Pediatrics > Neurologic Disorders > Flashcards

Neurologic Disorders Flashcards

(49 cards)

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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

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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

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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

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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

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A

Not indicated

24
Q

Management of Bell Palsy

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A
  • methylcellulose eye drops
  • steroids in newly diagnosed patients
25
Epilepsy and Seizure Disorders
- misfiring of cortical neurons of brain - convulsive: episodes of involuntary contraction of voluntary muscles - recurrent, unprovoked = "epilepsy" - multiple etiologies: genetic, symptomatic, idiopathic conditions
26
Epilepsy and Seizure Disorders - History
- 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
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Epilepsy and Seizure Disorders - Clinical Findings
- focal abnormalities/weakness - seizure activity during exam - hypertension - systemic disease - cardiovascular disease - neurocutaneous disease - signs of head trauma - transillumination of skull in infants
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Epilepsy and Seizure Disorders - Diagnostic Studies
- CBC, LFTs - Metabolic screen later in workup - Blood glucose - Urine/serum toxicology - LP if younger than 6 months - EG - MRI - CT - Polysomnography
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Nonepileptic Seizures
- 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
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Management of Epileptic Seizures
- 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
Febrile Seizures
- most common type in children - brief, generalized, simple or complex - concurrent illness with rapid fever rise
32
Febrile Seizures - History
- 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
Febrile Seizures - Diagnostic Studies
- LP - Blood glucose - CBC, calcium, electrolytes, urinalysis optional - EEG if neurological signs present - MRI for complex febrile seizures
34
Febrile Seizures - Management
- 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
Secondary Headache
- 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
Headaches - Physical Examination
- blood pressure: supine and standing - growth parameters - eyes, ears, neck, sinuses, teeth, TMJ - thyroid gland - bones and muscles of skull - nerves, reflexes
37
Management of Headaches
- pain and stress management - migraines: abortive therapy, reducing frequency, severity, length of treatment
38
Head Injury
- mild to severe tissue damage - acceleration-decelerration or rotational forces - long term sequelae more common in children
39
Open Head Trauma
more focal injuries
40
Closed Head Trauma
multifocal/diffuse injury
41
Secondary Effects of Head Injury
- hypoxia - ischemia - hypotension - hemorrhage
42
Head Injury - History
- 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
Head Injury - Physical Examination
- 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
Head Injury Diagnostic Studies
- 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
Management of Minor Closed Head Injury with no loss of consciousness
- observation in clinic, ED, home - understanding of signs to watch
46
Management of Minor Closed Head Injury with brief loss of consciousness
- observation in clinic, ED, home - understanding of signs to watch - CT scanning accepted - Hospitalization if reliable home monitoring not possible
47
Management of Moderate Head Injury with worrisome symptoms
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
Post-Trauma sequelae and post-concussion syndrome
- 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
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