NEURO peds Flashcards
(77 cards)
1
Q
What is the most important diagnostic tool in neurology?
A
History
2
Q
- headache fails to respond to therapy
- focal neurologic findings in first 2-6 months (palsy, diplopia, new onset strabismus, papilledema, hemiparesis, ataxia)
- progressively increasing frequency/ severity of HA , HA worse with valsalva
- HA awaken from sleep, worse in AM , AM vomiting,
- at -risk hx or condition : neurocutaneous disorder
A
Headache RED Flags
3
Q
brought on by fatigue, exertion, stress, poor hydration
- sx: constant, aching, tight, occipital, frontal or constricting band around head
- may occur with vascular headache
- TX: rest, analgesics
A
Tension-type headache (TTH)
4
Q
symptom of depression and or anxiety
- pain is: b/l diffuse, dull aching, present with awakening, not associated with n/v or neuro problems
- Evaluate : CT or MRI
- TX is difficult, ANTIDEPRESSANTS help
A
Chronic Tension Headache
5
Q
- severe, pulsatile (pounding)
- u/l, can be b/l
- frontal or temporal regions, retro orbital or cheek
- sx: N/V, photophobia, phonophobia, vertigo, fatigue, mood alteration
- vomiting may be only sx in younger children (abdominal migraines)
A
Migraine Headache
6
Q
when are neuro studies warranted in someone with migraine ha?
A
worse with an awakening, awaken pt, cough or bending over
7
Q
what can also cause migraines in children?
A
allergies
8
Q
treatment for migraines?
A
1 avoid triggers
- ibuprofen or acetaminophen early in attack
- caffeine + ergot
- triptans
- rest and quiet
- avoid narcotics
9
Q
TCA, beta blockers (propranolol), CCB (verapamil)
A
prevent migraines
10
Q
Mainly male
-
A
Cluster Headache
11
Q
a sudden, transient disturbance of brain function manifested, or psychic phenomena
A
Seizure
12
Q
2 or more seizures not provoked by particular event or cause
A
eiplepsy
13
Q
a benign condition of childhood with u/l focal seizures and speech abnormalities , often hereditary
A
Rolandic seizures
14
Q
What is the most common type of seizure in children?
A
Partial
15
Q
Children present with what in their first seizure?
A
Status Epilepticus
16
Q
who has seizures in the first 28 days of life (first few days), sometimes benign familial , secondary may progress (HIE, infection, IVH, thrombus)
A
Neonatal Sz
17
Q
What are 6mo -6 year old seizures, usually 2-5 /o
A
Febrile Seizure
18
Q
Seizure >30 min, sequential seizures without regain LOC > 30 mins
A
Status Epilepticus
19
Q
What is an adjunctive test to clinical history for seizures?
A
eeg
20
Q
what % of children “out grow” their seizures?
A
70-80%
21
Q
Absent (petit mal)
- Generalized tonic clinic (grand mal)
- Tonic
- Clonic
- Atonic
A
Generalized seizures
22
Q
Simple partial (focal)
- Complex partial (psycho- motor)
- Benign rolandic epilepsy
A
Partial seizures
23
Q
- Infantile spasms (West syndrome)
- Febrile sz
- Juvenile myoclonic
A
Other types of seizures
24
Q
- Onset of seizures begins in one area of cerebral hemisphere
- simple = no LOC
- complex = LOC (staring)
- Secondarily generalized = simple or complex partial seizure that ends in a generalized convulsion
- 40-60% of childhood epilepsies
A
Partial (focal) Epilepsy
25
a simple or complex partial seizure that ends in a generalized convulsion
secondarily generalized partial focal epilepsy
26
Duration : 90 seconds
Sx: sudden jerking, sensory phenomena , no LOC
Post ictal Sx: transient weakness or loss of sensation
Simple Partial
27
Duration: 1-2 mins
Sz: aura, automatism (lip smack, pick at clothes, fumbling)
unaware of envt, may wander
Post ictal Sx: amnesia of sz, mild to moderate confusion, sleepiness
Complex Partial
28
tingling of contralateral limb, face or side of body
- tonic clonic movements if upper limb
- head and eyes turn to opposite side
- see flashes of light, blurring
- sweat, flushing , pallor
Simple Partial seizure
29
in impaired consciousness
- hears music (hallucinations)
- olfactory hallucination
- chewing movements, picking at clothing
Complex Partial Sz
30
- Seizures arise from both hemispheres simultaneously
- Typical Absence : 6-20% children
- Myoclonic, tonic, atonic, atypical absence sz= 10-15% of childhood epilepsies
- Associated with underlying structure brain dz
- DIFFICULT TO TREAT AND CLASSIFY
Generalized seizures
31
Duration - 2-15 seconds
- Sx: stare, eyes fluttering, automatism (lip smack, pick clothes) help if needed
- Post ictal sx: amnesia for seizure events, no confusion, resume activity
Absence (petit mal)
32
Duration - 1- 2 mins
- Sz: cy, fall, tonicity, clonicity, may have cyanosis
- post itcal symptoms L amnesia for seizure , confusion, deep sleep
Generalized tonic - clonic (grand mal)
33
- Clinical spasms (1-2 seconds)
- occurs in clusters with drowsy
- brain insult : birth, malformation , tuberus sclerosis, metabolic origin ( hard to control, poor neurocog outcome)
- Cryptogenic = NO underlying cause --> best outcome
infantile spasms (west syndrome)
34
- Onset 3-13, males more
- 15% epileptic children
- Normal IQ, normal exam, normal MRI
- May have + FHx sz
Description: when awake, twitching or tingling on one side, speech arrest , my drool
Benign Roldandic Epilepsy
35
What is this treatment for?
indicated if : seizures are frequent, socially stigma if occurs in wakefulness, anxiety provoking for parents if occur in sleep
Benign rolandic epilepsy
36
Treatments
Avoidance for sleep deprivations
- Medications : carbamazepine, oxcarbazepine
- Time (outgrow by adolescence)
Benign Rolandic Epo epilepsy
37
- >30 minutes or more continuouse seizures, recurrent seizures without regaining consciousness
- medical emergency : structural damage, hypoxia, hypotension, death
- most children in children under 5 (85%) especially
Status Epileptics
38
structural damage, hypoxia, hypotension and death are associated with what sz?
status epilepticus
39
Use this in every case of suspected seizure disorder (not febrile) , abnormal in 60-80%
EEG
40
These are generally NOT helpful , only based on presentation and hx
Blood tests
41
Generalized - abnormal exam or difficult to control
Focal - not benign rolandic epilepsy, all others
Seizure Evaluation
42
WBC > 20 k = bacterial infection, left shift is seen d/t adrenocortical surge
- Blood culture, Urine C&S
- Lumbar puncture : under age 2 , any suggestion of meningitis
- Electrolytes
- Glucose
- Neonates : consider metabolic (lactate, amonia, urine ketones)
Seizure Workup (mostly look for secondary sources)
43
This test CANT make diagnosis of epilepsy.
- MOST USEFUL for classifying types and guiding therapy (absence [petit mal], psychomotor [temporal lobe], generalized tonic clonic [grand mal] , infantile spasms, mixed seizure disorder
- Useful in evaluating worsening seizures or projecting recurrence of seizures if medicine were to be stopped
EEG
44
1. Cannot make diagnosis of epilepsy
2. most useful for classifying types and guiding therapy
3. Useful in evaluating worsening seizures or projecting recurrence of seizures if medicines were to be stopped
EEG
45
- Antipyretic ineffective in febrile seizures
Treatment
46
Only diazepam indicated for abortive tx if prolonged complex
Febrile Seizure TX
47
Phenobarbital
Neonatal Sz
48
Phenytoin, phenobarbital, carbamazepine, valproic acid, primidone
Generalized TC
49
Ethosuximide, valproic acid
Absent sz
50
Felbamate , gabapentin, lamotrigine, topiramate, tiagabine, vigabatrine
New anti-epileptics
51
-2-4% of children age
Febrile Seizures
52
type of febrile seizure
- generalized convulsion (whole body shaking)
- brief (
Simple febrile seizure
53
type of febrile seizure
- focal seizure (one side of the body shaking, staring)
- prolonged ( >15 mins)
- multiple in 24 hours
- often post-ictal state
Complex febrile seizure
54
what seizures are usually harmless?
febrile
55
how often to febrile recurrences occur?
30% rate , does not change prognosis
56
is the progression to epilepsy common or uncommon?
uncommon ( no more than 1.3% )
57
febrile seizure treatment
usually none
58
rectal diazepam
abort prolonged complex febrile seizure
| - prevent complex febrile seizure clusters
59
phenobarbital and valproic acid
effective in prevention of febrile seizures
60
spells that mimic seizures?
migraine variants, benign breathholding spells, syncope, pseudoseizures
61
Common features
| - involuntary, children
Breath-Holding Spells
62
Precipitated by anger, frustration, fear
| - crys, stops breathing in expiration, becomes cyanotic
Cyanotic Spells
63
- Transient LOC and postural tone d/t cerebral ischemia and anoxia
- prodrome : dizzy, lighthead, nausea, sweating, pallor
- MAY HAVE JERKING MOTIONS while LOC, tonic clonic
- Family hx + in 90%
Syncope
64
- neurally mediated
- transient hypotension from vasodilation and or decreased heart rate
- arousal 1-2 minutes up to 1 h
Vaso-vagal or neurocardiogenic 95%
65
D/t cerebral edema, mass lesion
- S/S : infants --> bulging fontanelle, increased head circumference , separating sutures, lethargy, vomiting, FTT, "SETTING-SUN SIGN"
Children --> HA, diplopia/strabismis, papilledema, herniation syndromes
Increased ICP
| - cystic formation on the cns tract on the 4th ventricle, end up with hydrocephalus as a result
66
Location
- supratentorial - eye forehead temple
- infratentorial - occiput, neck
- worse in AM , standing up, night
- worsened by cough sneeze straining
- OFTEN WITH VOMIT WITHOUT NAUSEA
- subarachnoid hemorrhage : worse headache of life, suspect abuse in kids
Headache from Elevated ICP
67
increased ICP without identifiable mass or hydrocephalus
- obese teen girl
- HA, tinnitus, papilledema, visual loss (normal MRI)-
- MRI to exclude hydrocephalus or intracranial mass
- LP : elevated opening pressure (Essential to dx)
Pseudotumor Cerebri
68
- brief LOC or stunned for minutes to hours
- no localize neuro signs
- amnesia is common and transient
- Diagnostic - CT if hemorrhage
- observe and hospital --> suspect abuse, abnormal vital signs
- implications for sports- second impact syndrome
head injury concussion
69
- all children with amnesia or who were LOC should be evaluated in er
concussion
70
post ___ : complain of headahce, dizziness, forgetfulness, inability to concentrate, slowing of response time, mood swing, irritable
- resolve spontaneously
- weeks to months
post concussive syndrome
71
what is second impact syndrome?
kid isnt recovered from first concussion and gets second concussion which can worsen sx
72
what are congenital malformations?
meningomyelocele, encephalocele, lissencephaly, pachygyria, absent corpus callosum
73
neural tube forms and closes during days 0-28 of gestation
meningomyelocele, encephalocele
74
cell proliferation and migration after 28 days
lissencephaly, pachygryia, absent corpus callosum
75
smooth brain
lissencephaly
76
gyri too thick and overdeveloped
pachygyria
77
often identified on US likely to have elevated alpha fetoprotein on prenatal screen.
- Folate during pregnancy
meningomyelocele,
