"Neural Tube Defects"[MeSH Terms] AND examination

CDC neural tube defects spina bifida anencephaly clinical examination

neurological examination deep tendon reflexes dermatome sensory testing diagram

spina bifida myelomeningocele clinical photograph or diagram neural tube defect

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mkdir -p "/tmp/workspace/neural-defects-ppt/src" "/tmp/workspace/neural-defects-ppt/output" && python - <<'PY' from pathlib import Path p=Path('/tmp/workspace/neural-defects-ppt/src/create_deck.py') p.write_text(r'''from pptx import Presentation from pptx.util import Inches, Pt from pptx.enum.text import PP_ALIGN, MSO_ANCHOR from pptx.enum.shapes import MSO_SHAPE from pptx.dml.color import RGBColor from pptx.enum.dml import MSO_THEME_COLOR from pptx.enum.text import MSO_AUTO_SIZE OUT='/tmp/workspace/neural-defects-ppt/output/Examination_of_Neural_Defects.pptx' prs=Presentation() prs.slide_width=Inches(13.333) prs.slide_height=Inches(7.5) blank=prs.slide_layouts[6] NAVY=RGBColor(12,31,57); BLUE=RGBColor(32,99,155); TEAL=RGBColor(0,142,148); SKY=RGBColor(219,242,247) ORANGE=RGBColor(235,128,52); RED=RGBColor(190,55,55); GREEN=RGBColor(45,132,94); INK=RGBColor(31,45,61); GREY=RGBColor(94,109,125); PALE=RGBColor(246,249,252); WHITE=RGBColor(255,255,255) def rect(slide,x,y,w,h,color,rad=False,line=None): shp=slide.shapes.add_shape(MSO_SHAPE.ROUNDED_RECTANGLE if rad else MSO_SHAPE.RECTANGLE, Inches(x), Inches(y), Inches(w), Inches(h)) shp.fill.solid(); shp.fill.fore_color.rgb=color shp.line.color.rgb=line if line else color return shp def txt(slide,text,x,y,w,h,size=20,color=INK,bold=False,align=PP_ALIGN.LEFT, font='Aptos', valign=MSO_ANCHOR.TOP): tb=slide.shapes.add_textbox(Inches(x), Inches(y), Inches(w), Inches(h)) tf=tb.text_frame; tf.clear(); tf.word_wrap=True; tf.margin_left=Inches(.05); tf.margin_right=Inches(.05); tf.margin_top=Inches(.02); tf.margin_bottom=Inches(.02); tf.vertical_anchor=valign p=tf.paragraphs[0]; p.alignment=align r=p.add_run(); r.text=text; r.font.name=font; r.font.size=Pt(size); r.font.bold=bold; r.font.color.rgb=color return tb def add_footer(slide,n,section): rect(slide,0,7.16,13.333,.34,NAVY) txt(slide,section,0.48,7.20,9.8,.17,8,WHITE) txt(slide,f'{n:02d} | Teaching deck',11.35,7.20,1.5,.17,8,WHITE,align=PP_ALIGN.RIGHT) def add_title(slide,title,kicker,n,section): rect(slide,0,0,13.333,.23,TEAL) txt(slide,kicker.upper(),.5,.42,12.0,.26,10,TEAL,bold=True) txt(slide,title,.5,.78,12.1,.62,27,NAVY,bold=True) rect(slide,.5,1.5,1.05,.06,ORANGE) add_footer(slide,n,section) def bullets(slide,items,x=.62,y=1.85,w=7.2,h=4.7,size=19,accent=TEAL): box=rect(slide,x-.12,y-.10,w+.25,h+.15,WHITE,rad=True,line=RGBColor(222,230,237)) tf=slide.shapes.add_textbox(Inches(x),Inches(y),Inches(w),Inches(h)).text_frame tf.clear();tf.word_wrap=True;tf.margin_left=0;tf.margin_right=0; tf.margin_top=0 for i,item in enumerate(items): p=tf.paragraphs[0] if i==0 else tf.add_paragraph(); p.text=item; p.level=0; p.font.name='Aptos';p.font.size=Pt(size);p.font.color.rgb=INK;p.space_after=Pt(11); p.bullet=True return tf def side_panel(slide,heading,items,color=BLUE): rect(slide,8.35,1.85,4.35,4.75,color,rad=True) txt(slide,heading,8.7,2.15,3.65,.4,17,WHITE,bold=True) y=2.8 for item in items: rect(slide,8.68,y+.08,.14,.14,WHITE,rad=True) txt(slide,item,8.98,y,3.2,.52,14,WHITE) y+=.74 def note(slide, text): ns=slide.notes_slide ns.notes_text_frame.text='Speaker notes: '+text def diagram_neuron(slide): # stylised pathway for x,y,lab,col in [(1.0,3.0,'Cortex',BLUE),(3.3,3.0,'Brainstem',TEAL),(5.6,3.0,'Spinal cord',ORANGE),(8.0,3.0,'Peripheral nerve',GREEN),(10.6,3.0,'Muscle / skin',RED)]: rect(slide,x,y,1.55,.75,col,rad=True);txt(slide,lab,x+.08,y+.17,1.38,.35,14,WHITE,bold=True,align=PP_ALIGN.CENTER) for x in [2.58,4.88,7.28,9.88]: txt(slide,'→',x,3.15,.5,.3,22,NAVY,bold=True,align=PP_ALIGN.CENTER) def slide_content(n,title,kicker,items,panel_h,panel_items,section='NEUROLOGICAL EXAMINATION'): s=prs.slides.add_slide(blank);add_title(s,title,kicker,n,section);bullets(s,items);side_panel(s,panel_h,panel_items);note(s,'Use this slide to demonstrate the sequence, compare sides, and interpret findings in the clinical context.');return s # 1 s=prs.slides.add_slide(blank); rect(s,0,0,13.333,7.5,NAVY); rect(s,0,0,13.333,.18,TEAL);txt(s,'EXAMINATION OF\nNEURAL DEFECTS',.72,1.15,8.4,1.55,34,WHITE,True);txt(s,'A 50-slide clinical teaching presentation',.75,2.95,7.0,.35,17,RGBColor(190,220,235));rect(s,.75,3.62,2.1,.08,ORANGE);diagram_neuron(s);txt(s,'Neurological deficits + congenital neural-tube defects',.75,6.48,8.5,.3,15,WHITE);add_footer(s,1,'INTRODUCTION');note(s,'This deck combines examination of acquired neurological deficits with examination of congenital neural-tube defects.') # 2 slide_content(2,'Learning objectives','Introduction',['Perform a structured screening neurological examination.','Recognize patterns of motor, sensory, reflex, cranial nerve, cerebellar, and autonomic dysfunction.','Examine an infant or child with suspected neural-tube defect safely.','Document deficits, localize the lesion, and identify red flags.'],'By the end, learners can',['Sequence an exam','Compare sides','Localize lesions','Escalate urgent findings'],'INTRODUCTION') slide_content(3,'Scope: two meanings of “neural defects”','Introduction',['Neurological deficits: abnormal function of brain, spinal cord, roots, peripheral nerves, neuromuscular junction, or muscle.','Neural-tube defects (NTDs): congenital failure of neural tube closure, affecting brain and/or spine.','A good examination links observed signs to anatomy and immediate risk.'],'Deck structure',['Part I: deficits','Part II: NTDs','Part III: cases'],'INTRODUCTION') slide_content(4,'Safety, consent and preparation','Approach',['Explain the examination; gain consent and offer a chaperone when appropriate.','Ensure privacy, warmth, adequate lighting, and safe transfer or positioning.','Observe before touching. Avoid painful maneuvers unless clinically justified.','In infants with open spinal lesions: protect tissue, avoid latex, and seek urgent specialist input.'],'Prepare',['Tendon hammer','Cotton / pin','Tuning fork','Ophthalmoscope','Measuring tape'],'INTRODUCTION') slide_content(5,'The localization framework','Approach',['Central nervous system: brain or spinal cord patterns, often upper motor neuron signs.','Root, plexus, or peripheral nerve: segmental or named-nerve distribution, often lower motor neuron signs.','Neuromuscular junction: fatigable weakness with preserved sensation.','Muscle: proximal weakness, usually no sensory level.'],'Ask four questions',['Motor?','Sensory?','Reflex change?','Autonomic involvement?'],'INTRODUCTION') # 6 custom s=prs.slides.add_slide(blank);add_title(s,'Functional pathway: where can a deficit arise?','Approach',6,'NEUROLOGICAL EXAMINATION');diagram_neuron(s);txt(s,'Pattern recognition starts by mapping the deficit along the pathway.',1.0,4.35,11.1,.45,20,INK,True,align=PP_ALIGN.CENTER);txt(s,'Motor, sensory, reflex, and autonomic signs help distinguish each level.',1.0,4.95,11.1,.35,16,GREY,align=PP_ALIGN.CENTER);note(s,'Use the pathway to explain why similar weakness can have different localizations.') slide_content(7,'A practical sequence','Approach',['General observation and higher functions.','Cranial nerves, then motor system.','Tone, power, reflexes, coordination, and gait.','Sensory examination, autonomic review, and focused special tests.','Adapt the order to the patient, symptoms, and safety.'],'Core rule',['Compare left/right','Distal/proximal','Document grade','Correlate signs'],'NEUROLOGICAL EXAMINATION') slide_content(8,'General observation','Screening',['Look for posture, involuntary movements, facial asymmetry, and use of aids.','Note speech, alertness, respiratory pattern, nutrition, and skin changes.','Inspect hands and feet for wasting, deformity, ulcers, and fasciculations.','Observe spontaneous gait and functional tasks when safe.'],'Examples',['Foot drop','Hemiparetic posture','Tremor','Muscle wasting'],'NEUROLOGICAL EXAMINATION') slide_content(9,'Mental status and higher cortical function','Cognition',['Assess arousal, attention, orientation, and interaction.','Screen language: fluency, comprehension, repetition, naming, reading, writing.','Test memory when relevant: immediate recall, delayed recall, and history consistency.','Look for neglect, apraxia, agnosia, or executive dysfunction in focal cortical disease.'],'Localizing clues',['Aphasia: dominant cortex','Neglect: nondominant parietal','Apraxia: parietal/frontal'],'NEUROLOGICAL EXAMINATION') slide_content(10,'Speech: dysarthria versus aphasia','Cognition',['Dysarthria: impaired articulation with intact language content; consider corticobulbar, cerebellar, basal ganglia, or lower motor neuron causes.','Aphasia: disorder of language production or comprehension; examine named language tasks.','Dysphonia suggests laryngeal or vagal involvement; assess airway and swallowing risk.'],'Bedside prompts',['“Name this object”','“Follow 3 steps”','“Repeat this phrase”'],'NEUROLOGICAL EXAMINATION') slide_content(11,'Cranial nerves: overview','Cranial nerves',['I: smell when indicated. II: vision, fields, pupils, fundus.','III, IV, VI: pupils, eyelids, eye movements, diplopia, nystagmus.','V and VII: facial sensation, mastication, facial symmetry.','VIII: hearing and vestibular symptoms. IX, X, XI, XII: palate, voice, shoulder, tongue.'],'Red flags',['Acute pupil change','Bulbar weakness','New diplopia','Papilledema'],'NEUROLOGICAL EXAMINATION') slide_content(12,'Pupils and visual fields','Cranial nerves',['Inspect pupil size and symmetry before light exposure.','Test direct and consensual light responses; look for relative afferent pupillary defect when appropriate.','Screen confrontation visual fields in each eye.','Fundoscopy is useful when raised intracranial pressure, optic neuropathy, or vascular disease is suspected.'],'Interpretation',['Anisocoria','Field cut','RAPD','Papilledema'],'NEUROLOGICAL EXAMINATION') slide_content(13,'Eye movements and nystagmus','Cranial nerves',['Assess eyelid position, primary gaze, and smooth pursuit in an “H” pattern.','Ask about diplopia; determine direction of gaze that worsens it.','Observe nystagmus: direction, gaze-evoked change, and associated vertigo.','Check convergence when indicated.'],'Consider',['III palsy','VI palsy','Internuclear ophthalmoplegia','Central vertigo'],'NEUROLOGICAL EXAMINATION') slide_content(14,'Face, palate, voice and tongue','Cranial nerves',['Test facial movement: raise eyebrows, close eyes, smile, puff cheeks.','Assess jaw clench and facial sensation in V1-V3 distribution.','Listen for dysarthria or nasal voice; inspect palate elevation and uvular position.','Test shoulder elevation and tongue protrusion; look for wasting or fasciculation.'],'Urgent concern',['Dysphagia','Weak cough','Stridor','Rapid progression'],'NEUROLOGICAL EXAMINATION') slide_content(15,'Motor system: inspection','Motor examination',['Expose limbs sufficiently and compare bulk and contour.','Look for atrophy, hypertrophy, fasciculations, contractures, scars, and deformity.','Observe drift, pronation, spontaneous movement, and task performance.','Use functional testing: rise from chair, heel/toe walk, grip, and fine finger movements.'],'Pattern clues',['Distal wasting: neuropathy','Fasciculation: LMN','Contracture: chronic UMN/LMN'],'NEUROLOGICAL EXAMINATION') slide_content(16,'Tone: how to examine and interpret','Motor examination',['Ask the patient to relax; move joints slowly then briskly through range.','Spasticity: velocity-dependent increase in tone, often pyramidal pattern.','Rigidity: uniform resistance, sometimes cogwheel, typical of extrapyramidal disease.','Flaccidity: reduced tone, seen acutely in UMN lesions or with LMN disease.'],'Technique',['Elbow','Wrist','Knee','Ankle'],'NEUROLOGICAL EXAMINATION') slide_content(17,'Power testing and MRC grading','Motor examination',['Test key muscle groups against resistance, comparing both sides.','Position to isolate the movement and stabilize proximal joints.','MRC: 0 no contraction; 1 flicker; 2 movement with gravity eliminated; 3 against gravity; 4 against resistance; 5 normal.','Record pain, effort, fatigability, and whether testing was limited.'],'Document well',['“Right ankle dorsiflexion 3/5”','Not just “weak leg”'],'NEUROLOGICAL EXAMINATION') slide_content(18,'Patterns of weakness','Motor examination',['Hemiparesis: cortex, internal capsule, or brainstem depending on associated signs.','Paraparesis: spinal cord, bilateral brain, motor neuron, or peripheral causes.','Quadriparesis: cervical cord, brainstem, diffuse peripheral, NMJ, or muscle disease.','Proximal versus distal and symmetric versus asymmetric patterns refine localization.'],'Pattern matters',['Symmetric proximal','Asymmetric distal','Myotomal','Named nerve'],'NEUROLOGICAL EXAMINATION') slide_content(19,'Upper motor neuron syndrome','Motor examination',['Weakness with spasticity, brisk reflexes, clonus, and extensor plantar response.','May have reduced fine motor control and a pyramidal distribution of weakness.','Acute lesions can initially be flaccid and areflexic.','Localize with face involvement, sensory level, sphincter symptoms, and crossed signs.'],'Think CNS',['Cerebral lesion','Spinal cord lesion','Demyelination'],'NEUROLOGICAL EXAMINATION') slide_content(20,'Lower motor neuron syndrome','Motor examination',['Weakness with wasting, fasciculations, reduced tone, and depressed reflexes.','Distribution may follow anterior horn cell, root, plexus, or peripheral nerve anatomy.','Sensory loss suggests root, plexus, or peripheral nerve rather than pure motor neuron disease.','Chronic denervation may cause marked atrophy.'],'Think PNS',['Root','Plexus','Nerve','Anterior horn cell'],'NEUROLOGICAL EXAMINATION') slide_content(21,'Reflexes: technique','Reflexes',['Position comfortably and ensure relaxation; use reinforcement if needed.','Compare biceps, triceps, brachioradialis, knee, and ankle reflexes side-to-side.','Grade: 0 absent, 1+ reduced, 2+ normal, 3+ brisk, 4+ clonus.','Interpret in context: symmetry and spread can be more informative than absolute grade.'],'Common pitfalls',['Patient tense','Poor strike','Wrong tendon','Cold limb'],'NEUROLOGICAL EXAMINATION') slide_content(22,'Plantar response and clonus','Reflexes',['Stroke the lateral sole from heel toward little toe, then across forefoot.','Extensor plantar response in an adult suggests corticospinal tract dysfunction.','Sustained ankle clonus supports hyperreflexia but must be interpreted clinically.','Withdrawal, ticklishness, and poor technique can mislead.'],'Do not overcall',['Equivocal ≠ extensor','Use whole exam'],'NEUROLOGICAL EXAMINATION') slide_content(23,'Sensory examination: principles','Sensory examination',['Explain and demonstrate the stimulus with eyes open, then ask the patient to close eyes.','Compare sides and work from an area of reduced sensation to normal sensation.','Test only modalities relevant to the question, but assess pattern and boundaries carefully.','Map dermatomal, peripheral nerve, stocking-glove, sensory level, or hemisensory patterns.'],'Modalities',['Light touch','Pinprick','Vibration','Joint position'],'NEUROLOGICAL EXAMINATION') slide_content(24,'Primary sensory modalities','Sensory examination',['Light touch: cotton or fingertip; ask “same on both sides?”','Pinprick: safe neurotip or disposable pin; do not break skin.','Vibration: 128-Hz tuning fork over bony prominence, compare distal and proximal.','Proprioception: move distal phalanx minimally up or down while holding its sides.'],'Keep it reproducible',['Randomize stimuli','Avoid clues','Map changes'],'NEUROLOGICAL EXAMINATION') slide_content(25,'Sensory patterns that localize','Sensory examination',['A sensory level on trunk suggests spinal cord pathology and needs urgent evaluation if acute.','Dermatomal pain or numbness suggests radiculopathy; test myotomes and reflexes.','Named nerve loss suggests mononeuropathy; identify motor involvement.','Stocking-glove loss suggests length-dependent peripheral neuropathy.'],'Escalate',['New sensory level','Saddle anesthesia','Rapid progression'],'NEUROLOGICAL EXAMINATION') slide_content(26,'Cortical sensory testing','Sensory examination',['Only test after primary sensation is intact.','Stereognosis: identify a familiar object by touch.','Graphesthesia: identify a number traced on palm.','Two-point discrimination and extinction can reveal parietal dysfunction or neglect.'],'Requires',['Cooperation','Intact attention','Normal primary sensation'],'NEUROLOGICAL EXAMINATION') slide_content(27,'Coordination','Cerebellar examination',['Finger-nose-finger: dysmetria, intention tremor, decomposition.','Heel-shin: assess lower-limb dysmetria.','Rapid alternating movements: dysdiadochokinesia.','Check rebound only where safe; distinguish cerebellar ataxia from weakness or sensory loss.'],'Cerebellar signs',['Dysmetria','Nystagmus','Tremor','Hypotonia'],'NEUROLOGICAL EXAMINATION') slide_content(28,'Gait and stance','Cerebellar examination',['Observe usual gait first: base, stride, arm swing, turning, and stability.','Ask for tandem gait if safe; support high-risk patients.','Romberg assesses sensory integration: worsening with eyes closed suggests sensory or vestibular impairment, not pure cerebellar ataxia.','Look for hemiplegic, spastic, high-stepping, waddling, parkinsonian, and ataxic patterns.'],'Safety first',['Guard patient','Use mobility aid','Stop if unsafe'],'NEUROLOGICAL EXAMINATION') slide_content(29,'Autonomic and sacral function','Spinal / autonomic',['Ask about urinary retention, urgency, incontinence, constipation, sexual dysfunction, and orthostatic symptoms.','When indicated, examine perianal sensation, anal tone, and bulbocavernosus reflex with consent and chaperone.','A new bladder or bowel deficit with saddle anesthesia is an emergency.'],'Red flags',['Cauda equina','Cord compression','Autonomic dysreflexia'],'NEUROLOGICAL EXAMINATION') slide_content(30,'Spinal cord syndromes: examination clues','Spinal / autonomic',['Anterior cord: bilateral motor and pain-temperature loss, relative dorsal-column sparing.','Posterior column dysfunction: impaired vibration and position sense, sensory ataxia.','Brown-Sequard pattern: ipsilateral UMN and dorsal-column signs with contralateral pain-temperature loss below lesion.','Central cord: often arm weakness greater than leg weakness, but patterns vary.'],'Always establish',['Sensory level','Motor level','Sphincter status'],'NEUROLOGICAL EXAMINATION') slide_content(31,'Peripheral neuropathy examination','Peripheral nervous system',['Inspect feet for deformity, callus, ulcers, and autonomic skin change.','Assess distal strength, ankle reflexes, and stocking sensory loss.','Test gait, balance, vibration, and position sense.','Ask about tempo, pain, toxins, diabetes, alcohol, family history, and autonomic symptoms.'],'Urgent pattern',['Rapid ascending weakness','Bulbar / respiratory signs','Autonomic instability'],'NEUROLOGICAL EXAMINATION') slide_content(32,'Radiculopathy, plexopathy, mononeuropathy','Peripheral nervous system',['Radiculopathy: myotomal weakness, dermatomal symptoms, reflex change; pain may radiate.','Plexopathy: affects multiple roots/nerves in a regional distribution.','Mononeuropathy: weakness and sensory loss confined to a named nerve territory.','Provocative maneuvers support but do not replace full examination.'],'Compare maps',['Myotome','Dermatome','Peripheral nerve'],'NEUROLOGICAL EXAMINATION') slide_content(33,'Neuromuscular junction and myopathy','Peripheral nervous system',['Fatigable weakness, ptosis, or diplopia with normal sensation points toward NMJ disease.','Myopathy often causes symmetric proximal weakness, difficulty rising or lifting arms, and preserved reflexes until weakness is severe.','Assess neck flexion, respiratory effort, swallowing, and fatigability.'],'Do not miss',['Bulbar weakness','Respiratory compromise','Rhabdomyolysis clues'],'NEUROLOGICAL EXAMINATION') slide_content(34,'How to document a neurological examination','Documentation',['State mental status and cranial nerve findings relevant to the presentation.','Record tone, bulk, power by muscle and MRC grade, reflexes, plantars, sensation distribution, coordination, and gait.','Describe negative findings only when they were actually assessed.','Provide a localization and urgency statement.'],'Example close',['“Findings localize to…”','“No cord red flags…”'],'NEUROLOGICAL EXAMINATION') slide_content(35,'Part II: neural-tube defects','Transition',['Neural tube closure normally occurs in the third and fourth weeks of pregnancy.','Defects can involve cranial or caudal portions of the neural tube.','Major forms include anencephaly, encephalocele, and spina bifida.','Examination priorities are protection, associated anomalies, neurological level, and complications.'],'Main types',['Anencephaly','Encephalocele','Open spina bifida','Closed dysraphism'],'NEURAL-TUBE DEFECTS') slide_content(36,'Classifying neural-tube defects','NTDs',['Anencephaly: severe cranial defect with absent major portions of brain and skull.','Encephalocele: herniation of meninges and/or brain through a skull defect.','Spina bifida: defect of vertebral arch closure; may be open or closed.','Myelomeningocele is an open spinal dysraphism with neural tissue and meninges in a sac.'],'Examination focus',['Cranium','Spine / skin','Limbs','Bladder / bowel'],'NEURAL-TUBE DEFECTS') slide_content(37,'Risk factors and prevention context','NTDs',['Folate deficiency is a modifiable population-level risk factor.','Other associations include prior affected pregnancy, certain antiseizure medicines, diabetes, obesity, and hyperthermia.','Examination does not establish cause; avoid blaming language and use nonjudgmental counseling.','Preconception folic-acid advice follows local guidance and individual risk assessment.'],'Clinical message',['Prevention matters','Support families','Refer appropriately'],'NEURAL-TUBE DEFECTS') slide_content(38,'Prenatal assessment overview','NTDs',['Screening and diagnosis may involve ultrasound and maternal serum markers, depending on setting and gestation.','Detailed fetal imaging defines lesion level, ventriculomegaly, associated anomalies, and counseling needs.','Postnatal examination remains essential for neurological function and immediate safety.'],'Avoid overstatement',['Imaging + exam','Multidisciplinary counseling'],'NEURAL-TUBE DEFECTS') slide_content(39,'Delivery-room priorities for open spinal lesions','NTDs',['Maintain airway, temperature, and cardiorespiratory stability.','Place prone or lateral to avoid pressure on the lesion.','Cover lesion with sterile saline-moistened nonadherent dressing; avoid trauma and contamination.','Avoid latex exposure because sensitization/allergy is more common.','Urgently involve neonatology, neurosurgery, urology, and rehabilitation teams.'],'Do not',['Apply pressure','Use adhesive on sac','Delay escalation'],'NEURAL-TUBE DEFECTS') slide_content(40,'Inspecting the spine and skin','NTDs',['Inspect entire midline from occiput to sacrum in good light.','Open lesion: identify location, size, tissue exposure, CSF leak, and dressing condition without probing.','Closed dysraphism clues: midline lipoma, hemangioma, dermal sinus, deviated gluteal cleft, focal hair tuft, or atypical dimple.','Document lesion level using vertebral landmarks and photograph only with consent and policy compliance.'],'Caution',['Do not probe sinus','Protect open tissue'],'NEURAL-TUBE DEFECTS') slide_content(41,'Neurological level in spina bifida','NTDs',['Assess spontaneous lower-limb movement before handling.','Test hip flexion/adduction/abduction, knee extension/flexion, ankle dorsiflexion/plantarflexion, and toe movement as feasible.','Check tone, reflexes, deformity, and asymmetry.','Functional level may differ from anatomical lesion level and changes over time.'],'Record',['Right / left','Movement grade','Contracture','Foot position'],'NEURAL-TUBE DEFECTS') slide_content(42,'Orthopaedic examination','NTDs',['Inspect hips, knees, ankles, and feet for contracture and deformity.','Assess hip stability where appropriate and avoid forceful maneuvers in fragile infants.','Common findings include clubfoot, vertical talus, hip dislocation, knee flexion contracture, and scoliosis.','Early positioning and orthopaedic referral influence function and skin safety.'],'Examine',['Range of motion','Alignment','Skin pressure areas'],'NEURAL-TUBE DEFECTS') slide_content(43,'Bladder and bowel assessment','NTDs',['Ask or observe voiding pattern, wet diapers, retention signs, urinary infection history, constipation, and stool continence appropriate to age.','Neurogenic bladder may threaten renal function even when symptoms are subtle.','Assess abdomen for distension and use specialist-directed evaluation for residual urine, renal imaging, and urodynamics.'],'Refer early',['Urology','Renal surveillance','Bowel program'],'NEURAL-TUBE DEFECTS') slide_content(44,'Hydrocephalus and Chiari II: clinical screening','NTDs',['Measure head circumference serially and plot on a growth chart.','Look for rapidly increasing head size, bulging fontanelle, vomiting, irritability, sunsetting eyes, or altered consciousness.','Brainstem symptoms can include stridor, apnea, swallowing difficulty, or weak cry.','Urgent deterioration requires immediate senior/neurosurgical review.'],'Red flags',['Apnea','Feeding difficulty','Rapid head growth','Reduced alertness'],'NEURAL-TUBE DEFECTS') slide_content(45,'Tethered cord: change over time','NTDs',['Consider tethered cord with progressive leg weakness, gait decline, pain, new deformity, scoliosis progression, or loss of bladder/bowel function.','Compare to prior functional baseline, not only to a single examination.','Skin markers may coexist with occult dysraphism, but imaging and specialist assessment guide diagnosis.'],'Trend matters',['New decline','New pain','New continence change'],'NEURAL-TUBE DEFECTS') slide_content(46,'Latex allergy and skin protection','NTDs',['Use latex-free environment and equipment where possible.','Ask about rash, wheeze, peri-procedural reactions, and prior sensitization.','Reduced sensation increases risk of pressure injuries and burns: inspect skin routinely.','Teach families to check orthoses, footwear, seating, and pressure points.'],'Prevent harm',['Latex-free care','Daily skin check','Safe temperature'],'NEURAL-TUBE DEFECTS') slide_content(47,'Case 1: acute paraparesis','Case application',['A patient develops bilateral leg weakness, urinary retention, and a sensory change rising to the umbilicus.','Examination: spastic legs, brisk knee reflexes, extensor plantar responses, and a clear trunk sensory level.','Localization: spinal cord until proven otherwise.','Action: urgent emergency assessment and imaging pathway.'],'Why urgent?',['Cord compression can progress','Bladder dysfunction is a red flag'],'CASE APPLICATION') slide_content(48,'Case 2: newborn with lumbosacral sac','Case application',['A newborn has a lumbosacral, uncovered sac and reduced ankle movement.','First actions: prone positioning, sterile saline-moistened nonadherent cover, latex avoidance, full neonatal assessment, urgent specialist referral.','Then document motor function, limb deformity, head circumference, and voiding/bowel status.'],'Avoid',['Probing lesion','Pressure on sac','Latex exposure'],'CASE APPLICATION') slide_content(49,'Take-home examination checklist','Summary',['Observe before touching; examine safely and compare sides.','Document motor, sensory, reflex, coordination, gait, cranial, and autonomic findings in a localizing pattern.','Treat sensory level, sphincter dysfunction, bulbar/respiratory weakness, and rapidly progressive deficit as red flags.','For NTDs: protect open lesions, avoid latex, define function, and screen for bladder, orthopaedic, and hydrocephalus complications.'],'One-line summary',['Examine → localize → document → escalate'],'SUMMARY') slide_content(50,'Selected sources and further reading','References',['Bradley and Daroff’s Neurology in Clinical Practice: Neurological Examination.','Goldman-Cecil Medicine: Neural Tube Defects.','Bailey & Love’s Short Practice of Surgery: Spina Bifida.','CDC: Neural Tube Defects, accessed September 2026.','Use local institutional pathways for emergency, neonatal, and folate-prevention guidance.'],'Evidence note',['Recent reviews: PMIDs 41500170, 41427157, 38823051','Guidance may vary by region'],'REFERENCES') assert len(prs.slides)==50 prs.save(OUT) print(OUT) ''') PY python "/tmp/workspace/neural-defects-ppt/src/create_deck.py"

python - <<'PY' from pptx import Presentation from pathlib import Path p=Path('/tmp/workspace/neural-defects-ppt/output/Examination_of_Neural_Defects.pptx') prs=Presentation(str(p)) print('exists',p.exists(),'bytes',p.stat().st_size,'slides',len(prs.slides)) for i,s in enumerate(prs.slides,1): texts=[] for sh in s.shapes: if getattr(sh,'has_text_frame',False): texts.append(sh.text.replace('\n',' | ')) if not texts: print('EMPTY',i) if i in (1,2,35,50): print(i,' :: '.join(texts[:3])) print('notes',sum(1 for s in prs.slides if s.notes_slide.notes_text_frame.text.strip())) PY python - <<'PY' # quick package integrity import zipfile p='/tmp/workspace/neural-defects-ppt/output/Examination_of_Neural_Defects.pptx' with zipfile.ZipFile(p) as z: print('zip entries',len(z.namelist()),'bad',z.testzip()) PY