
•There is no cure for the disease, and treatment is symptomatic and preventive, primarily preventing joint
contractures and treating orthopedic problems, the most serious of which is scoliosis. Hip subluxation and
dislocation may also occur. supplemental gastrostomy feedings may be required to maintain adequate
nutritional status and maintain weight gain.
•Upper respiratory tract infections often occur and are treated with antibiotic therapy; they are the cause of
death in many children.
•Children with SMA type 1 who undergo tracheotomy and invasive ventilation often remain ventilator
dependent for the rest of their lives
•Palliative care is an important aspect of care for families of children with SMA type 1. In addition to non
invasive respiratory support, some infants and children may benefit from tracheostomy and mechanical
ventilation. If untreated, some infants may die of respiratory complications in infancy.
نﯾﺟﻟ ﺔﯾﺋﯾزﺟﻟا ﺔﯾﻧﯾﺟﻟا ﺔﻣﻼﻌﻟا ﻰﻠﻋ صﯾﺧﺷﺗﻟا دﻣﺗﻌﯾ) (..)ﻗ ﻰﻠﻋ ءﺎﻘﺑﻠﻟ ﺔﯾﻛرﺣﻟا ﺔﯾﺑﺻﻌﻟا ﺎﯾﻼﺧﻟا دﯾ
ةﺎﯾﺣﻟا .(ﻓ ةرﺷﺗﻧﻣﻟا ﺔﯾﻧﯾﻧﺟﻟا ﺎﯾﻼﺧﻠﻟ ﻲﻧﯾﺟﻟا لﯾﻠﺣﺗﻟا ﻖﯾرط نﻋ ةدﻻوﻟا لﺑﻗ صﯾﺧﺷﺗﻟا ءارﺟإ نﻛﻣﯾ مد ﻲ
ﻲﺳوﯾﻧﻣﻷا لﺋﺎﺳﻟا ﻲﻓ ةرﺷﺗﻧﻣﻟا ﺔﯾﻧﯾﻧﺟﻟا ﺎﯾﻼﺧﻟا وأ مﻷا .ﺧﺗ ﺔﯾﻓﺎﺿﻹا ﺔﯾﺻﯾﺧﺷﺗﻟا تﺎﺳاردﻟا لﻣﺷﺗ طﯾط
تﻼﺿﻌﻟا ﺔﯾﺑرﮭﻛ(..)ﺔﻟﺎﺣﻟا صﯾﺧﺷﺗﻟ ﻲﺑھذﻟا رﺎﯾﻌﻣﻟا وھ ﻲﻧﯾﺟﻟا لﯾﻠﺣﺗﻟا ﺢﺑﺻأ ،كﻟذ ﻊﻣو ،.
•ﺎﻘﻣﻟا ﻲﻓو ،ًﺎﯾﺋﺎﻗوو ًﺎﯾﺿرﻋ نوﻛﯾ جﻼﻌﻟاو ،ضرﻣﻠﻟ ﻲﻓﺎﺷ جﻼﻋ دﺟوﯾ ﻻ م
فﻧﺟﻟا ﺎھرطﺧأو مﺎظﻌﻟا لﻛﺎﺷﻣ جﻼﻋو لﺻﺎﻔﻣﻟا تﺎﺻﻠﻘﺗ ﻊﻧﻣ لوﻷا . دﻗ
ﮫﻌﻠﺧو كروﻟا ﻊﻠﺧ ﺎًﺿﯾأ ثدﺣﯾ .ﯾﻠﯾﻣﻛﺗﻟا ةدﻌﻣﻟا ﺔﯾذﻐﺗﻟ ﺔﺟﺎﺣ كﺎﻧھ نوﻛﺗ دﻗ ﺔ
نزوﻟا ةدﺎﯾز ﻰﻠﻋ ظﺎﻔﺣﻟاو ﺔﯾﻓﺎﻛﻟا ﺔﯾوذﻐﺗﻟا ﺔﻟﺎﺣﻟا ﻰﻠﻋ ظﺎﻔﺣﻠﻟ.
ﺔﯾوﯾﺣﻟا تادﺎﺿﻣﻟﺎﺑ ﺎﮭﺟﻼﻋ مﺗﯾو يوﻠﻌﻟا ﻲﺳﻔﻧﺗﻟا زﺎﮭﺟﻟا تﺎﺑﺎﮭﺗﻟا ثدﺣﺗ ﺎﻣ ﺎًﺑﻟﺎﻏ .طﻷا نﻣ دﯾدﻌﻟا ةﺎﻓو بﺑﺳ ﻲﮭﻓلﺎﻔ.
عوﻧﻟا نﻣ ﺄﺷﻧﻣﻟا ﻲﻋﺎﺧﻧ ﻲﻠﺿﻌﻟا روﻣﺿﻟﺎﺑ نوﺑﺎﺻﻣﻟا لﺎﻔطﻷا1 سﻔﻧﺗﻟا زﺎﮭﺟ ﻰﻠﻋ نﯾدﻣﺗﻌﻣ نوﻠظﯾ ﺎﻣ ﺎًﺑﻟﺎﻏ ﺔﯾزﺎﻐﻟا ﺔﯾوﮭﺗﻟاو ﺔﯾﺋاوﮭﻟا ﺔﺑﺻﻘﻟا ﻖﺷﻟ نوﻌﺿﺧﯾ نﯾذﻟاو
مﮭﺗﺎﯾﺣ ﺔﯾﻘﺑﻟ ﻲﻋﺎﻧﺻﻟا
• عوﻧﻟا نﻣ ﺄﺷﻧﻣﻟا ﻲﻋﺎﺧﻧ ﻲﻠﺿﻌﻟا روﻣﺿﻟﺎﺑ نﯾﺑﺎﺻﻣﻟا لﺎﻔطﻷا رﺳأ ﺔﯾﺎﻋر نﻣ ﺎًﻣﮭﻣ ﺎًﺑﻧﺎﺟ ﺔﯾﻔﯾطﻠﺗﻟا ﺔﯾﺎﻋرﻟا رﺑﺗﻌﺗ1 . ﻲﺳﻔﻧﺗﻟا مﻋدﻟا ﻰﻟإ ﺔﻓﺎﺿﻹﺎﺑ
ﺔﯾﻛﯾﻧﺎﻛﯾﻣﻟا ﺔﯾوﮭﺗﻟاو ﺔﯾﺋاوﮭﻟا ﺔﺑﺻﻘﻟا بﻘﺛ نﻣ لﺎﻔطﻷاو ﻊﺿرﻟا ضﻌﺑ دﯾﻔﺗﺳﯾ دﻗ ،ﻲﺣارﺟﻟا رﯾﻏ .ﺑ ﻊﺿرﻟا ضﻌﺑ توﻣﯾ دﻗ ،ﮫﺟﻼﻋ مﺗﯾ مﻟ اذإ بﺑﺳ
ﺔﻟوﻔطﻟا ﺔﻠﺣرﻣ ﻲﻓ ﻲﺳﻔﻧﺗﻟا زﺎﮭﺟﻟا تﺎﻔﻋﺎﺿﻣ.
The diagnosis is based on the molecular genetic marker for the (SMN) (survival motor neuron) gene.
Prenatal diagnosis may be made by genetic analysis of circulating fetal cells in maternal blood or circulating
fetal cells in amniotic fluid. Further diagnostic studies include muscle electromyography (EMG), however,
the genetic analysis has become the gold standard for diagnosis of the condition.
Therapeutic Management
•There is no cure for the disease, and treatment is symptomatic and preventive, primarily preventing joint
contractures and treating orthopedic problems, the most serious of which is scoliosis. Hip subluxation and
dislocation may also occur. supplemental gastrostomy feedings may be required to maintain adequate
nutritional status and maintain weight gain.
•Upper respiratory tract infections often occur and are treated with antibiotic therapy; they are the cause of
death in many children.
•Children with SMA type 1 who undergo tracheotomy and invasive ventilation often remain ventilator
dependent for the rest of their lives
•Palliative care is an important aspect of care for families of children with SMA type 1. In addition to non
invasive respiratory support, some infants and children may benefit from tracheostomy and mechanical
ventilation. If untreated, some infants may die of respiratory complications in infancy.
نﯾﺟﻟ ﺔﯾﺋﯾزﺟﻟا ﺔﯾﻧﯾﺟﻟا ﺔﻣﻼﻌﻟا ﻰﻠﻋ صﯾﺧﺷﺗﻟا دﻣﺗﻌﯾ) (..)ﻗ ﻰﻠﻋ ءﺎﻘﺑﻠﻟ ﺔﯾﻛرﺣﻟا ﺔﯾﺑﺻﻌﻟا ﺎﯾﻼﺧﻟا دﯾ
ةﺎﯾﺣﻟا .(ﻓ ةرﺷﺗﻧﻣﻟا ﺔﯾﻧﯾﻧﺟﻟا ﺎﯾﻼﺧﻠﻟ ﻲﻧﯾﺟﻟا لﯾﻠﺣﺗﻟا ﻖﯾرط نﻋ ةدﻻوﻟا لﺑﻗ صﯾﺧﺷﺗﻟا ءارﺟإ نﻛﻣﯾ مد ﻲ
ﻲﺳوﯾﻧﻣﻷا لﺋﺎﺳﻟا ﻲﻓ ةرﺷﺗﻧﻣﻟا ﺔﯾﻧﯾﻧﺟﻟا ﺎﯾﻼﺧﻟا وأ مﻷا .ﺧﺗ ﺔﯾﻓﺎﺿﻹا ﺔﯾﺻﯾﺧﺷﺗﻟا تﺎﺳاردﻟا لﻣﺷﺗ طﯾط
تﻼﺿﻌﻟا ﺔﯾﺑرﮭﻛ(..)ﺔﻟﺎﺣﻟا صﯾﺧﺷﺗﻟ ﻲﺑھذﻟا رﺎﯾﻌﻣﻟا وھ ﻲﻧﯾﺟﻟا لﯾﻠﺣﺗﻟا ﺢﺑﺻأ ،كﻟذ ﻊﻣو ،.
•ﺎﻘﻣﻟا ﻲﻓو ،ًﺎﯾﺋﺎﻗوو ًﺎﯾﺿرﻋ نوﻛﯾ جﻼﻌﻟاو ،ضرﻣﻠﻟ ﻲﻓﺎﺷ جﻼﻋ دﺟوﯾ ﻻ م
فﻧﺟﻟا ﺎھرطﺧأو مﺎظﻌﻟا لﻛﺎﺷﻣ جﻼﻋو لﺻﺎﻔﻣﻟا تﺎﺻﻠﻘﺗ ﻊﻧﻣ لوﻷا . دﻗ
ﮫﻌﻠﺧو كروﻟا ﻊﻠﺧ ﺎًﺿﯾأ ثدﺣﯾ .ﯾﻠﯾﻣﻛﺗﻟا ةدﻌﻣﻟا ﺔﯾذﻐﺗﻟ ﺔﺟﺎﺣ كﺎﻧھ نوﻛﺗ دﻗ ﺔ
نزوﻟا ةدﺎﯾز ﻰﻠﻋ ظﺎﻔﺣﻟاو ﺔﯾﻓﺎﻛﻟا ﺔﯾوذﻐﺗﻟا ﺔﻟﺎﺣﻟا ﻰﻠﻋ ظﺎﻔﺣﻠﻟ.
ﺔﯾوﯾﺣﻟا تادﺎﺿﻣﻟﺎﺑ ﺎﮭﺟﻼﻋ مﺗﯾو يوﻠﻌﻟا ﻲﺳﻔﻧﺗﻟا زﺎﮭﺟﻟا تﺎﺑﺎﮭﺗﻟا ثدﺣﺗ ﺎﻣ ﺎًﺑﻟﺎﻏ .طﻷا نﻣ دﯾدﻌﻟا ةﺎﻓو بﺑﺳ ﻲﮭﻓلﺎﻔ.
عوﻧﻟا نﻣ ﺄﺷﻧﻣﻟا ﻲﻋﺎﺧﻧ ﻲﻠﺿﻌﻟا روﻣﺿﻟﺎﺑ نوﺑﺎﺻﻣﻟا لﺎﻔطﻷا1 سﻔﻧﺗﻟا زﺎﮭﺟ ﻰﻠﻋ نﯾدﻣﺗﻌﻣ نوﻠظﯾ ﺎﻣ ﺎًﺑﻟﺎﻏ ﺔﯾزﺎﻐﻟا ﺔﯾوﮭﺗﻟاو ﺔﯾﺋاوﮭﻟا ﺔﺑﺻﻘﻟا ﻖﺷﻟ نوﻌﺿﺧﯾ نﯾذﻟاو
مﮭﺗﺎﯾﺣ ﺔﯾﻘﺑﻟ ﻲﻋﺎﻧﺻﻟا
• عوﻧﻟا نﻣ ﺄﺷﻧﻣﻟا ﻲﻋﺎﺧﻧ ﻲﻠﺿﻌﻟا روﻣﺿﻟﺎﺑ نﯾﺑﺎﺻﻣﻟا لﺎﻔطﻷا رﺳأ ﺔﯾﺎﻋر نﻣ ﺎًﻣﮭﻣ ﺎًﺑﻧﺎﺟ ﺔﯾﻔﯾطﻠﺗﻟا ﺔﯾﺎﻋرﻟا رﺑﺗﻌﺗ1 . ﻲﺳﻔﻧﺗﻟا مﻋدﻟا ﻰﻟإ ﺔﻓﺎﺿﻹﺎﺑ
ﺔﯾﻛﯾﻧﺎﻛﯾﻣﻟا ﺔﯾوﮭﺗﻟاو ﺔﯾﺋاوﮭﻟا ﺔﺑﺻﻘﻟا بﻘﺛ نﻣ لﺎﻔطﻷاو ﻊﺿرﻟا ضﻌﺑ دﯾﻔﺗﺳﯾ دﻗ ،ﻲﺣارﺟﻟا رﯾﻏ .ﺑ ﻊﺿرﻟا ضﻌﺑ توﻣﯾ دﻗ ،ﮫﺟﻼﻋ مﺗﯾ مﻟ اذإ بﺑﺳ
ﺔﻟوﻔطﻟا ﺔﻠﺣرﻣ ﻲﻓ ﻲﺳﻔﻧﺗﻟا زﺎﮭﺟﻟا تﺎﻔﻋﺎﺿﻣ.
Nursing Care Management
•Special attention should be directed to preventing muscle and joint contractures, promoting
independence in performance of ADLs, and becoming incorporated into the mainstream of
school when possible.
•It is important to assess adequate oxygenation, especially during the sleep phase when
shallow breathing occurs and hypoxemia may develop. Home pulse oximetry may be used to
assess the child during sleep and provide noninvasive mechanical ventilation as necessary .
•Supportive care also includes management of orthoses and other orthopedic equipment as
required.
•Children who are able to sit require proper support and attention to alignment to prevent
deformities and other complications.
•The parents of a child who is chronically ill require much support and encouragement.
•Parents who have not sought genetic counseling should be encouraged to do so to evaluate
further risk potential.
•ﻼﻘﺗﺳﻻا زﯾزﻌﺗو ،لﺻﺎﻔﻣﻟاو تﻼﺿﻌﻟا تﺎﺻﻠﻘﺗ ﻊﻧﻣﻟ صﺎﺧ مﺎﻣﺗھا ﮫﯾﺟوﺗ ﻲﻐﺑﻧﯾ ل
ءادأ ﻲﻓADLs ،ﺎﻧﻛﻣﻣ كﻟذ نوﻛﯾ ﺎﻣدﻧﻋ ﺔﺳردﻣﻠﻟ ﻲﺳﯾﺋرﻟا رﺎﯾﺗﻟا ﻲﻓ جﺎﻣدﻧﻻاو.
• ﻲﻓ ﺔﺟﺳﻛﻷا صﻘﻧ ثدﺣﯾ دﻗو لﺣﺿﻟا سﻔﻧﺗﻟا ثدﺣﯾ ﺎﻣدﻧﻋ موﻧﻟا ﺔﻠﺣرﻣ ءﺎﻧﺛأ ﺔﺻﺎﺧ ،ﺔﯾﻓﺎﻛﻟا نﯾﺟﺳﻛوﻷا ﺔﯾﻣﻛ مﯾﯾﻘﺗ مﮭﻣﻟا نﻣ
مدﻟا .ا دﻧﻋ ﺔﯾﺣارﺟ رﯾﻏ ﺔﯾﻛﯾﻧﺎﻛﯾﻣ ﺔﯾوﮭﺗ رﯾﻓوﺗو موﻧﻟا ءﺎﻧﺛأ لﻔطﻟا مﯾﯾﻘﺗﻟ ﻲﻟزﻧﻣﻟا ﻲﺿﺑﻧﻟا ﺞﺳﻛﺄﺗﻟا سﺎﯾﻗ مادﺧﺗﺳا نﻛﻣﯾةرورﺿﻟ.
•ﺔﺟﺎﺣﻟا بﺳﺣ ىرﺧﻷا مﺎظﻌﻟا مﯾوﻘﺗ تادﻌﻣو مﺎظﻌﻟا مﯾوﻘﺗ ةزﮭﺟأ ةرادإ ﺎًﺿﯾأ ﺔﻣﻋادﻟا ﺔﯾﺎﻋرﻟا لﻣﺷﺗ.
•ىرﺧﻷا تﺎﻔﻋﺎﺿﻣﻟاو تﺎھوﺷﺗﻟا ﻊﻧﻣﻟ ةاذﺎﺣﻣﻟﺎﺑ مﺎﻣﺗھﻻاو بﺳﺎﻧﻣﻟا مﻋدﻟا ﻰﻟإ سوﻠﺟﻟا ﻰﻠﻋ نوردﺎﻘﻟا لﺎﻔطﻷا جﺎﺗﺣﯾ.
•ﻊﯾﺟﺷﺗﻟاو مﻋدﻟا نﻣ رﯾﺛﻛﻟا ﻰﻟإ نﻣزﻣ ضرﻣﺑ بﺎﺻﻣﻟا لﻔطﻟا ادﻟاو جﺎﺗﺣﯾ.
•ﺔﻠﻣﺗﺣﻣﻟا رطﺎﺧﻣﻟا نﻣ دﯾزﻣﻟا مﯾﯾﻘﺗﻟ كﻟذﺑ مﺎﯾﻘﻟا ﻰﻠﻋ ﺔﯾﺛاروﻟا ةرﺎﺷﺗﺳﻻا اوﺑﻠطﯾ مﻟ نﯾذﻟا تﺎﮭﻣﻷاو ءﺎﺑﻵا ﻊﯾﺟﺷﺗ ﻲﻐﺑﻧﯾ.
•Special attention should be directed to preventing muscle and joint contractures, promoting
independence in performance of ADLs, and becoming incorporated into the mainstream of
school when possible.
•It is important to assess adequate oxygenation, especially during the sleep phase when
shallow breathing occurs and hypoxemia may develop. Home pulse oximetry may be used to
assess the child during sleep and provide noninvasive mechanical ventilation as necessary .
•Supportive care also includes management of orthoses and other orthopedic equipment as
required.
•Children who are able to sit require proper support and attention to alignment to prevent
deformities and other complications.
•The parents of a child who is chronically ill require much support and encouragement.
•Parents who have not sought genetic counseling should be encouraged to do so to evaluate
further risk potential.
•ﻼﻘﺗﺳﻻا زﯾزﻌﺗو ،لﺻﺎﻔﻣﻟاو تﻼﺿﻌﻟا تﺎﺻﻠﻘﺗ ﻊﻧﻣﻟ صﺎﺧ مﺎﻣﺗھا ﮫﯾﺟوﺗ ﻲﻐﺑﻧﯾ ل
ءادأ ﻲﻓADLs ،ﺎﻧﻛﻣﻣ كﻟذ نوﻛﯾ ﺎﻣدﻧﻋ ﺔﺳردﻣﻠﻟ ﻲﺳﯾﺋرﻟا رﺎﯾﺗﻟا ﻲﻓ جﺎﻣدﻧﻻاو.
• ﻲﻓ ﺔﺟﺳﻛﻷا صﻘﻧ ثدﺣﯾ دﻗو لﺣﺿﻟا سﻔﻧﺗﻟا ثدﺣﯾ ﺎﻣدﻧﻋ موﻧﻟا ﺔﻠﺣرﻣ ءﺎﻧﺛأ ﺔﺻﺎﺧ ،ﺔﯾﻓﺎﻛﻟا نﯾﺟﺳﻛوﻷا ﺔﯾﻣﻛ مﯾﯾﻘﺗ مﮭﻣﻟا نﻣ
مدﻟا .ا دﻧﻋ ﺔﯾﺣارﺟ رﯾﻏ ﺔﯾﻛﯾﻧﺎﻛﯾﻣ ﺔﯾوﮭﺗ رﯾﻓوﺗو موﻧﻟا ءﺎﻧﺛأ لﻔطﻟا مﯾﯾﻘﺗﻟ ﻲﻟزﻧﻣﻟا ﻲﺿﺑﻧﻟا ﺞﺳﻛﺄﺗﻟا سﺎﯾﻗ مادﺧﺗﺳا نﻛﻣﯾةرورﺿﻟ.
•ﺔﺟﺎﺣﻟا بﺳﺣ ىرﺧﻷا مﺎظﻌﻟا مﯾوﻘﺗ تادﻌﻣو مﺎظﻌﻟا مﯾوﻘﺗ ةزﮭﺟأ ةرادإ ﺎًﺿﯾأ ﺔﻣﻋادﻟا ﺔﯾﺎﻋرﻟا لﻣﺷﺗ.
•ىرﺧﻷا تﺎﻔﻋﺎﺿﻣﻟاو تﺎھوﺷﺗﻟا ﻊﻧﻣﻟ ةاذﺎﺣﻣﻟﺎﺑ مﺎﻣﺗھﻻاو بﺳﺎﻧﻣﻟا مﻋدﻟا ﻰﻟإ سوﻠﺟﻟا ﻰﻠﻋ نوردﺎﻘﻟا لﺎﻔطﻷا جﺎﺗﺣﯾ.
•ﻊﯾﺟﺷﺗﻟاو مﻋدﻟا نﻣ رﯾﺛﻛﻟا ﻰﻟإ نﻣزﻣ ضرﻣﺑ بﺎﺻﻣﻟا لﻔطﻟا ادﻟاو جﺎﺗﺣﯾ.
•ﺔﻠﻣﺗﺣﻣﻟا رطﺎﺧﻣﻟا نﻣ دﯾزﻣﻟا مﯾﯾﻘﺗﻟ كﻟذﺑ مﺎﯾﻘﻟا ﻰﻠﻋ ﺔﯾﺛاروﻟا ةرﺎﺷﺗﺳﻻا اوﺑﻠطﯾ مﻟ نﯾذﻟا تﺎﮭﻣﻷاو ءﺎﺑﻵا ﻊﯾﺟﺷﺗ ﻲﻐﺑﻧﯾ.
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