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Pediatrics > Neurologic Disorders > Flashcards

Neurologic Disorders Flashcards

1
Q

Autonomic Nervous System

A
  • controls visceral activities
  • comprised of sympathetic/parasympathetic systems, with opposite effects on same organs
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2
Q

Sympathetic Nervous System

A
  • “fight or flight”
  • epinephrine and norepinephrine
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3
Q

Parasympathetic Nervous System

A
  • slows activity, decreases metabolic rate
  • acetylcholine
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4
Q

Pathophysiology and Defense Mechanisms

A
  • nervous system is related to all parts of the body
  • neurotransmitters include dopamine, serotonin, glutamate
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5
Q

Assessment of the Nervous System - History

A
  • onset
  • pain and/or headache
  • sensory deficits
  • injury
  • reflexive responses
  • behavioral changes
  • motor/balance changes
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6
Q

Assessment of the Nervous System - Medical History

A
  • prenatal
  • birth history/neonatal course
  • injuries/infections
  • cardiovascular/respiratory disorders
  • environmental exposure to toxins
  • metabolic disorders
  • past neurologic diseases/tests
  • drug ingestion
  • urinary tract disease
  • physical growth
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7
Q

Assessment of the Nervous System - Family Disease History

A
  • similar symptoms/pedigree
  • consanguinity
  • migraine history
  • intellectual functioning of family members
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8
Q

Specifics of the Neurological Examination

A
  1. Behavior and mental status
  2. Cranial nerve function
  3. Motor examination
  4. Sensory examination
  5. Reflexes
  6. Cranium examination
  7. Autonomic nervous system
  8. Meningeal signs
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9
Q

Diagnostic Studies for Neurologic Disorders

A
  • CT/MRI
  • Laboratory studies for systemic disease, infection, inflammation
  • lumbar puncture
  • electroencephalogram
  • US in infants
  • polysomnography, electromyography, nerve conduction, evoked responses, cerebral arteriography
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10
Q

Multiple Sclerosis

A
  • chronic, relapsing disorder of the CNS
  • demyelination of brain, spinal cord, optic nerves
  • rare before the age of 10
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11
Q

Multiple Sclerosis Symptoms

A
  • unilateral weakness, ataxia, other cerebellar symptoms
  • symptoms last more than 24 hours
  • HA
  • motor symtoms: vague parasthesias
  • visual disturbances
  • vertigo, dysarthria, sphincter disturbances
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12
Q

Multiple Sclerosis - Diagnostic Studies

A
  1. Neuroimaging
  2. Lumbar puncture
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13
Q

Multiple Sclerosis - Management

A
  1. Corticosteroids
  2. IVIG
  3. Plasmapheresis
  4. Monoclonal antibodies
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14
Q

Cerebral Palsy

A
  • nonreversible disorder
  • chronic, nonprogressive; impairs control of movement
  • may have disturbances in sensation, perception, cognition, communication, behavior
  • epilepsy, musculoskeletal problems may be present
  • degree of brain injury individual
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15
Q

Three Types of Cerebral Palsy

A
  1. Spastic - muscle stiffening and tightness
  2. Athetoid - involuntary, purposeless muscle movement
  3. Ataxic - affects balance and coordination
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16
Q

Cerebral Palsy - Clinical Findings

A
  1. Prenatal/natal history
  2. Seizures
  3. Hearing, vision problems
  4. Change in growth parameters, head circumference
  5. Early head injury or meningitis
  6. Developmental milestones
  7. Functional health problems - feeding, irritability, movement difficulties, persistent primitive reflexes, communication
  8. Orthopedic exams - scoliosis, fractures, dislocations
  9. Neurologic exam - DTR, tone, atrophy, fasciculations, asymmetric movements, head size
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17
Q

Cerebral Palsy - Diagnostic Studies

A
  • imaging studies
  • chromosomal and metabolic studies
  • lumbar puncture if sepsis is suspected
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18
Q

Cerebral Palsy Prevention

A
  • good prenatal care and screening
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19
Q

Management of Cerebral Palsy

A
  • referral of suspected cases
  • family education/support/financial resources
  • nutrition/elimination
  • dentistry/drooling
  • respiratory, skin, mobility, vision, communication, pain, osteopenia
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20
Q

Bell Palsy

A
  • sudden, acute unilateral paralysis/weakening of facial nerve without sensory loss
  • viral etiology suspected
  • onset rapid; may last 1-9 weeks; spontaneous remission
21
Q

Bell Palsy - History

A
  • localized pain
  • swelling in one ear
  • sagging of face
  • URI within previous 2 weeks/exposure to cold temperatures
22
Q

Clinical Findings of Bell Palsy

A
  • unilateral motor changes - forehead, cheek, perioral
  • normal BP
  • dribbling liquids from weak side/eating difficult
  • hypersensitivity to noise
  • eyelid fails to close on affected side
  • lacrimation, taste, salivation impaired
  • no limb weakness
  • herpes lesions on affected side
23
Q

Bell Palsy Diagnostic Studies

A

Not indicated

24
Q

Management of Bell Palsy

A
  • methylcellulose eye drops
  • steroids in newly diagnosed patients
25
Q

Epilepsy and Seizure Disorders

A
  • misfiring of cortical neurons of brain
  • convulsive: episodes of involuntary contraction of voluntary muscles
  • recurrent, unprovoked = “epilepsy”
  • multiple etiologies: genetic, symptomatic, idiopathic conditions
26
Q

Epilepsy and Seizure Disorders - History

A
  • description of seizure
  • underlying medical diagnoses
  • pervious CNS infection or birth trauma
  • intrauterine infection, trauma, bleeding
  • toxic exposure, drug use
  • anticonvulsant medication stopped abruptly, doses missed, change in brands
  • recent head injury
  • family history
  • milestones
27
Q

Epilepsy and Seizure Disorders - Clinical Findings

A
  • focal abnormalities/weakness
  • seizure activity during exam
  • hypertension
  • systemic disease
  • cardiovascular disease
  • neurocutaneous disease
  • signs of head trauma
  • transillumination of skull in infants
28
Q

Epilepsy and Seizure Disorders - Diagnostic Studies

A
  • CBC, LFTs
  • Metabolic screen later in workup
  • Blood glucose
  • Urine/serum toxicology
  • LP if younger than 6 months
  • EG
  • MRI
  • CT
  • Polysomnography
29
Q

Nonepileptic Seizures

A
  • most common manifestation of conversion disorder
  • unilaterally/bilaterally coordinated motor activity like thrashing, jerking
  • occur only when observed; do not interrupt play
  • pupils normally reactive to light
  • situation specific
  • no associated injury
  • abrupt recovery – no postictal state
  • no incontinence
  • no EEG changes, even during episodes
30
Q

Management of Epileptic Seizures

A
  • referral
  • PCP can monitor stable children
  • drug monitoring
  • ketogenic diet
  • surgery
  • antiepileptic medication withdrawal (gradual withdrawal after 2 years of no seizures)
  • safety (swimming, driving, sports)
  • immunizations (pertussis vaccine on individualized basis)
31
Q

Febrile Seizures

A
  • most common type in children
  • brief, generalized, simple or complex
  • concurrent illness with rapid fever rise
32
Q

Febrile Seizures - History

A
  • duration, type, frequency in 24 hours
  • fever, level of temperature
  • abnormal neural findings (not consistent with febrile seizure)
  • family history of seizures
  • maternal smoking in perinatal period
  • prematurity
  • development of child
33
Q

Febrile Seizures - Diagnostic Studies

A
  • LP
  • Blood glucose
  • CBC, calcium, electrolytes, urinalysis optional
  • EEG if neurological signs present
  • MRI for complex febrile seizures
34
Q

Febrile Seizures - Management

A
  • protect airway, breathing, circulation
  • time duration of seizure
  • reduce fever with tylenol or ibuprofen
  • anticonvulsants only if complex; if neurological signs present
  • prophylaxis not recommended
  • education about febrile seizures
35
Q

Secondary Headache

A
  • worse in the morning on awakening
  • wakens child from sleep
  • vomiting without nausea
  • increased pain with straining, sneezing, coughing
  • occipital/neck pain
  • mental, personality, behavioral alterations
36
Q

Headaches - Physical Examination

A
  • blood pressure: supine and standing
  • growth parameters
  • eyes, ears, neck, sinuses, teeth, TMJ
  • thyroid gland
  • bones and muscles of skull
  • nerves, reflexes
37
Q

Management of Headaches

A
  • pain and stress management
  • migraines: abortive therapy, reducing frequency, severity, length of treatment
38
Q

Head Injury

A
  • mild to severe tissue damage
  • acceleration-decelerration or rotational forces
  • long term sequelae more common in children
39
Q

Open Head Trauma

A

more focal injuries

40
Q

Closed Head Trauma

A

multifocal/diffuse injury

41
Q

Secondary Effects of Head Injury

A
  • hypoxia
  • ischemia
  • hypotension
  • hemorrhage
42
Q

Head Injury - History

A
  • Acute Concussion Evaluation (ACE) tool
  • History of injury
  • Loss/alteration of consciousness, confusion, irritability, behavior
  • Vomiting
  • HA, blurred vision, diplopia
  • Numbness/loss of sensation
43
Q

Head Injury - Physical Examination

A
  • vital signs
  • thorough physical examination
  • care neurologic examination
  • signs of CNS involvement
  • Glasgow coma scale
  • periorbital hemorrhage (raccoon eyes) - ED emergency
  • “battle sign” (ecchymosis behind the ear) - ED emergency
44
Q

Head Injury Diagnostic Studies

A
  • severity dictates need for studies
    1. penetrating trauma
    2. altered LOC
    3. amnesia about injury
    4. focal neurological signs/deficit
    5. depressed skull fracture/basilar injury (raccoon eyes and battle sign)
    6. Seizures
    7. Persistent vomiting
    8. History of coagulopathy
45
Q

Management of Minor Closed Head Injury with no loss of consciousness

A
  • observation in clinic, ED, home
  • understanding of signs to watch
46
Q

Management of Minor Closed Head Injury with brief loss of consciousness

A
  • observation in clinic, ED, home
  • understanding of signs to watch
  • CT scanning accepted
  • Hospitalization if reliable home monitoring not possible
47
Q

Management of Moderate Head Injury with worrisome symptoms

A
  1. admission, prolonged observation in ED
  2. Hospitalize for the following:
    - changing vital signs
    - seizures
    - AMS, slurred speech
    - prolonged unconsciousness/persistent memory deficit
    - depressed or basilar skull fractures
    - persistent HA
    - recurrent vomiting/unexplained fever
    - unexpected injury (child abuse)
    - worrisome CT/MRI findings
48
Q

Post-Trauma sequelae and post-concussion syndrome

A
  • cognitive deficits may persist for months
  • speech/motor difficulties for years
  • HA, dizziness, irritability, impaired concentration in adolescents, aggression, disobedience, regression, inattention, anxiety in younger children
49
Q
A

Pediatrics (12 decks)

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