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D2 E1 Shea > Peds NEURO 2 - HA, Cerebral Palsy, Spina Bifida, Chiari > Flashcards

Peds NEURO 2 - HA, Cerebral Palsy, Spina Bifida, Chiari Flashcards

1
Q

MCC of HA

A

URI due to strep

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2
Q

The following are ___________ causes of HAs

Meningitis, encephalitis, cerebral abscess

Subarachnoid hemorrhage

Increase ICP

A

life-threatening

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3
Q

What are other causes of HAs?

A

Toxin/substance abuse

Postictal phase

HTN (*consider pre-eclampsia in adolescent females & nephrotic syndrome)

Psychogenic

Sleep deprivation

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4
Q

What must you ask about when trying to figure out the cause of a child’s HA?

A

**Ask about pattern, school absences, changes at home**

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5
Q

What are the 4 types of HA patterns?

A

Acute

Acute Recurrent

Chronic progressive

Chronic Nonprogressive/Daily

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6
Q

Acute HA pattern (single episode w/o prior hx) is usually due to what?

A

febrile illness

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7
Q

Acute recurrent HA pattern (episodes separated by pain-free intervals) is usually due to what?

A

typical migraine

tension HA

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8
Q

Chronic progressive pattern (most concerning pattern) is usually due to what?

A

inc. ICP

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9
Q

Chronic Nonprogressive/Daily pattern (>4 mo or >15 mo) is usually due to what?

A

psych factors

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10
Q

Most severe on awakening, awaken in middle of night

Severely exacerbated by coughing or bending

Acute onset without previous history

Present daily with progressive worsening

Accompanied with vomiting

Focal neurologic signs

Aggravated by Valsalva-like maneuvers

What do these sx describe?

A

A worrisome condition

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11
Q

If HA worse when lying flat, think increased _____.

A

If HA worse when lying flat, think increased ICP

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12
Q

Sx of what?

_**Frequently begins in childhood**_

•Periodic headaches w/vomiting and relieved by rest

Frontal, bitemporal or unilateral pounding/throbbing for 2-72h

Sx relieved by sleep

Possible visual aura 15-30 minutes prior

**N/V, abd pain, phono/photophobia**

A

Migraines

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13
Q

Step 1 in management of migraines

A

Eliminate triggers: diet, menses, stress

Inc. exercise & sleep

HA diary

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14
Q

Migraines: Acute treatment?

A

NSAIDs, acetaminophen

triptans (nasal sumatriptan approved >12 y/o)

antiemetics

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15
Q

When would you use prophylaxis for migraines and what is it?

A

for kids with frequent, prolonged or disabling HAs

<6yo: cyproheptadine

>6yo: propranolol, amitriptyline (TCA), topiramate, others (PAT)

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16
Q

What is the prognosis for migraines?

A

Good; improve with time, some may continue to have HAs

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17
Q

Etiology of what condition?

Inc. ICP w/o space-occupying lesion or obstruction

Cause unknown (likely multifactorial)

A

Pseudotumor Cerebri AKA idiopathic intracranial hypertension (IIH)

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18
Q

Clinical Px of which condition?

MC in females of childbearing age; occurs in peds 11+

Inc. ICP sx: HAs, blurred vision, diplopia, vision loss

HA worse at night, aggravated by sudden movement

neck stiffness, tinnitus, dizziness, paresthesias

A

Pseudotumor Cerebri (IIH)

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19
Q

What is seen on PE of Pseudotumor Cerebri (IIH)?

What is the main complication of this condition?

A

PE: Papilledema, abnormal visual field testing

Complication: vision loss

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20
Q

Dx of Pseudotumor Cerebri (IIH)

A

Diagnosis of exclusion: R/O all other causes of inc. ICP

MRI and MR venography r/o venous sinus thrombosis

LP: inc opening pressue & normal composition

_**IMAGING BEFORE LP**_

21
Q

Why do we need to image before LP?

A

inc. ICP may cause cerebral herniation when LP is performed if obstructive hydrocephalus or mass

22
Q

Pseudotumor Cerebri (IIH) Management

A

Goal: improve sx and preserve vision

Sometimes sx resolve after diagnostic LP

23
Q

Pseudotumor Cerebri (IIH) Tx (meds)/surgery/lifestyle

A

Meds: Acetazolamide, Topiramate

Surgery: Optic nerve sheath fenestration, CSF shunt

Lifestyle: dec. Na+ intake

24
Q

Non-progressive clinical syndrome characterized by motor and postural dysfunction

Results from brain injury or malformation (before birth, during or after delivery)

What condition is this?

A

Cerebral Palsy

25
Q

T/F: CP is often accompanied by other disorders of cerebral function.

A

TRUE

Intellectual disability (50%), epilepsy, behavioral d/o, sleep d/o

Blindness, deafness, bladder control d/o, others

26
Q

The following are _______ causes of CP

Prematurity

Intrauterine growth restriction

Intrauterine infection

Antepartum hemorrhage

Severe placental pathology

Multiple pregnancy

Hypoxic brain injury

Stroke

Cerebral dysgenesis

A

prenatal

27
Q

The following are _____ causes of CP

Stroke

Kernicterus

Trauma

Near-drowning

Toxins

Hypoxic brain injury

A

postnatal

28
Q

What are the 4 major classifications that reflect the area of brain injury in CP?

A
  1. Spastic (most common type, 70 – 80%)
  2. Athetoid/Dyskinetic
  3. Ataxic (most rare form)
  4. Atonic
29
Q

Sx of what type of CP?

UMN lesions/sx

A

spastic CP (most common type)

30
Q

Sx of what type of CP?

slow, smooth, writhing movements that involve distal muscles

A

Athetoid CP

31
Q

Sx of what type of CP?

decreased spontaneous movement, hypotonia, and suppressed primitive reflexes

A

Dyskinetic

32
Q

Sx of what type of CP?

Wide-based gait, intention tremor, slow, jerking movements

A

Ataxic (most rare form)

33
Q

Sx of what type of CP?

Severe hypotonia, never stand or walk. May have cerebral dysgenesis, microcephaly, profound intellectual disability

A

Atonic

34
Q

Cerebral Palsy Tx

A

Social and emotional development

Communication

Education

Nutrition

Mobility

Maximal independence in activities of daily living

PT/OT/ST

35
Q

Cerebral Palsy Prognosis

A

varies based on severity of dz

36
Q

This is a description of what condition?

Neural tube disorder (NTD) = defective closure of the caudal neural tube early in gestation (about week 4)

Anomalies may vary depending on degree of closure defect

May be just defect of L5 and S1 vertebral arch

Most severe form results in exposure of meninges & spinal cord

A

Spina bifida

37
Q

What type of spina bifida?

Meninges and spinal cord exposed; total paralysis, loss of bowel/bladder control, accompanying Chiari II malformation*

spinal cord is enclosed in the cyst

_**Most serious type of spina bifida**_

A

Myelomeningocele

38
Q

What type of spina bifida?

Spinal canal and meninges are exposed, underlying spinal cord is intact

_**2nd most serious type**_

A

Meningocele

39
Q

What type of spina bifida?

Skin intact but underlying defects in bone and spinal canal present

May see sinus tract, dimple or tuft of hair.

May have neuro deficits

Discovered only on x-rays or scans & most ppl never become aware of their condition

_**least serious**_

A

Occulta

40
Q

Spina Bifida Prevention

A

Folic Acid supplements pre-pregnancy & during pregnancy

41
Q

Dx of Spina Bifida

A

Routine screening for AFP level @ 16-18 wks in maternal serum

US @ 12-14 wks & 18-20 wks

42
Q

Spina Bifida Management

A

Surgical closure

VP shunt

Adjunct therapies: Cognitive disabilities, self-catheterization

43
Q

Almost all patients with a myelomeningocele have the _______________, and most have associated ___________.

A

Almost all patients with a myelomeningocele have the Chiari II malformation**, and most have associated **hydrocephalus.

44
Q

heterogeneous group of disorders that are defined by anatomic anomalies of the cerebellum, brainstem, and craniocervical junction, with downward displacement of the cerebellum, either alone or together with the lower medulla, into the spinal canal

What condition does this describe?

A

Chiari Malformation

45
Q

What type of Chiari?

downward displacement of medulla & cerebellar tonsils

syringomyelia

A

Chiari 1

46
Q

What type of Chiari?

Herniation of the cerebellar tonsils

hydrocephalus

kink in medulla

myelomeningocele

syringomyelia

A

Chiari 2 (Arnold-Chiari Malformation)

47
Q

What type of Chiari?

Further herniation of the cerebellum below the foramen magnum forming an encephalocele in addition to spina bifida

A

Chiari 3

48
Q

What type of chiari?

hypoplasia/aplasia of the cerebellium with spina bifida

A

Chiari 4

49
Q
A

D2 E1 Shea (13 decks)

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