Flashcards in Neuro Deck (84)
Which neuro abnormalities are seen in pts w/ static sxs?
congenital abnormalities or brain injury (think cerebral palsy)
Which neuro abnormalities are seen in pts w/ progressive sxs?
degenerative disease or neoplasn
Which neuro abnormalities are seen in pts with intermittent sxs?
epileptic or migraine syndromes
Which neuro abnormalities are seen in pts with saltatory sxs?
bursts of sxs followed by partial recovery
-vascular, demyelinating d/o
What PE findings may indicate spine bifida?
tufts of hair, lipomas, dimpling
Accelerating pattern of head circumference may indicate? decelerating pattern?
degenerative neurologic disorder
How can you assess CN II?
pupillary light reflex, visual acuity
How can you assess CN III, IV, VI?
following objects, fixating, oculocephalic reflex, EOMs
How can you assess CN V?
sucking/swallowing, light touch
How can you assess CN VII?
observe fast at rest, crying/blinking
How can you assess CN VIII?
How can you assess CN IX, X?
gag reflex, sucking, salivation
How can you assess CN XI?
posture, spontaneous movement
How can you asses CN XII?
What are some primitive reflexes? When do most of them disappear?
Moro, grasp, rooting, foot placing, tonic neck
asymmetry indicates focal brain or PNS lesions
s/s seen w/ upper motor neurons
Spastic paralysis, Increased tone
Increased DTRs/+Babinski (in older children, normal in infants); usually with clonus
Minimal muscle atrophy/strength loss
May have sensory disturbances
STIFFNESS, INCREASED PASSIVE TONE
s/s seen w/ lower motor neurons?
Profound muscle Atrophy
May have sensory
WEAKNESS, DECREASED PASSIVE TONE
What are some red flags for children w/ headaches?
headache in child <5y/o
new (“explosive onset”) & worsening HA in a previously healthy child
worst HA of life
night time or early morning awakening HA
HA w/ vomiting
HA worse w/ straining
What is the most concerning headache pattern in children?
>4 months or >15x/month
usually increased ICP
possible psych factors
When should you order imaging in child presenting w/ HA?
Abnormal neurologic exam
Concern for space occupying lesion
Typical pediatric sxs for migraines?
Frontal, bitemporal or unilateral throbbing for 2-72 hrs (Unilateral sxs usually after puberty)
sxs relived by sleep
+/- visual aura
N/V, abdominal pain, phono/photophobia
Tx for migraines?
eliminate triggers: HA diary
acute: NSAIDs, APAP, triptans, antiemetics
>6: Propranolol, Amitriptyline, Topiramate
Non pharm: B12
What is Pseudotumor Cerebri - Idiopathic intracranial hypertension (IIH)
elevated ICP w/ norm cerebrospinal fluid composition, and no other cause of intracranial hypertension
s/s: HA, papilledema, vision loss, intracranial noises, photopsia
Epidemiology of pseudotumor cerebri?
MC in females of childbearing age; does occur in peds- usually adolescents (11 years +)
MC risk factor for pseudotumor cerebri?
assoc. meds: tetracycline, steroids, retinol
Dx criteria for pseudotumor cerebri?
each of the following:
Papilledema OR VI (abducens) nerve palsy (unilateral or bilateral)
Normal neuro exam, except for papilledema and CN abn
Neuroimaging: norm brain parenchyma w/o evidence of hydrocephalus, mass, structural lesion, or meningeal enhancement
Normal CSF composition
Elevated LP opening pressure
When should you check imaging in pt with concern for pseudotumor cerebri?
Imaging BEFORE lumbar puncture
Increased ICP may cause cerebral herniation when LP is performed if obstructive hydrocephalus or mass
What is the main complication of pseudotumor cerebri?
Tx for pseudotumor cerebri?
sometimes sxs resolve after diagnostic LP
wt loss for obese pts
Meds: (decreases the volume & pressure of CSF w/in the CNS):
-optho eval critical
-CSF shunt when all else fails
decrease salt intake