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PEDS 2- clinical disciplines > Neuro > Flashcards

Flashcards in Neuro Deck (84)
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1

Which neuro abnormalities are seen in pts w/ static sxs?

congenital abnormalities or brain injury (think cerebral palsy)

2

Which neuro abnormalities are seen in pts w/ progressive sxs?

degenerative disease or neoplasn

3

Which neuro abnormalities are seen in pts with intermittent sxs?

epileptic or migraine syndromes

4

Which neuro abnormalities are seen in pts with saltatory sxs?

bursts of sxs followed by partial recovery

-vascular, demyelinating d/o

5

What PE findings may indicate spine bifida?

Midline defects:
tufts of hair, lipomas, dimpling

6

Accelerating pattern of head circumference may indicate? decelerating pattern?

hydrocephalus

degenerative neurologic disorder

7

How can you assess CN II?

pupillary light reflex, visual acuity

8

How can you assess CN III, IV, VI?

following objects, fixating, oculocephalic reflex, EOMs

9

How can you assess CN V?

sucking/swallowing, light touch

10

How can you assess CN VII?

observe fast at rest, crying/blinking

11

How can you assess CN VIII?

hearing

12

How can you assess CN IX, X?

gag reflex, sucking, salivation

13

How can you assess CN XI?

posture, spontaneous movement

14

How can you asses CN XII?

tongue movement

15

What are some primitive reflexes? When do most of them disappear?

Moro, grasp, rooting, foot placing, tonic neck


4-6 months

asymmetry indicates focal brain or PNS lesions

16

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

Fasciculations absent

May have sensory disturbances

STIFFNESS, INCREASED PASSIVE TONE

17

s/s seen w/ lower motor neurons?

Flaccid paralysis

Decreased tone

Absent DTRs

Profound muscle Atrophy

Fasciculations present

May have sensory
disturbances

WEAKNESS, DECREASED PASSIVE TONE

18

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

unexplained fever

night time or early morning awakening HA

HA w/ vomiting

HA worse w/ straining

postural HA

neurocutaneous stigmata

19

What is the most concerning headache pattern in children?

chronic progressive
>4 months or >15x/month

usually increased ICP

possible psych factors

20

When should you order imaging in child presenting w/ HA?

Abnormal neurologic exam

Concern for space occupying lesion

21

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

22

Tx for migraines?

eliminate triggers: HA diary

acute: NSAIDs, APAP, triptans, antiemetics

Prophylaxis:
<6: Cyproheptadine
>6: Propranolol, Amitriptyline, Topiramate

Non pharm: B12

23

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

24

Epidemiology of pseudotumor cerebri?

MC in females of childbearing age; does occur in peds- usually adolescents (11 years +)

25

MC risk factor for pseudotumor cerebri?

obesity

assoc. meds: tetracycline, steroids, retinol

26

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

27

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

28

What is the main complication of pseudotumor cerebri?

vision loss

29

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):
Acetazolamide
Topiramate

Surgery
-optho eval critical
-CSF shunt when all else fails

decrease salt intake

30

What is cerebral palsy?

heterogeneous group of conditions involving permanent nonprogressive central motor dysfunction that affect muscle tone, posture, and movement

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