20- HA Flashcards Preview

Pediatrics > 20- HA > Flashcards

Flashcards in 20- HA Deck (23):
1

tension headache presentation

is most often episodic
generally worsens throughout the day
is of mild to moderate intensity
may feel like a band around the head or involve the occipital area with accompanying tenderness of the posterior muscles of the neck

2

tension HA triggers

emotional stress (at home, school or related to peer interactions), fatigue, lack of sleep, and other stressors.

3

atypical migraine examples

cyclical vomiting
abdominal migraines
benign paroxysmal vertigo

4

hints for life threatening HA

forceful vomiting- increased ICP
awaken from sleep- increased ICP
Worsens with cough or Valsava- ICP

sudden onset- intracranial hemorrhage.

+ fever, photophobia- infectious etiology such as meningitis or encephalitis.

progressively worsens

5

Post-infectious cerebellitis

kids 1-3

autoimmune --> cerebellar demyelination.

several weeks after a viral infection

ataxia, vomiting, nystagmus

recover completely within a few months

CSF- elevated protein

6

most common cause of acute ataxia in children.

Post-infectious cerebellitis

7

Infectious cerebellitis

viral-mumps, enteroviruses and Epstein-Barr virus.

bacterial- Streptococcus pneumoniae, Neisseria meningitidis and Haemophilus influenzae type B.

fever, mental status change

8

Opsoclonus-myoclonus syndrome

A paraneoplastic syndrome that occurs most often with neuroblastoma, generally occurs in the younger child (6 months-3 years).

Ataxia is accompanied by intermittent jerking movements (myoclonus) and erratic, jerky conjugate movements of the eyes (opsoclonus).

9

causes of ataxia

Opsoclonus-myoclonus syndrome
Infectious cerebellitis
Post-infectious cerebellitis
meds, toxins
intracranial mass
migraine
hydrocephalus
metabolic disease
neurodegenerative disease
psych - conversion disorder

10

Basilar migraine

uncommon migraine variant.
young women or children, first develop

bilateral visual phenomena, transient cortical blindness may also occur.

Vertigo, ataxia
Incoordination of the limbs
Dysarthria, and
Bilateral limb and perioral paresthesias.

sometimes followed by transient LOC --> occipital throbbing headache + nausea and vomiting.

11

cerebellar lesions

Lesions within the vermis (midline) cause dysarthria, truncal ataxia, and gait abnormalities.

Cerebellar hemispheric lesions cause ipsilateral limb abnormalities, nystagmus, tremor/dysmetria and tend to spare speech.

Patients fall towards the side of the lesion and have worse nystagmus when they look towards the side of the lesion.

Lesions of the deep cerebellar nuclei cause resting tremor, myoclonus, and opsoclonus such as that seen in children with a neuroblastoma.

12

Infratentorial lesions

cerebellar signs and signs of raised intracranial pressure (ICP).

13

Cerebellar hemispheric lesions

changes in muscle tone and DTRs, but usually lead to hypotonia and hyporeflexia.

14

Supratentorial lesions

focal motor and sensory abnormalities on the side opposite to the lesion

15

Brain stem tumors

cranial nerve and gaze palsies

16

supretentorial vs infratentorial ages

supra- under 2, and teens, and adults

infra- kids over 2

17

effects of brain radiation /chemo

Neurocognitive defects
Attention deficit disorder
Learning disabilities
Endocrine abnormalities, and
Stroke.

18

risk factors for decreased IQ after brain radiation

Younger age at time of treatment
Longer time elapsed since treatment
Female gender
Hydrocephalus
Use of radiation therapy and its extent and dose.

19

Cobblestoning

sign of allergies

fine granular appearance of the palpebral conjunctivae resulting from edema and hyperplasia of the papillae.

Cobblestoning of the pharynx occurs with chronic nasopharyngeal drainage of allergic rhinitis and represents areas of lymphocytic hyperplasia.

20

brain stem gliomas

either quite aggressive, resulting in diffuse infiltration of the pons, or may be low-grade in nature, resulting in a focal tumor in the midbrain or medulla.

Surgical resection alone is required for low-grade gliomas. good prognosis

21

ependymomas

arise from within the fourth ventricle (from the ependymal lining) and cause symptoms related to hydrocephalus.

Treatment generally includes surgical resection, followed by radiation. 50% prognosis

22

astrocytoma of cerebellum

cystic

best prognosis

treatment: *surgery, or radiation (for high grade)

23

medulloblastoma

most common child brain tumor

capable of mets

tx: surgery, radiation, chemo