Neurological Problems in Childhood

Abstract

This chapter discusses the disorders and diseases of the motor system. An injury to the brachial plexus can result from traction at birth, particularly in breech presentations. The degree of improvement depends on whether the nerves are stretched or torn. If the lesion is mild, weakness may not be noted for a while after birth. The most common type is involvement of the upper roots of the brachial plexus (Erb's palsy). This will lead to wasting and paresis of the deltoid, superspinatus, infraspinatus, biceps, brachioradialis, and sometimes of the extensors of the wrist and fingers. The arm will be held in the tip position because of weakness of abduction at the shoulder and of external rotation of the arm. The biceps and radial reflexes will be absent. If the lower roots of the plexus are injured (Klumpke's paralysis), there will be weakness and wasting of the hand muscles, and often a Horner's syndrome on the affected side with ptosis, enophthalmos, a small pupil, and absence of sweating on the side of the face.