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Bloc J - Neuro > Oct9 M3-Pediatric Neurology > Flashcards

Oct9 M3-Pediatric Neurology Flashcards

1
Q

neuro hx in neuro peds

A

standard medical hx but with particular interest on

  • gestational and perinatal hx
  • FHx ask many qs, consanguinity
  • dev history (school, plateau, regression)
  • handedness (dominance of one hand over the other for movements) is abnormal before the age of 18 months
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2
Q

plateau vs regression def

A

plateau: acquired a developmental milestone (you ask about these)
regression: lose an already acquired milestone. NEVER normal.

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3
Q

handedness before 18 mo: what’s happening

A

focal neurological deficit

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4
Q

4 domains dev milestones are divided in

A
  • gross motor
  • fine motor
  • language
  • personal and social
  • have charts for that. draw age of child and know what should be doing for their age*
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5
Q

examples of dev milestones

A
  • walking at 12 mo
  • primitive pincer grasp at 9 mo
  • smiles at 6 weeks
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6
Q

global developmental delay def

A
  • significant delay in at least 2 dev domains

- we say this for children <5 (5+ = intellectual delay)

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7
Q

imp thing on exam

A
  • observation (alertness, tone, etc.)
  • standard neuro exam with special interest on
  • dysmorphism + look at parents
  • growth parameters head circumference child + parents
  • organomegaly
  • skin exam (pigmentation hyper hypo)
  • spine
  • axial and appendicular (peripheral) tone
  • primitive reflexes in babies (disappear at a certain age)
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8
Q

examples of way to test for hypotonia

A
  • frog position when baby lies on bed on their back
  • traction of hands up when baby lying on their back + head lags down
  • lift baby by abdomen horizontally = body should be horizontal
  • vertical suspension by the chest under the shoulders: no flexion = axial hypotonia
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9
Q

causes of axial and peripheral hypotonia in infants

A

CNS (Central) or PNS (peripheral) problem (axial hypotonia doesn’t mean CNS problem)

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10
Q

peripheral cause of hypotonia: charact

A
  • decreased reflexes
  • no other features except joint abnormalities
  • Fhx of muscle or nerve prob
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11
Q

central cause of hypotonia charact

A
  • increased muscles + sustained clonus (few beats of clonus is NORMAL)
  • abnormal lvl of consciousness (encephalopathy)
  • seizures
  • dysmorphism
  • Hx of posible CNS insult (infection, hypoxia), usually in low apgar at birth, acidotic fluids at birth, baby born flat
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12
Q

epilepsy def

A
  • two UNPROVOKED seizure at at least 24hr apart
  • one seizure with recurrence risk estim to be >60%
  • child with palsy and extremely active EEG and recur risk >60% after ONE seizure
  • dx of epilepsy syndrome with classical seizures and sx and features
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13
Q

classif of seizures

A
  • generalized
  • focal (starts at one location and can spread to adjacent and distant region = secondary generalization): with or without impairment of consciousness
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14
Q

ex of meds exclusively for focal seizures

A

CBZ and phenytoin (both gen and focal in another lecture)

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15
Q

ex of meds exclusively for generalized seizures

A

ethosuximide (absences)

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16
Q

ex of meds for both focal and generalized seizures

A

valproic acid (only generalized in another lecture), levetiracetam, lamotrigine, benzos, topiramate, pheno

17
Q

Sandifer’s syndrome def

A
  • GERD (reflux) syndrome
  • in the infant, can cause body arching (due to discomfort) and gurgling sounds + may find regurgitation (milk for example)
  • is NOT a seizure
18
Q

Sandifer’s syndrome key point

A

when you’re not sure if it’s a seizure, call it a PAROXYSMAL event

19
Q

breath holding spells def

A

Breath-holding spells are brief periods when young children stop breathing for up to 1 minute. These spells often cause a child to pass out (lose consciousness). KEY INFO ON HX IS IT’S ALWAYS THE SAME THING TRIGGERING IT

  • can be crying for ex (the trigger)
  • if baby turns blue = cyanotic type
20
Q

link between seizures and breath holding spells

A
  • can have 1-5 seizures after a breath holding spell

- these seizures would be considered PROVOKED

21
Q

breath holding spells main things

A
  • between 6 mo and 6 yrs
  • FHx sometimes
  • may have seizure after
  • ALWAYS DO A CBC and IRON STUDY bc is assoc with iron deficiency anemia and if tx it = solved
22
Q

18 month old with first seizure. everyone sick at home with a URTI. the patient is febrile. dx

A 
Febrile seizure (provoked)
*febrile is key info*
23
Q

febrile seizure def

A

seizure occuring with fever WITHOUT CNS infection and WITHOUT electrolyte imbalance

24
Q

febrile seizures charact

A
  • 6 mo to 6 yrs
  • FHx. 5% of general pop
  • simple vs complex type
25
Q

simple febrile seizures def

A
  • typical
  • generalized (GTC or any)
  • single event (1 in 24hrs)
26
Q

complex febrile seizures def

A
  • atypical
  • focal
  • prolonged (>15 min)
  • multiple seizures in 24 hrs
27
Q

febrile seizures management

A
  • tylenol and antipyretics don’t help
  • often no tx
  • simple febrile seizure = same risk of epilepsy as general pop
  • atypical (complex) febrile seizure = increased risk of epilepsy
  • dx epilepsy if other seizure after without fever
28
Q

what kinds of seizures present as staring spells

A
  • absence seizures

- focal seizures with IMPAIRED consciousness (partial complex)

29
Q

absence seizure charact

A
  • many per day. up to 100 per day
  • <30 sec
  • NEVER have an aura (are a generalized seizure)
  • NEVER have post-ictal fatigue (just like putting pause on video, when stops, child back to activity)
  • can often be activated by hyperventilation
  • generalized on EEG
30
Q

focal seizure charact

A
  • rarely > 1-2 per day
  • > 30 sec
  • frequent AURAS (young child = can’t describe, may say: always runs to his mom before)
  • frequent POST-ICTAL FATIGUE
  • rarely activated by hyperventilation
  • focal EEG
31
Q

automatisms def

A

things that people do during a seizure. some seizures types have that. examples include

  • lip smacking
  • looking at something
  • hand automatisms
  • IS PRESENT IN BOTH ABSENCE AND COMPLEX PARTIAL TYPES SO CAN’T USE THAT TO DIFF THE TWO*
32
Q

management of absence seizures

A

have to be tx bc can have an effect on learning (to be ‘‘absent’’ often in a day)

33
Q

7 year old with convulsion 2 hours after falling asleep. remembers sensation in right side of cheek before falling asleep. then doesn’t remember anything. dx

A

secondarily generalized seizure (FOCAL ONSET, initially focal with retained awareness)

  • Hx suggestive of self-limited Rolandic epilepsy
  • it’s age dependent and goes away with time
  • subtle changes later in life, increased chance of ADHD, etc.
34
Q

precautions to take during a GTC seizure

A
  • put patient on the side
  • take out everything around them
  • don’t restrict their mvmts
  • nothing in mouth
  • call 911 if concerned and always call if seizure >5 min
35
Q

precautions in the typical epilepsy patient

A
  • health bracelet
  • shower instead of bath (may drown if seizure during bath)
  • never lock the door in the bathroom
  • watch pt in water if you know them (family member), don’t rely on lifeguard watching the whole pool
  • always wear a helmet in sports where needed

Bloc J - Neuro (60 decks)

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