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Brachial plexus palsies, well-known complications of dystocia, usually result from forcible extraction of the fetus by traction on the shoulder in a breech presentation or from traction and tipping of the head in a shoulder presentation The effects of such injuries are sometimes lifelong Their neonatal onset is betrayed later by the small size and inadequate osseous development of the affected limb Either the upper brachial plexus ( fth and sixth cervical roots) or the lower brachial plexus (seventh and eighth cervical and rst thoracic roots) suffer the brunt of the injury Upper plexus injuries (Erb) are about 20 times more frequent than lower ones (Klumpke) Sometimes the entire plexus is involved (page 1164) Facial paralysis, due to forceps injury to the facial nerve immediately distal to its exit from the stylomastoid foramen is another common (usually unilateral) peripheral nerve affection in the newborn.

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Epilepsy. See also Seizures centrencephalic, 283 clinical approach to, 285 292 corticoreticular, 283 discharging lesion in, 281 283 driving and, 298 299 EEG in, 28, 283 284 gelastic, 278 genetic factors in, 285, 286t hereditary hearing loss with, 951 of hereditary metabolic disease, 830 of infancy and childhood, 883 884 benign, with centrotemporal spikes, 279 laboratory anomalies associated with, 284 myoclonic, 87 88 juvenile, 272, 274, 275, 290 nocturnal, 343 344 with occipital spikes, 279 280 pathology of, 284 285 postinfarction, 738 posttraumatic, 762 re ex, 280 281 rolandic, 279 sylvian, 279 treatment of, 292 299 antiepileptic drugs in, 292t, 292 296, 293t dietary, 299 regulation of physical and mental activity in, 299 for status epilepticus, 296 298 surgical, 298 vagal nerve stimulation for, 299 vertiginous, 258 volvular, 278 Epilepsy surgery, 298 Epileptiform discharges, 28 Episodic memory, 376, 377t Epstein-Barr virus (EBV) infections, congenital, 883 Equilibrium disorders of, 63 in cerebellar disorders, 77 gait and, 100 Equine gait, 102t, 103 104 Erectile dysfunction, 471 Ergotamine, for migraine, 154, 155 Ergotism, 1032 1033 Erythema chronicum migrans, 618 620, 620f meningitis associated with, 633, 634 Erythrocyanotic headache, 160 161 Erythromelalgia, 189 190, 465 Erythromycin for bacterial encephalitis, 602 for neurosyphilis, 618

Failure of one eye to close and dif culty in sucking make this condition easy to recognize It must be distinguished from the congenital facial diplegia that is often associated with abducens palsy, ie, the Mobius syndrome discussed earlier in the chapter In most cases of facial paralysis due to physical injury, function is recovered after a few weeks; in some, the paralysis is permanent and may account for lifelong facial asymmetry..

more active than others At rest, with the muscles shortened to midposition, they are accid to palpation and electromyographically silent If the arm is extended or the leg exed very slowly, there may be little or no change in muscle tone By contrast, if the muscles are briskly stretched, the limb moves freely for a very short distance (free interval), beyond which there is an abrupt catch and then a rapidly increasing muscular resistance up to a point; then, as passive extension of the arm or exion of the leg continues, the resistance melts away This sequence constitutes the classic claspknife phenomenon With the limb in the extended or exed position, a new passive movement may not encounter the same sequence; this entire pattern of response constitutes the lengthening and shortening reaction.

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Thus the essential feature of spasticity is a velocity-dependent increase in the resistance of muscles to a passive stretch stimulus Although a clasp-knife relaxation following peak resistance is highly characteristic of cerebral hemiplegia, it is by no means found consistently In some cases, the arm exors and leg extensors are spastic, while the antagonist muscles show an even resistance throughout the range of passive movement ie, rigidity (discussed in Chap 4); or rigidity may be more prominent than spasticity in all muscles This plastic or rigid resistance, in DennyBrown s view, is the mild form or precursor of an altered posture that he called dystonic (the term is used differently now) and considered to be a characteristic feature of hemiplegic spasticity Nor is there a constant relationship between spasticity and weakness.

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