MENELIK II MEDICAL AND HEALTH SCIENCE

COLLEGE
DEPARTMENT OF Medical Radiology Technology
Pediatrics Assignment
Childhood Subdural Effusion, Hydrocephalus, Neural Tube Defects, and
Acute Hemiplegia
Student’s Name I.D
1) Hiwot Solomon MRT/R/007/14

2) Tinsae Awel MRT/R/018/14

3) Yonatan Zeleke MRT/R/021/14

SUBMITTED TO: Dr. Ermias Getaneh

SUBMITTED DATE: 20 February 2025

Table of Contents
1 Neural Tube Defects (NTDs) .................................................................................................1
1.1 Definition .....................................................................................................................1
1.2 Epidemiology ...............................................................................................................1
1.3 Causes .........................................................................................................................1
1.4 Risk Factors .................................................................................................................2
1.5 Pathology .....................................................................................................................2
1.6 Signs and Symptoms .....................................................................................................3
1.7 Investigations ...............................................................................................................3
1.8 Management & Treatment............................................................................................4
2 Acute Hemiplegia .................................................................................................................4
2.1 Definition .....................................................................................................................4
2.2 Epidemiology ...............................................................................................................4
2.3 Causes .........................................................................................................................5
2.4 Clinical Manifestations .................................................................................................5
2.5 Investigations ...............................................................................................................5
2.6 Management & Treatment............................................................................................6
3 Childhood Subdural Effusion ................................................................................................6
3.1 Definition .....................................................................................................................6
3.2 Epidemiology ...............................................................................................................7
3.3 Causes .........................................................................................................................7
3.4 Risk Factors .................................................................................................................7
3.5 Pathology .....................................................................................................................7
3.6 Signs and Symptoms .....................................................................................................7
3.7 Clinical Manifestations .................................................................................................8
3.8 Investigations ...............................................................................................................8
3.9 Management & Treatment............................................................................................8
4 Hydrocephalus .....................................................................................................................8
4.1 Definition .....................................................................................................................8
4.2 Epidemiology ...............................................................................................................8
4.3 Causes .........................................................................................................................8
4.4 Risk Factors .................................................................................................................9
4.5 Pathology .....................................................................................................................9
4.6 Signs and Symptoms .....................................................................................................9
4.7 Clinical Manifestations .................................................................................................9
4.8 Investigations ............................................................................................................. 10
4.9 Management & Treatment.......................................................................................... 10
Reference ............................................................................................................................... 11
1 Neural Tube Defects (NTDs)
1.1 Definition
Neural tube defects (NTDs) are congenital malformations resulting from incomplete closure of
the neural tube during early embryonic development, leading to defects in the brain, spine, or
spinal cord. Nelson’s Textbook of Pediatrics classifies NTDs into spina bifida, anencephaly, and
encephalocele, all of which stem from neural tube closure failure between the third and fourth
weeks of gestation. These defects can lead to significant morbidity and mortality depending on
the severity of the malformation and the associated complications.

1.2 Epidemiology
Global

NTDs affect approximately 0.5 to 2 per 1,000 live births worldwide, with varying prevalence
based on geographic, ethnic, and socioeconomic factors. Countries that have implemented
mandatory folic acid fortification have seen a significant reduction in NTD incidence,
demonstrating the crucial role of maternal nutrition in preventing these conditions. However,
disparities remain in regions with inadequate healthcare access, malnutrition, and lack of public
health interventions.
Ethiopia

In Ethiopia, NTDs are a significant public health concern, with reported incidence rates as high
as 5.2 per 1,000 births in certain regions. Studies attribute this high prevalence to multiple
factors, including limited access to prenatal folic acid supplementation, widespread maternal
malnutrition, high rates of teenage pregnancies, and inadequate prenatal care (Ethiopian Ministry
of Health, 2023). Additionally, lack of awareness regarding the importance of periconceptional
folic acid intake has contributed to persistently high rates of NTDs.

1.3 Causes
NTDs result from a complex interplay of genetic predisposition and environmental influences.
Key contributing factors include:

• Folic Acid Deficiency: Essential for DNA synthesis and cellular replication, folic acid
deficiency impairs neural tube closure, significantly increasing the risk of NTDs (WHO
Guidelines on Folic Acid Supplementation, 2022).
• Genetic Factors: Variants in genes involved in folate metabolism, such as MTHFR,
increase susceptibility (Nelson’s Textbook of Pediatrics, 2020).

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 • Maternal Health Conditions: Uncontrolled diabetes, obesity, and hyperthermia in early
pregnancy are associated with an elevated risk of neural tube malformations (AAP
Guidelines, 2021).

• Teratogenic Exposures: Medications such as valproic acid and methotrexate interfere

with neural tube formation, leading to an increased risk of defects (CDC Birth Defects
Report, 2022).

1.4 Risk Factors

Several maternal and environmental factors contribute to the occurrence of NTDs:

• Nutritional Deficiencies: Inadequate folic acid intake prior to conception and in early
pregnancy is a primary preventable cause of NTDs.
• Socioeconomic Factors: Poor access to healthcare, lower educational status, and food
insecurity increase the risk.
• Genetic Predisposition: A family history of NTDs raises the recurrence risk in
subsequent pregnancies.
• Geographic and Ethnic Influences: Certain populations with dietary limitations in folic
acid-rich foods exhibit a higher prevalence of NTDs.

1.5 Pathology
NTDs result from failed closure of the neural tube during early embryogenesis, leading to severe
congenital malformations:

• Spina Bifida: The spinal column fails to close completely, leaving the spinal cord
exposed in severe cases (myelomeningocele), causing neurological deficits.

• Anencephaly: Characterized by the absence of major brain structures, anencephaly is

universally fatal at or shortly after birth.

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 • Encephalocele: Herniation of brain tissue through skull defects, often associated with
neurological impairment and developmental delays.

1.6 Signs and Symptoms

The presentation of NTDs varies depending on the severity and type of defect:

• Spina Bifida: Can range from asymptomatic spina bifida occulta to severe neurological
impairment with paralysis and bowel/bladder dysfunction.

• Anencephaly: Characterized by the absence of a functional cerebrum and skull, leading

to stillbirth or early neonatal death.

• Encephalocele: Manifests as a cranial mass with possible hydrocephalus, seizures, and

motor or cognitive impairment.

1.7 Investigations
• Prenatal Screening:

o Maternal Serum Alpha-Fetoprotein (MSAFP): Elevated levels at 16-18 weeks

gestation indicate possible open NTDs.
o Ultrasound: Detects structural abnormalities of the spine and skull.

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 o Amniocentesis: Measures alpha-fetoprotein and acetylcholinesterase for
confirmation.

• Postnatal Diagnosis:

o MRI and CT Scans: Evaluate the extent of spinal and cranial defects.

1.8 Management & Treatment

• Preventive Measures:

o Daily 400-800 mcg folic acid supplementation for all women of reproductive age
(WHO, 2022).

o Mandatory food fortification policies to reduce NTD prevalence.

• Surgical Interventions:
o Spina Bifida Repair: Early closure of myelomeningocele within 48 hours post-
birth to prevent infection and further neurological damage.
o Ventriculoperitoneal Shunting: For hydrocephalus associated with NTDs.

• Multidisciplinary Support:

o Physiotherapy and Occupational Therapy to improve mobility.

o Urological and Orthopedic Interventions to manage associated complications.

2 Acute Hemiplegia
2.1 Definition
Acute hemiplegia refers to a sudden onset of unilateral paralysis or weakness, often resulting
from stroke, trauma, infections, or metabolic disorders. Pediatric stroke, a major cause, requires
urgent evaluation to determine underlying etiology. Rudolph’s Pediatrics highlights the
importance of rapid diagnosis and intervention to prevent long-term neurological deficits.

2.2 Epidemiology
Global

The incidence of pediatric stroke ranges from 1 to 13 per 100,000 children per year, with
ischemic strokes being more common than hemorrhagic strokes (AAP Stroke Guidelines, 2021).
Risk factors such as congenital heart disease, sickle cell anemia, and infections contribute to the
burden of acute hemiplegia worldwide.

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Ethiopia

Although national data on pediatric stroke are scarce, risk factors such as sickle cell disease,
malnutrition, and infectious diseases contribute to an assumed high prevalence.

2.3 Causes
• Cerebrovascular Events: Arterial ischemic stroke and hemorrhagic stroke.

• Infections: Meningitis, encephalitis, and post-viral inflammatory syndromes.

• Trauma: Traumatic brain injury leading to vascular damage.

• Metabolic Disorders: Mitochondrial diseases and hypoglycemia-induced strokes.

2.4 Clinical Manifestations

• Mild Cases: Transient weakness with full recovery.

• Severe Cases: Persistent hemiparesis and cognitive impairment.

• Recurrent Episodes: Suggest underlying hematologic or metabolic disorders.

2.5 Investigations
• Neuroimaging:

o MRI with Diffusion-Weighted Imaging (DWI) for ischemic stroke diagnosis.

o CT Scan to assess hemorrhage.
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 • Laboratory Tests:

o Coagulation Panel for clotting disorders.

o Inflammatory Markers for infection-related causes.

• Echocardiography to assess embolic stroke sources.

2.6 Management & Treatment

• Acute Care:

o Thrombolysis (tPA) in select cases of pediatric ischemic stroke.

o Anticoagulation Therapy (aspirin, heparin) for stroke prevention.

• Surgical Interventions:

o Decompressive Craniectomy for life-threatening hemorrhagic strokes.

• Rehabilitation:

o Physical, Occupational, and Speech Therapy for functional recovery.

3 Childhood Subdural Effusion

3.1 Definition
Subdural effusion refers to the accumulation of fluid, typically cerebrospinal fluid (CSF), in the
subdural space between the dura mater and the arachnoid membrane. In pediatric patients, this
condition often arises secondary to infections, trauma, or as a complication of neurosurgical
procedures.

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3.2 Epidemiology
The exact incidence of subdural effusion in children is not well-documented globally. However,
it is recognized as a potential complication following bacterial meningitis, with studies indicating
that up to 30% of children with meningitis may develop subdural effusions. In Ethiopia, specific
data on the prevalence of pediatric subdural effusion are scarce, but the high rates of infectious
diseases suggest a potentially higher incidence.

3.3 Causes
Subdural effusions in children can result from various etiologies:
• Infections: Bacterial meningitis is a leading cause, where inflammation leads to
increased permeability of the meninges, allowing fluid to accumulate in the subdural
space.

• Trauma: Head injuries can cause bleeding or fluid leakage into the subdural space.
• Post-surgical Complications: Neurosurgical interventions may disrupt normal CSF
pathways, leading to effusion.

3.4 Risk Factors

Several factors increase the risk of developing subdural effusions in children:

• Age: Infants and young children are more susceptible due to the fragility of their
meninges.
• Infection Prevalence: Regions with high rates of bacterial infections, such as Ethiopia,
may see higher incidences.
• Socio-economic Factors: Limited access to healthcare can delay the treatment of
infections, increasing the risk of complications like subdural effusion.

3.5 Pathology
The accumulation of fluid in the subdural space can lead to increased intracranial pressure,
causing compression of brain tissues. This pressure can result in neurological deficits and, if
untreated, may lead to brain herniation.

3.6 Signs and Symptoms

Clinical manifestations vary depending on the effusion's size and underlying cause:

• Increased Intracranial Pressure: Symptoms include vomiting, bulging fontanelles in

infants, and altered consciousness.
• Neurological Deficits: Seizures, hemiparesis, or cranial nerve palsies may occur.

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3.7 Clinical Manifestations
In infants, a rapid increase in head circumference may be observed. Older children might present
with headaches, lethargy, or focal neurological signs. The presentation can mimic other
intracranial pathologies, making accurate diagnosis crucial.

3.8 Investigations
Neuroimaging is essential for diagnosis:

• Computed Tomography (CT) Scan: Identifies fluid collections and assesses their
extent.

• Magnetic Resonance Imaging (MRI): Provides detailed images of the effusion and
surrounding brain structures.

3.9 Management & Treatment

Treatment focuses on addressing the underlying cause and relieving pressure:

• Medical Management: Antibiotics for infections and corticosteroids to reduce

inflammation.

• Surgical Intervention: In cases where the effusion causes significant mass effect,
procedures like subdural taps or the placement of subdural drains may be necessary.

4 Hydrocephalus
4.1 Definition
Hydrocephalus is characterized by an abnormal accumulation of cerebrospinal fluid (CSF)
within the brain's ventricular system, leading to increased intracranial pressure and potential
brain damage.

4.2 Epidemiology
Globally, hydrocephalus affects approximately 0.1-0.6% of newborns. In Ethiopia, neural tube
defects and associated hydrocephalus impact over 44,000 pregnancies annually.

ifglobal.org

4.3 Causes
Hydrocephalus can be congenital or acquired:

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 • Congenital Causes: Genetic abnormalities, such as L1CAM gene mutations, can lead to
aqueductal stenosis, obstructing CSF flow.

• Acquired Causes: Infections like meningitis, intraventricular hemorrhage, or brain

tumors can disrupt normal CSF dynamics.

4.4 Risk Factors

Factors increasing the risk include:

• Genetic Predisposition: Family history of hydrocephalus.

• Prenatal Infections: Maternal infections during pregnancy.

• Socio-economic Factors: Limited access to prenatal care, prevalent in low-resource

settings like Ethiopia.

4.5 Pathology
The imbalance between CSF production and absorption leads to ventricular dilation, increased
intracranial pressure, and subsequent compression of brain tissues.

4.6 Signs and Symptoms

Clinical features vary by age:
• Infants: Rapid head growth, bulging fontanelles, irritability, and poor feeding.

• Older Children: Headaches, vomiting, blurred vision, and balance difficulties.

4.7 Clinical Manifestations

In infants, noticeable signs include a disproportionately large head and a tense anterior
fontanelle. Older children may exhibit symptoms of increased intracranial pressure, such as
papilledema and sixth nerve palsy.

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4.8 Investigations
Diagnostic tools include:

• Ultrasound: Useful in infants with open fontanelles.

• CT and MRI Scans: Provide detailed images of ventricular enlargement and potential
underlying causes.

4.9 Management & Treatment

Acute Management

• Medical Stabilization (if symptomatic with raised ICP):

o Elevate the head of the bed to 30°
o IV Mannitol or Hypertonic Saline (for acute ICP reduction)

o Acetazolamide (reduces CSF production)

o Corticosteroids (if inflammatory component present)

o Control blood pressure and optimize oxygenation

• Temporary CSF Diversion:

o External Ventricular Drain (EVD) in cases of acute hydrocephalus

Surgical Management

A. Permanent CSF Diversion Procedures

• Ventriculoperitoneal (VP) Shunt (most common)

• Ventriculoatrial (VA) Shunt

• Lumboperitoneal (LP) Shunt

B. Endoscopic Third Ventriculostomy (ETV)

• Creates an opening in the third ventricle floor to bypass an obstruction

• Preferred for obstructive (non-communicating) hydrocephalus
• Less risk of long-term complications compared to shunts

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Reference
ETHIOPIA - IF Global

Nelson, W.E. (2019) Nelson Textbook of Pediatrics. 21st Edition, Elsevier, Amsterdam.

Mengiste FG, Shibeshi MS, Gechera DY. Neural Tube Defect in a Resource Limited Setting:
Clinical Profile and Short Term Outcome. Pediatric Health Med Ther. 2023;14:289-299
https://doi.org/10.2147/PHMT.S421868

Mulugeta B, Seyoum G, Mekonnen A, Ketema E. Assessment of the prevalence and associated

risk factors of pediatric hydrocephalus in diagnostic centers in Addis Ababa, Ethiopia. BMC
Pediatr. 2022 Mar 18;22(1):145. doi: 10.1186/s12887-022-03212-6. PMID: 35303805; PMCID:
PMC8932009.

In Ethiopia, a Hidden Public Health Emergency Affects 40,000 Children Each Year

Paul, V. K. (2019). Ghai Essential Pediatrics. CBS publishers.

Rosser, T. (2007). Pediatric neurology : a case-based review. Lippincott Williams & Wilkins.

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