Neurology Flashcards
(163 cards)
1
Q
what is the best dx tool for neuro?
A
History
2
Q
where is LP done?
A
22 gauge needle at L3-L4 intervertebral space
3
Q
what is LP used for measuring?
A
Opening pressure, cell count (red and white), glucose, protein, culture, gram stain, PCR for viruses
4
Q
what does CT find?
A
bleeding and masses
5
Q
what does MRI show?
A
Myelination and demyelenation
Can see posterior fossa best
6
Q
what can US show?
A
Eval for hydro, hemorrhage, gross structures, calcification
7
Q
Routine neuroimaging is or is not indicated for children presenting with recurrent headaches unless
A
is there is an abnl neuro exam, coexistence of seizures or other red flags.
8
Q
when do you do CT or MRI for HA?
A
rarely necessary/appropriate
Concern about sub-arachnoid, subdural hematoma
Concern about increased IC pressure or hemorrhage
9
Q
when should you do labs for HA
A
if suspect infectious origin
CBC, blood cultures, lumbar puncture etc for meningitis
10
Q
what are 5 red flags of HA
A
- Headache fails to respond to therapy
- focal neurologic findings appear (in first 2-6 months)
- progressively increasing frequency / severity of headache, headache worse with valsalva
- headache awakens from sleep, worse in the morning, AM vomiting
- at-risk hx or condition: neurocutaneous disorder
11
Q
(brain tumor, hemorrhage, hydrocephalus, pseudotumor, meningitis,) may cause
A
increased ICP
12
Q
(intracerebral hemorrhage, vasculitis, or AVM) may cause
A
vascular HA
13
Q
(postictal or ictal) may cause what 2ndary HA?
A
epilepsy
14
Q
(sinusitis, dental abscess, trigeminal neuralgia, TMJ pain, carotid dissection) may cause what 2ndary HA
A
h and neck patho
15
Q
(HTN, DM, cardiac disease-source of emboli/stroke) may cause
A
2ndary HA
16
Q
what drugs may cause 2ndary HA
A
(analgesic overuse/rebound, drug abuse-cocaine, psychostimulants, OCPs, steroids)
17
Q
what psych do may cause 2ndary HA?
A
depression
18
Q
HA that is Severe, pulsatile (pounding)
unilateral, can be bilateral
Frontal or temporal regions, retro orbital or cheek
A
Migraine
19
Q
May be only symptom in younger children (cyclic vomiting)
Vomiting may herald the end of the headache
A
Migraine
20
Q
Assoc symptoms
N/V photophobia, phonophobia, vertigo, fatigue, mood alteration
Vomiting
A
Migraine
21
Q
children have what kind of aura for HA
A
visual
22
Q
when are studies warranted for migraines?
A
focal neurologic signs
HA worse on awakening , or awakens pt , or with a cough or bending over.
23
Q
how do you treat migraines
A
Ibuprofen or acetaminophen early in the attack
Caffiene, caffiene+ergot
Triptans (sumatriptan, rizatriptan, etc.) and DHE (dihydroergotamine)
Rest and quiet
Avoid narcotics
24
Q
how do prevent migraines?
A
Tricyclic antidepressants
Beta Blockers ie propranolol
Calcium channel blockers, such as verapamil
25
how do you dx a migraine?
Hx
26
what are TTH brought on by?
Brought on by fatigue, exertion, stress
27
which of the following is not for migraines?
narcotic - morphine
28
what is Pain described as
Constant, aching, tight
Occipital, frontal or constricting band around head
May occur simultaneously with vascular headache
TTH
29
how do you treat TTH?
Relieved by rest, analgesics
30
who gets cluster HA
Predominantly male
| Unusual in children under 10
31
what is HA that is Unilateral, severe pain
Periorbital or retro-orbital
May have ipsilateral autonomic dysfunction (flushing, tearing, sweating, nasal congestion)
Patient can’t sit still due to the pain
Cluster HA
32
how long does cluster HA last
Lasts minutes to hours – typical 30 min to 2 hrs
33
t or f cluster ha Occur in clusters, often seasonal
T
34
how do you treat cluster HA?
O2 - 100%
35
A sudden, transient disturbance of brain function manifested by involuntary motor, sensory, autonomic, or psychic phenomena.
seizure
36
2 or more seizures not provoked by particular event or cause.
epilepsy
37
sz can be d/t
Metabolic, truamatic, anoxic, infectious insult to brain
38
a benign condition of childhood with unilateral focal seizures and speech abnormalities, often hereditary.
rolandic epilepsy
39
sz that is in first 28 days (typically first few days)
Benign familial ( outgrow )
Secondary may progress ( HIE,Infex, IVH, thrombus)
neonatal sz
40
sz in 6 mo – 6 yrs, w no evidence of intracranial infection or defined cause
febrile
41
what is status epilepticus
Seizure > 30 min
| Sequential seizures without regain LOC > 30min
42
do children out grow sz?
70-80% do
43
what are partial sz types
```
simple partia (focal)
Complex partial (psycho-motor)
Benign rolandic epilepsy
```
44
what are generalized sz types
```
Absence (petit mal)
Generalized tonic clonic (grand mal)
Tonic
Clonic
Atonic
```
45
what sz are unique to kids?
Infantile spasms (West syndrome)
Febrile seizures
Juvenile myoclonic
46
what is simple partial sz
No LOC
47
what is complex partial sz?
LOC (staring) – altered consciousness
48
what is 2ndarily gen sz?
: a simple or complex partial seizure that ends in a generalized convulsion
49
what is a partial sz?
Onset of seizure begins in one area of one cerebral hemisphere (apparent clinically or via the EEG)
50
can eeg tell us if someone has epilepsy?
No -
51
what is a generalized sz?
Seizures arise from both hemispheres, simultaneously
52
what szs are Frequently associated with underlying structural brain disease and
Difficult to treat and classify
Myoclonic,Tonic, Atonic and Atypical absence
53
symptoms of Stare Eyes fluttering Automatisms (such as lip smacking, picking at clothes, fumbling) if prolonged
Absence (petit mal)
54
what has symptoms of A cry Fall Tonicity (rigidity) Clonicity (jerking) May have cyanosis
Generalized tonic-clonic (Grand mal)
55
what has post-ictal of Amnesia for seizure events No confusion Promptly resumes activity
absence
56
what has post-ictal of Amnesia for seizure events Confusion Deep sleep
tonic-clonic
57
what is are infantile spasms? (west syndrome?
Clinical Spasms ( 1-2 seconds)
Mistaken for colic, reflux, startle
Occur in clusters when drowsy
58
what could cause infantile spasm? and out comes of both?
-Brain insult at birth, malformation ,Tuberous Sclerosis, metabolic origin
Hard to control
Poor neurocognitive outcome
Cryptogenic = no identifyable cause.
Best outcome
59
Seizure description:
-When awake:
twitching and/or tingling on one side of body
speech arrest, speech difficulty, may drool / gag
no loss of consciousness, usually
Benign Rolandic EpilepsyBenign Focal Epilepsy of Childhood
60
what is the IQ of someone with rolandic epi?
normal
61
what is the Fhx of someone with rolandic epi
positive for
62
who gets rolandic epilepsy?
Boys>girls
63
when do you treat rolandic epi?
frequent (which is unusual)
Socially stigmatizing if occur in wakefulness
Anxiety provoking for parents if occur in sleep
64
what is status epilepticus?
30 minutes or more of continuous seizures or recurrent seizures without regaining consciousness
Medical emergency
Prolonged seizure may cause structural damage, hypoxia, hypotension, death
65
who is status epi common Most common in?
children under 5 (85%) , especially < 12 mo
66
how do you treat status epi?
ABCs, then IV anticonvulsants (Valium)
67
what are most common causes of status epi?
Infection and metabolic disorders are most common causes in children.
68
how do you work up sz?
EEG CT or MRI
EEG
Every case of suspected seizure disorder (but not necessary for febrile seizures)
Abnormal in 60-80%
Blood tests
Generally not helpful
Only if specifically suggested by presentation, history
CT scan or MRI
Generalized - Abnormal exam or difficult to control
Focal – Not for benign Rolandic epilepsy, but all others
69
what specimens should be collected for Sz eval?
```
-CBC
WBC > 20k may suggest bacterial infection
Left shift often seen due to adrenocortical surge
-Blood cultures , Urine C+S ,
-Lumbar puncture
Some under age 2(younger the child, the more important)
Any suggestion of meningitis
-Electrolytes
Na,K,Cl,HCO3,BUN,Cr,Ca,Phos,Mag
Glucose
-Neonates – consider metabolic
Lactate, Amonia, Urine ketones
```
70
who should get labs for sz?
Neonatal,abnormal mental status persistent, diabetics, renal disease, diuretic use, Dehydration, malnourishment
71
what is EEG most used for?
-->Most useful for classifying types and guiding therapy
Absence (petit mal), psychomotor (temporal lobe),
generalized tonic clonic (grand mal)
Infantile spasms
Mixed seizure disorders
-->Useful in evaluating worsening seizures or projecting recurrence of seizures if medicines were to be stopped
72
how do you treat febrile sz
diazepam, phenobarbital, valproic acid
73
how do you tx neonate sx
phenobarbital
74
do you tx febrile sz
no - if you have to for continual sz - diazepam
75
is a febrile sz epilepsy?
NO
76
if a child presents with complex febrile sz
more likely will have epilepsy but as a whole does not progress they just have the increased risk
77
lots of things that mimic seizure
Apnea / ALTE
GER
Sleep disorders (nocturnal myoclonus, night terrors, narcolepsy/cataplexy)
Migraine variants (esp. aura)
Benign breathholding spells
Syncope
Movement Disorders (tics, tremor, dystonia)
Pseudoseizures (psychogenic seizures)
-Strange posturing, back arching, writhing
-Alternating L and R limb shaking during same
seizure
-Psychosocial stressor
78
what are the 3 common features of breath-holding spells?
-Involuntary:
Children < 4 can’t voluntarily hold breath
Most start before 18 mo
Resolve usually by 4, definitely by 8
-Brief loss of consciousness
-May have “seizure” activity while unconscious
79
what are cyanotic spells precipitated by?
anger frustration and fear
80
how does cyanotic spells occur?
Cries, stops breathing in expiration, becomes cyanotic
81
what sz has symptoms of No loss of consciousness. Sudden jerking sensory phenomena
simple partial
82
what sz symptoms of May have aura Automatisms (such as lip smacking, picking at clothes, fumbling) Unaware of environment May wander
complex partial
83
what sz has postictal of transient weakness or loss of sensation
simple partial
84
what sz has a postictal of Amnesia for seizure events Mild to moderate confusion, sleepiness
complex partial
85
what HA often has symptoms of depression and/or anxiety. Secondary gain is common (e.g., school avoidance)
chronic tension
86
what HA has pain Bilateral and diffuse
Dull and aching
Often present upon awakening
Not associated with nausea, vomiting, neurologic problems
chronic tension
87
how do you tx chronic tension HA?
Treatment is difficult but antidepressants seem helpful
88
what may work up include for chronic tension HA
a CT scan or MRI
89
syncope has prodrome T or F?
May have prodrome
| Dissiness, lightheadedness, nausea, sweating, pallor
90
what is Transient LOC and postural tone due to cerebral ischemia or anoxia.
syncope
91
syncope absolutely does not have jerking motions when unconscious, T or F
F
92
what is link in syncope
Family history + in 90% of patients
93
what syncope is Neurally mediated
Transient hypotension from vasodilation and/or decreased heart rate
Arousal 1-2 min up to 1h
Vaso-vagal or neurocardiogenic
94
what is the most common syncope type
Vaso-vagal or neurocardiogenic
95
what syncope has CP and palpitations with it? and occurs during exercise?
cardiac
96
how do you work up syncope?
Vitals , BP, Hgb, EKG
97
how do you treat syncope?
Direct management of any cardiac cause
| Reassurance and avoidance of triggers for vaso-vagal stimulation
98
what may cause inc ICP?
Cerebral edema
| Mass lesion
99
Infant with symptoms of
Bulging fontanelle
Increasing head circumference, separating sutures
Lethary, vomiting, FTT, “setting-sun sign”
inc ICP
100
```
Children with symptoms of
Headaches
Diplopia/Strabismus
Papilledema
Herniation syndromes
```
increased ICP
101
what does setting sun sign go with?
hydrocephalus
102
where is HA from elevated ICP located?
Supratentorial – eye, forehead, temple
Infratentorial – occiput, neck
Generalized
103
when does the pain occur for elevated ICP
Worse in morning on awakening and standing up, or at night
Worsened by maneuvers that transiently increase ICP: Coughing, sneezing, straining
104
what occurs along with pain d/t inc ICP? describe pain?
Often also have vomiting without nausea
Constant and unremitting
105
what is assoc with Well person who suddenly experiences “worst headache in my life”
SAH
106
classic pt who is girl obese with HA, tinnitus, papilledema,visual loss normal MRI increased opening pressure
psuedotumor cerebri
107
what is Increased intracranial pressure without identifiable mass or hydrocephalus
pseudotumor cerebri
108
what is cause of pseudotumor cerebri?
unknown (dx of exclusion)
109
what are the most common causes of childhood stroke?
Cyanotic heart disease
Sickle cell anemia
Meningitis
Hypercoagulable states
110
what presents as hemiplegia, unilateral weakness, seizures.
childhood stroke
111
what hx do you want for childhood stroke?
Assess for history of infections, head/neck truma, familial clotting disorders, CHD
112
what studies should you do for childhood stroke?
CBC, ESR, Chemistries, BUN/Cr , clotting studies, CXR, EKG,Urine tox, UA ( CSF not usually helpful unless eval infection)
CT or MRI
113
how do you tx stroke?
No treatment to repair damage
Preventive management
Underlying disease , anticoagulants
114
What is the most common cause of concussion in children?
Fall
115
Brief loss of consciousness or stunned for minutes to hours No localizing neurologic signs
Amnesia is common and transient
concussion
116
what is the major diagnostic for concussion?
CT
117
All children with amnesia or who were unconcscious should be evaluated in ER t or f?
T
118
what is post concussive syndrome and when does it resolve
Many children complain of headache, dizziness, forgetfulness, inability to concentrate, slowing of response time, mood swings, irritability
Resolve spontaneously
Can take weeks to months
119
what are congenital malformations of neuro? 6
Meningomyelocele, encephalocele, Lissencephaly, pachygyria, absence of corpus callosum
120
what is MMC identified by and is d/t?
Often identified on US, likely have elevated alpha fetoprotein on prenatal screen.
Folate during pregnancy
121
what is displaced cerebellum through foramen magnum into spinal canal –
arnold chiari I
122
how do you treat arnold chiari i?
posterior laminectomy
123
what has sx of progressive ataxia or vertigo
arnold chiari I
124
what is displaced cerebellum plus meningomyelocele
arnold chiari II
125
which chiari has Varying degrees of paralysis depending on site/level of defect
hydroceph and sz
II
126
how do you treat AC II
surgical repair and shunt
127
what has low lying tonsils alone and asympt
chiari I
128
what has low lying tonsils + hydrocephalus and diffuse HA
chiari II
129
smooth brain
| Severe delay, seizures. Associated with syndromes
lissencephaly
130
Most common disorder of neuronal migration
lissenecephaly
131
what is Premature closure of sutures
Craniosynostosis
132
most common craniosynostosis?
saggital suture > coronal suture
133
what limits lateral growth and has Elongated (scaphoid) head
saggital suture craniosyn
134
```
what Limits AP growth
Short wide (brachycephalic) head
```
coronal suture craniosyn
135
does craniosyn affect brain
Doesn’t constrict brain unless many sutures involved (↓ head size)
136
how do you dx craniosyn
Diagnosed on basis of palpable, raised, fixed suture lines and/or changing shape of head Skull Xrays
137
how do you treat craniosyn?
Treatment is surgical excision of fused suture line – best done prior to 6 months of age
138
Impairment of coordination and balance of voluntary movement
ataxia
139
where is the problem in the brain with ataxia?
cerebellar problem
140
what is the most common cause of ataxia?
post infectious or drug intox
141
what are other causes of ataxia?
Brain lesions or tumors
Infection (CNS ; encphalitis, meningitis)
Hereditary Ataxic (Friedreich Ataxia )
Metabolic
142
what illness may cause ataxia?
usually viral (varicella, mono, URI, GI )
143
what has symptoms of Sudden onset of ataxia,staggering, frequent falls
Nystagmus, vomiting, irritaility, lethargy possible
Sensory and reflexes preserved
No evidence increased ICP
post infectious acute cerebellar ataxia
144
what is the prognosis of post infectious cerebellar ataxia
– 90% of children with acute cerebellar ataxia have complete recovery in 1-4 weeks
145
disease at the Anterior Horn Cells
SMA – spinal muscular atrophy
146
nerve NM d/o?
Guillian Barre – post viral autoimmune
147
NMJ NM d/o?
Myasthenia Gravis
148
neouromuscular d/o at the muscle
Muscular dystrophy
| Myotonic dystrophy
149
progressive weakness and wasting of skeletal muscles Normal mental, language and social skills
Eventual respiratory failure and death
anterior horn cell spinal musc atrophy (AR)
150
muscle weakness, which may manifest with floppiness, delayed motor milestones, unsteady gait or muscle fatiguability you should think...
NM d/o
151
Acute post-infectious polyneuropathy
| often follows URI / GI infection (autoimmune)
GB syndrome
152
ascending symmetrical weakness; starts as numbess or tingling in hand / feet… heavy feeling in legs
bulbar palsy and respiratory depression
Autonomic dysfunction –hyper/hypotension , tachycardia
GB syndrome
153
>10 years old, ophthalmoplegia and ptosis, loss of facial expression and difficulty chewing
Juvenile myasthenia
154
presents later in life, less severe
| Death usually in adulthood
Becker Muscular Dystrophy
155
```
X-Linked recessive
Onset at 2-6 yrs
Proximal muscles affected before distal
Waddling gait, difficulty with stairs
pseudohypertrophic calf
```
duchenne MD
156
what has +Gower Sign (pelvic weakness)
| Elevated CPK , Rx Steroids
DMD
157
in MD weakness starts...
proximal and goes distal
158
when does death occur in duchenne
DMD
159
what is the most common CP
spastic - Monoplegia, paraplegia, hemiplegia, quadraplegia,
160
what is Muscular – motor problem,
| Non-progressive and originated before or at or near birth
CP
161
what is an Autosomal Dominant
| with Café au lait spots - >6 of 5mm prepubertal pt
NF
162
AD, rare , characterized by benign tumors in vital organs such as the brain, eyes, kidneys, heart and skin.
tuber-like growths in the brain which calcify with age and become hard, or sclerotic.
tuberous sclerosis
163
-Unilateral port wine stain over upper face
Follows cranial nerve V
-Intracranial leptomeningeal vascular anomaly and calcifications
-Buphthalmos with enlarged globe, corneal clouding
-Mental Retardation
Embryonal developmental anomaly
sturge weber
