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Neurological Disorders Flashcards

1
Q

most important tool diagnostically in neuro

A

history

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2
Q

most common HA in kids

A

migraine and tension-type

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3
Q

CT or MRI scan is very necessary and appropriate for eval of a headache

A

FALSE. Unless concern about sub-arachnoid, subdural hematoma or concern about increased IC pressure or hemorrhage

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4
Q

HA red flags

A 
fails to respond to therapy
focal neurologic findings
progressive frequency/severity
worsens with valsalva
awakens from sleep
worse in am/morning vomiting 
at risk hx
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5
Q

HA brought on by fatigue or stress. Constant, aching, constricting band around the head

A

tension type HA

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6
Q

Pain is bilateral and diffuse, dull and aching,

often present upon awakening, not associated with nausea, vomiting, neurologic problems

A

chronic tension HA

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7
Q

treat tension type HA

A

difficult, sometimes antidepressants

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8
Q

Pain is severe, pulsatile (pounding), unilateral, can be bilateral, frontal or temporal regions, retro orbital or cheek

A

migraine

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9
Q

may be the only symptom of migraine in younger children

A

vomiting

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10
Q

HA associated with N/V photophobia, phonophobia, vertigo, fatigue, mood alteration

A

migraine

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11
Q

when should you do studies on a child’s migraine

A

if they have focal neurologic signs, HA worse on awakening , or awakens pt , or with a cough or bending over

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12
Q

diagnosis of migraine

A

history

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13
Q

HA that is recurrent with acute onset that often resolves only after sleep

A

migraine

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14
Q

treat a migraine

A

Ibuprofen or acetaminophen early in the attack
Caffiene, caffiene+ergot
Triptans (sumatriptan, rizatriptan, etc.) and DHE (dihydroergotamine)
Rest and quiet
Avoid narcotics

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15
Q

prevent a migraine

A

Tricyclic antidepressants
Beta Blockers ie propranolol
Calcium channel blockers, such as verapamil

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16
Q

Predominantly male
Unusual in children under 10
Unilateral, severe pain

A

cluster HA

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17
Q

A sudden, transient disturbance of brain function manifested by involuntary motor, sensory, autonomic, or psychic phenomena

A

seizure

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18
Q

2 or more seizures not provoked by particular event or cause

A

epilepsy

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19
Q

a benign condition of childhood with unilateral focal seizures and speech abnormalities, often hereditary

A

Rolandic epilepsy

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20
Q

Pain is severe, pulsatile (pounding), unilateral, can be bilateral, frontal or temporal regions, retro orbital or cheek

A

migraine

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21
Q

generalized seizures

A 
Absence (petit mal)
Generalized tonic clonic (grand mal)
Tonic
Clonic
Atonic
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22
Q

partial seizures

A 
Simple partial (focal) 
Complex partial (psycho-motor)
Benign rolandic epilepsy
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23
Q

Onset of seizure begins in one area of one cerebral hemisphere (apparent clinically or via the EEG)

A

partial/focal epilepsy

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24
Q

complex focal means

A

LOC (starting)

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25
this type of seizure makes up 40-60% of childhood seizures
partial/focal
26
Seizures arise from both hemispheres, simultaneously
generalized seizures
27
these seizures are frequently associated with underlying structural brain disease and are difficult to treat and classify
myotonic, tonic, atonic, atypical absence
28
infantile spasms aka
west syndrome
29
these are clinical spasms that occur in clusters when drowsy. Severely abnormal EEG. Related to a brain insult at birth, malformation, tuberous sclerosis, or metabolic origin
infantile spasms
30
Strange posturing, back arching, writhing Alternating L and R limb shaking during same seizure Psychosocial stressor
pseudoseizures
31
Seizures can happen when awake (twitching and tingling on one side of the body) or when asleep (grand mal)
Benign Rolandic epilepsy | benign focal epilepsy of childhood
32
treat benign rolandic epilepsy
avoid sleep deprivation carbamazapine oxcarbazepine time (outgrown)
33
30 minutes or more of continuous seizures or recurrent seizures without regaining consciousness
status epilepticus
34
treat status epilepticus
ABCs, IV lorazepam (valium)
35
You think a kid has BRE, so you order a CT or MRI. Good or bad?
Bad, dont need one for BRE
36
this type of febrile seizure: one side of body shakes, stares, prolonged (over 15 min), multiple in 24 hours
complex seizures
37
Cannot make diagnosis of epilepsy | Most useful for classifying types and guiding therapy
EEG
38
treat febrile seizures
usually none rectal diazepam if prolonged PB or VA can prevent (consider SEs) fever management prop doesnt work
39
this type of febrile seizure is most common
simple- whole body shakes, brief (less than 20 min), only 1 in the course of illness
40
this type of febrile seizure is more likely to progress to epilepsy
complex
41
spells that mimic seizures
``` migraine variants breathholding spells (tantrums- breath holding on exhalation) syncope pseudoseizures ```
42
Strange posturing, back arching, writhing Alternating L and R limb shaking during same seizure Psychosocial stressor
pseudoseizures
43
Transient LOC and postural tone due to cerebral ischemia or anoxia
syncope
44
most common cause of childhood stroke
cyanotic heart disease sickle cell anemia meningitis hypercoagulable states
45
Neurally mediated Transient hypotension from vasodilation and/or decreased heart rate Arousal 1-2 min up to 1h
vasovagal or neurocardiogenic syncope
46
most common type of syncope
vasovagal or neurocardiogenic syncope
47
syncope that may have cardiac symptoms (angina, palpitations) Often occurs during exercise
cardiac
48
causes of increased ICP
cerebral edema | mass lesion
49
infant comes in with bulging fontanelle Increasing head circumference, separating sutures Lethary, vomiting, FTT, “setting-sun sign”
increased ICP
50
kid comes in with headaches, diplopia/Strabismus, papilledema, herniation syndromes
increased ICP
51
supretentorial HA location
eye, forehead, temple
52
intratentorial HA location
occiput, neck
53
smooth brain
lissencephaly (a migrational disorder)
54
Increased intracranial pressure without identifiable mass or hydrocephalus Obese teenage girl is typical phenotype
pseudotumor cerebri
55
what is essential to diagnosis of pseudotumor cerebri
LP- elevated opening pressure
56
most common cause of childhood stroke
cyanotic heart disease sickle cell anemia meningitis hypercoagulable states
57
kid comes in with hemiplegia, unilateral weakness, seizures. what do you think
stroke
58
Brief loss of consciousness or stunned for minutes to hours No localizing neurologic signs Amnesia is common and transient
head injury-concussion
59
diagnosis of concussion
head CT
60
child complains of headache, dizziness, forgetfulness, inability to concentrate, slowing of response time, mood swings, irritability
post concussive syndrome
61
Often identified on US, likely have elevated alpha fetoprotein on prenatal screen
MMC
62
displaced cerebellum through foramen magnum into spinal canal – posterior laminectomy. Progressive ataxia or vertigo
Arnold Chiari I
63
displaced cerebellum plus meningomyelocele – surgical repair and shunt
Arnold Chiari II
64
occipital encephalocele – surgical repair | Hydrocephalus common
Arnold Chiari III
65
smooth brain
lissencephaly (a migrational disorder)
66
most common migrational disorder
lissencephaly
67
disorder of anterior horn cells
SMA | poliomyelitis
68
disorder of the nerve itself
Guillian Bare | bell palsy
69
Autosomal Dominant | Café au lait spots - >6 of 5mm prepubertal pt
neurofibromatosis
70
disorder of the muscle itself
muscular dystrophy | myotonic dystrophy
71
how can you eval tuberous sclerosis
woods lamp
72
Unilateral port wine stain over upper face (follows CN V). Associated with seizures
Sturge Weber
73
Impairment of coordination and balance of voluntary movement | Cerebellar problem
ataxia
74
most common cause of ataxia in children
post-infectious (2nd drug intoxication)
75
hereditary ataxia
Friedreich
76
Sudden onset of ataxia,staggering, frequent falls Nystagmus, vomiting, irritaility, lethargy possible Sensory and reflexes preserved (motor abnormal) No evidence increased ICP. Recently had a viral prodromal illness
post infectious acute cerebellar ataxia
77
prognosis post infectious acute cerebellar ataxia
90% recover in 1-4 weeks
78
while kid tries to get up… uses hands to walk up legs
Gower sign
79
disorder of anterior horn cells
SMA
80
disorder of the nerve itself
Guillian Bare
81
disorder of the NMJ
Myasthenia gravis
82
disorder of the muscle itself
muscular dystrophy | myotonic dystrophy
83
Present with muscle weakness, which may manifest with floppiness, delayed motor milestones, unsteady gait or muscle fatiguability
NM disorders
84
spinal muscular atrophy: (AR) progressive weakness and wasting of skeletal muscles; Normal mental, language and social skills (SAD) Eventual respiratory failure and death
Anterior horn cell disorders
85
progression associated with bulbar palsy and respiratory depression
peripheral nerve disorders
86
kid >10 years old, ophthalmoplegia and ptosis, loss of facial expression and difficulty chewing
juvenile myasthenia
87
``` X-Linked recessive Onset at 2-6 yrs Proximal muscles affected before distal Waddling gait, difficulty with stairs pseudohypertrophic calf Gower Sign – pelvic weakness ```
Duchenne MD
88
this MD has 75% mortality by age 20
DMD
89
this MD comes about later and is less severe. Death occurs usually in adulthood
Becker MD
90
specific lab for MD
elevated CPK (prescribe steroids)
91
most common type of cerebral palsy
spastic
92
MOTOR problem. Non-progressive and originated before or at or near birth. Ataxia, choreoathetosis, and can have seizures
cerebral palsy

Pediatrics (15 decks)

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