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Neurology Flashcards

1
Q

What is the leading cause of death in children older > 1 year

A

Head trauma

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2
Q

What are the four common reasons for head trauma in children?

A
  1. Falls
  2. Motor vehicle accidents
  3. Bicycle injuries
  4. Abuse
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3
Q

Which age is most susceptible to head trauma due to falls?

A

Toddlers

1-3 years

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4
Q
  1. Which age is most susceptible to head trauma due to abuse?
  2. What are potential signs?
A
  1. Infants
  2. Hematoma and/or fracture

Birth to 1

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5
Q

What two underdevelopment puts children at risk for acceleration-deceleration injury?

A
  1. cervical musculoligamentous*
  2. Skull

immature neck muscles

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6
Q

What two injuries do acceleration-deceleration injury cause?

A
  1. Shearing of blood vessels and nerves
  2. Bruising of brain
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7
Q

What is the most common primary head injury?

A

Concussion

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8
Q

What are the two hallmark symptoms of concussions?

A
  1. Amnesia
  2. Confusion
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9
Q
  1. Which tool is used to perform a quick assessment of concussions?
  2. If quick assessment is positive for concussion what would be next assessment?
A
  1. Pocket Concussion Recognition Tool
  2. Sports Concussion Assessment Tool
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10
Q

Define

Second impact syndrome

A

condition in which a second concussion occurs before a first concussion has properly healed

can cause rapid/severe brain swelling and death

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11
Q

What is the Return to Learn/Play plan?
When is it used?

A

Criterias to engage back in academic/sports settings following a concussion.

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12
Q

Define

Concussion

A

immediate/transient alteration in brain function* resulting from mechanical force or trauma

alteration of mental status and level of consciousness

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13
Q

Define

Contusion

A

Brusing or petechial hemorrhages that occur on the brain

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14
Q

Which can be seen with a CT or MRI scan?

Concussion or Contusion?

A

Contusion

Brusing shows on CT; Bleed shows on MRI

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15
Q

Which primary head injury is considered local? Which is considered broad?

Concussion vs. Contusion

A
  1. Contusion is a local injury
  2. Concussion is broad injury
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16
Q

What does the nurse suspect if a scalp hematoma is present in an infant?

or retinal hemorrhaging

A

Shaken baby syndrome

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17
Q

Which type of hemorrhage/hematoma occurs more commonly with skull fractures?

A

Subdural hemorrhage/hematoma

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18
Q

Which type of hemorrhage/hematoma do you suspect for the following symptom “brief period of unconsciousness; followed by lucid period; followed by rapid progression into unconsciousness”

Lucid = consciousness

A

Epidural hemorrhage/hematoma

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19
Q
  1. Which type of brain hemorrhage/hematoma is more dangerous?
  2. Why?
A
  1. Epidural hemorrhage/hematoma
  2. Rupture of menigeal artery in temporal lobe.

*Bleeding happens quickly due to artery, risk of aneurysm

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20
Q

Shaken baby syndrome can cause which type of hemorrhage/hematoma?

A

Subdural hemorrhage/hematoma

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21
Q

Which type of hemorrhage/hematoma effects veins?

A

Subdural hemorrhage (hematoma)

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22
Q

Which type of hemorrhage (hematoma) effects arteries?

A

Epidural hemorrhage (hematoma)

Remember where does it cause a rupture?

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23
Q

Where does bleeding occur for epidural hemorrhage (hematoma)?

A

Bleeding occurs between dura and skull.

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24
Q

Where does bleeding occur for subdural hemorrhage/hematoma?

A

Bleeding occurs between dura and brain.

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25
Which hemorrhage/hematoma can occur days or even weeks after initial injury?
**Subdural** hemorrhage/hematoma
26
What are the four reasons to go to the hospital for head trauma?
1. Loss of consciousness for more than a few mins 2. Seizures 3. Neurological signs 4. Vomiting more than 2x.
27
What are the first three things conducted on a diagnostic evaluation for head trauma?
1. Stablize spine 2. Circulation, Airway, Breathing (CAB) 3. Evaluate for shock* | S&S include: HR ↑, BP ↓, perfusion ↓ to extremities, changes in LOC.
28
What should you tell parents about monitoring a child post-head injury at home?
1. Check consciousness q2h. 2. Re-examine in 1-2 days by practitioner* | Risk of cerebral edema
29
# Signs and symptoms of what? 1. Headaches 2. Visual and balance problems (***dizziness***) 3. Nausea 4. Depression 5. Difficulty concentrating 6. Irritability 7. Changes in sleep patterns 8. New phobias 9. Changes in behavior
Postconcussion syndrome
30
What score should the nurse be concerned with on the Glasgow Coma Scale?
Score < 8 | Lower scores correlate w/ severity
31
What is a sign for neurosurgical emergency with head trauma?
Fixed and dilated pupils | Risk of herniation into brain stem
32
What is Cushing triad?
Late signs of increased intracranial pressure (ICP)
33
What are the three signs of Cushing triad?
1. Bradycardia (HR ↓) 2. Widened pulse pressure* 3. Irregular RR and rhythm | *↑ difference b/w systolic and diastolic pressure
34
What are the two tests for extraocular eye movements?
1. Doll's Head maneuver 2. Oculovestibular test
35
Which EOM is contraindicated if cerival spine injury is suspected?
Doll's Head maneuver
36
When is the Doll's Head maneuver **contraindicated**?
If you suspect cervical spine injury
37
What is the expected **normal** finding in the oculovestibular test?
Eye should move to the side of cold water.
38
When is the oculovestibular test **contraindicated**?
Infection of the ear or ruptured tympanic membranes
39
1. What can a fundoscopic exam diagnose with head trauma? 2. What can be seen with a fundoscopic exam?
1. Cerebral edema 2. Papilledema
40
Decorticate posturing (**flexion of upper extremities**) is associated with injury to which area?
Cerebral cortex | De**cort**icate = Cortex
41
Decerebrate posturing (**extension of arms and legs**) is associated with injury to which area?
Midbrain | sign of worsening neurological function
42
Sun setting eyes in **infants** is a sign of what? | can see a large amt of sclera w/ iris closer to bottom of eyelid
Increased cranial pressure
43
What is usually the first sign of papilledema?
venous engorgement
44
What three nursing actions are contraindicated for patients with ICP?
1. **DEEP** Suctioning and percussions 2. Rectal temps 3. Turning patient side to side (***avoid neck compression***) | *Risk of jugular compression
45
What is a positive finding of cerebral spinal fluid on test strips when assessing nose drainage?
glucose
46
Which medication would be indicated for cerebral edema?
Osmotic diuretic (Mannitol) | draws fluid from intracellular to extracellular fluid; remove thru urine
47
What medication is indicated for swelling that may occur from head injury?
**Corticosteroid** (*Dexamethasone*)
48
What is the manifestation of seizure determined by?
site of origin
49
What increases the risk for febrile seizures?
Family history of febrile seizures
50
* Which type of seizure is anticonvulsant (*antiepileptic*) not indicated for? * What is the exception to this rule?
* febrile seizures * family hx of febrile; can use anticonvulsant.
51
Which type of seizure is usually benign? | Most cases do not result in neurological damage or epilepsy
Febrile seizures
52
What is the requirement for diagnosis of epilepsy?
Two **unprovoked** seizures occuring 24 hours apart. | (*e.g., not R/T injury, infection, low blood sugar etc*)
53
Which children have increased risk for seizures?
Children diagnosed w/ Autism
54
What is the difference between partial and generalized seizures?
Partial occurs on side side of the brain; generalized affects both hemispheres.
55
Which partial seizure can develop into generalized seizures?
Complex partial
56
Which two types of infections commonly cause fever associated w/ febrile seizures?
1. Upper respiratory infection 2. Gastrointestinal infection | two types of infections that often cause high or rapid fevers
57
1. Which seizures do not cause of LOC? 2. Which ones may or may not cause cause LOC? | Loss of consciousness
1. Simple partial and Myoclonic 2. Atonic and Infantile spasms
58
Which seizure has the earliest possible onset of 3 months of age?
Infantile spasm
59
1. What does infantile spasms increase the risk of developing? 2. What factors are associated with that development?
1. Lennox-Gastaut Syndrome 2. Intellectual disability
60
# Describe **simple partial seizures** * Loss of consciousness? * Aura? * Describe manifestation
* No LOC * No Aura * Tonic-clonic movements on **contralateral** side and sensory signs
61
# Describe **complex partial seizures** * Loss of consciousness? * Aura? * Describe manifestation
* Impaired LOC * Aura present * Automatisms* | Repeated activities w/ or w/o purpose carried out in dreamy state
62
# What are the following medication treatments for 1. Viabatrin 2. ACTH | Adrenocorticotropic hormone
Infantile spasms
63
What must be monitored carefully with the medication Viabatrin?
Retinopathy (visual field loss) side effect
64
Which seizure can occur over 100x in one day?
Infantile spasms
65
Sudden dropping of head forward, trunk flexed forward, knees drawn up in a child under 1 is a sign of which seizure?
Infantile spasms
66
Why would you conduct lab tests, CT scans, and X-ray when presented with a child exhibiting seizure?
Assess for seizures that were provoked to occur
67
# Why would the following exams be conducted when concerned about seizures? 1. CBC 2. CMP 3. CT scan 4. X-Ray
1. R/O infection 2. R/O Electrolyte imbalance, hypoglycemia 3. R/O Tumors 4. R/O fractures caused by abuse | All the following can be the cause of seizures
68
When can you begin the withdrawl of anticonvulsants?
1. Normal EEG 2. No occurance of seizures for 3 years
69
What is the ketogenic diet entail for seizures?
Meals high in fat; low in carb and protein
70
1. Which seizures are VNS indicated for as treatment? 2. Why is it indicated for that seizure? 3. What is the appropriate age to begin?
1. complex partial seizures 2. Aura is present 3. Children ≥ 6 years.
71
What is a status epilpticus?
medical emergency for a seizure that lasts > 5 minutes
72
# Which seizure is described? Convulsive episodes w/ brief contraction of muscles or group of muscles.
myoclonic seizures
73
# which seizure is described? sudden or momentary loss of muscle tone
Atonic seizure
74
What risks are associated with atonic seizures?
Risk for falls | Head gear may be indicated
75
Which seizure has a higher prevalence in females?
Absence (petit mal) seizures
76
# Which seizure is described? * Brief loss of consciousness * Mistaken for day dreaming | No recollection of events
Absence (petit mal)
77
Which EOM test can be used for patients that are unconscious? | Checks CN III, VI, VIII and brain stem intact
Dolls Head (Eye) Maneuver
78
What is the **normal** finding w/ Dolls head maneuver?
Eye should move in **opposite** direction head is turned
79
When is surgery indicated for seizures?
repetitive incapacitating seizures that do not respond to other treatment modalities. | *seizure w/ a focal area at the brain stem contraindicated*
80
What additional medications are given w/ Phenobarbital for seizures?
1. Folic acid 2. Vitamin D
81
What three things are assessed with a Glasgow Coma Scale?
1. Eye opening 2. Verbal 3. Motor

Pediatrics (10 decks)

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