Neurology Flashcards
(107 cards)
0
Q
Craniosynostosis - dx?
A
1) head measurement
2) CT/xray
1
Q
What is craniosynostosis?
A
premature fusion of the suture
restricts the brain from growing
2
Q
Craniosynostosis - tx?
A
neurosurgery
3
Q
Craniosynostosis - most common?
A
scaphocephaly (egg shape)
4
Q
What can cause microcephaly?
A
mom:
- TORCH
- FAS
- drugs
5
Q
What type of macrocephaly?
A
hydrocephalus (too much CSF)
6
Q
Macrocephaly- cx?
A
TORCH (toxo)
aquaductal stenosis
7
Q
Congenital hydrocephalus - sx adults?
A
cushing’s triad - increased ICP
- bradycardia
- hypertension
- irregular breathing pattern
8
Q
Congenital hydrocephalus - sx infants?
A
triad:
- increased head circumference
- widening of sutures
- bulging fontanels
9
Q
ICP in infants?
A
vomiting
jerky movements
sun-setting eyes (eyes cannot move up)
10
Q
Hydrocephalus - tx?
A
VP shunt
11
Q
Neural tube defects conditions?
A
anencephaly
encephalocele
spina bifida
12
Q
Neural tube defect - anencephaly?
A
failure of tube closure
bad news bears
13
Q
Neural tube defects - encephalocele?
A
protusion of meninges
surgical repair but longterm consequences
14
Q
Neural tube defects - spina bifida type?
A
spina bifida cystic
15
Q
Meningocele?
A
protusion of the dural sac
16
Q
Types of spina cystica?
A
meningocele
mylelomeningocele
17
Q
Spina bifida occulta?
A
NO obvious physical features
ONLY problematic if chord attaches to the defect
18
Q
Mylelomeningocele?
A
protrusion of NEURAL elements
lack of sensation and motor
signs of kyphosis/scoliosis
impairment of bladder of bowel fxn
19
Q
Spinal dysraphism - sx newborns?
A
hairy patch
20
Q
Spinal dysraphism?
A
complication of spina bifida occulta - has tethered chord
21
Q
Spinal dysraphism - infants and older childern sx?
A
sciolosis
bladder changes
22
Q
Dysraphism- dx?
A
gold standard: MRI scan
US: <2-3 mo
23
Q
Spinal dysraphism-tx?
A
neuro surgery
24
What are the different categories of cerebral palsy?
spastic
non spastic
limbs: one, two, three, four
25
Cerebral palsy?
insult of the CNS system
26
Cerebral palsy - sx?
spasticity
seizures
EXAGGERATED PRIMITIVE REFLEXES for more than 1yr
27
Cerebral palsy - dx?
CT
28
Cerebral palsy - tx?
symptomatic care
- benzo: spasticity
- bracing/ortho
29
Cerebral palsy - complication?
scoliosis
| contractures
30
What are the 3 phases of seizures?
pre-seizure
seizure
post ictal
31
Seizure - tx and ADRS?
carbamazepine: SJS, neutropenia, aplastic anemia
phenytoin: gingival hyperplasia, neuropathy
lamotrigine: SJS, hepatoxicity
32
What is sandifer syndrome?
DDx for seizures
| tiny human GERD
33
Sandifer syndrome-sx?
spit up
arching of back
cyanosis
34
Sandifer syndrome-dx?
pH probe testing
35
Spells -age?
common in 15mo-36 mo
36
Spells?
seizure DDx
child holds breathe when not getting their way
able to "reproduce" when this happened - unlike seizures
37
Spells -types?
cyanotic
| pallid
38
Tics?
DDx for seizures
| isolated muscle group (face, neck)
39
Nonepileptic myoclonus?
hiccups
hypnic jerks
nocturnal myoclonus
DDx for seizures
40
Absence seizure -sx?
staring off into space
| no more than 30 sec --> no post ictal phase
41
Absence seizure - dx?
EEG: 2.5-3
42
Absence seizures - tx and ADR?
Ethosuximide: JS, leukopenia, panctypenia
| valporic acid
43
Can febrile seizures turn into epilepsy?
NO
44
Febrile seizures - criteria?
```
fever 100.4F
less than 15 min
6mo-6yrs (peak at 2yrs)
no hx of seizures
no family hx of seizures
no signs of CNS infxn
does not reoccur in 24 hrs
```
45
When do you LP febrile seizure?
<12 mo with NO immunization
12-18mo
signs and sx of meningeal
hx of 2wks of abx
46
Febrile seizure- tx?
supportive and reassurance
| +/- tylenol (no proven studies)
47
Meningitis - sx adults?
triad:
- fevers
- rigidity
- changes in mentation
48
Meningitis - infants-sx?
bulging fontanelle
decreased activities
not eating
pallor
49
<3mo baby has fever for 48hrs?
ER
50
<30days old + fever - labs?
```
UA
CXR
BC
LP
CBC
```
51
Meningitis - bug?
viral> bacterial
52
Meningitis - bacterial bug?
s. pneumoniae
h influenza
n. meningitis
53
What is important to know about the bacterial meningitis?
vaccines are available
| bugs are from mom's vaginal during delivery
54
Meningitis - bug <1mo?
Group B strep
55
Meningitis - bug 1-23mo?
strep pneumoniae
56
Meningitis - bug 2-18yo?
N meningitis d/t being in school, dorms
57
Meningitis - bug 19-60yo?
strep pneumoniae
58
Meningitis - labs?
```
CBC w/ diff
BC
PT/INR d/t petechiae
glucose
lytes
UA + cultures
LP w/ gram stain and cell counts
```
59
What is in LP fluid analysis?
```
glucose
protein
CBC
opening pressure
CSF to serum glucose ratio
```
60
Meningitis tx?
1) cover all gram pos --> VANCOMYCIN/AMPICILLIN (babies)
2) adjust management after results
3) manage complications: sepsis, DIC, seizures
longterm: hearing impairment, speech, cognitive delays
61
Muscular dystrophy -types?
Duchenne muscular dystrophy
| Becker muscular dystrophy
62
What is muscular dystrophy?
hereditary
non inflammation
progressive weakness
degeneration of muscles
63
What is Duchenne muscular dystrophy?
X linked
| males
64
What causes death in Duchenne muscular dystrophy?
diaphragm dies out b/c no longer able to breath
wheel chair bound at 6-10yrs
bad news bears
65
Duchenne muscular dystrophy - PE?
inability to walk/regression
Gower sign
big calves d/t unstable hips
66
Duchenne muscular dystrophy-labs?
CK
| muscle bx - GOLD STANDARD
67
Duchenne muscular dystrophy - tx?
prednisone
| supportive
68
Becker muscular dystrophy?
not as bad- can live up to adult hood
69
Boy that is not able to walk by 18mo - labs?
CK
70
Neurocutaneous syndrome - types?
Neurofibromatosis I and II
Sturge weber syndrome
Tuberous sclerosis
71
What is neurocutaneous syndrome?
congenital
| inherited
72
NF1-sx?
short
MACROCEPHALY
bowing of long legs
learning difficulties
73
NF1 - imaging?
MRI brain
74
Child has cafe au lait spots?
look for:
1) axillary freckling
2) MRI
3) opthalamologist - lisch nodules
4) surgery for myelin sheath
75
NF 1 - tx?
- opthalamologic eval if vision is affected
| - genetic counseling
76
NF 1- prognosis?
until late 50s
77
NF 2 -tx?
surgery
chemo
auditory brainstem implant
78
NF 2 criteria?
bilateral vestibular schwannomas/acoustic neuroma
OR
family hx of NF 2 + unilateral acoustic neuroma + 2 of meningioma, glioma, schwannaoma
79
Baby has birth mark?
look for more
80
Baby has lisch nodules?
NF 1 until proven otherwise
81
Acoustic neuroma?
NF2
82
NF 1 and NF 2-cx?
autosomal dominant
83
What is sturge weber syndrome?
port-wine stain w/ ophthalmic division of trigeminal nerve
84
Sturge weber sx-sx?
intracranial calfication
| glaucoma
85
Sturge weber syndrome - imaging?
CT scan
86
Sturge weber sx - tx?
seizures - antiepileptic, surgery
glacoma - beta blocker drops, ophthalomologic surgery
HA - ASA
87
Tuberous sclerosis-sx?
seizures
mental retardation
tumors: brain, heart, liver, kidneys
88
Tuberous scerosis - PE?
ash-leaf spots
shagreen patch
periungal fibromas
89
What is shagreen patch?
thickening of skin w/ orange peel texture
90
What is ash leaf spots?
hyperpigmented maules w/ irregular borders
91
Tuberous scleorsis - imaging?
CT/MRI - astrocytomas (predisposes seizures)
92
Tuberous sclerosis -tx?
antiepliptic meds
| supportive
93
Questions to ask for TBI?
battle signs?
visual changes?
unexplained vomiting?
bleeding/discharge from nose? (leaking of cribiform)
94
When do you scan TBI?
```
GCS1 min
open skull fx
battle sign
visual changes
amnesia
high impact
```
95
When do you scan <2yo?
```
fall is from 3+ft
scalp hematoma
unwitnessed fall
vomiting
LOC > 30sec
behavioral changes
```
96
Concussion-cx?
usually d/t coup/countercoup
97
Concussion - sx?
13
| normal CT
98
Concussion dx criteria-somatic?
- HA
- N&V
- dizziness
- visual probs
99
Concussion dx criteria- affective?
irritability
| sadness
100
Concussion diagnostic criteria-cognitive?
foggy
cannot concentrate
cannot remember
confused
101
Concussion diagnostic criteria-sleep?
drowsiness
| sleeping more/less
102
When to scan concussion?
ANY 1 FOR CONCUSSION Dx CRITERIA - SOMATIC, AFFECTIVE, SLEEP, COGNITIVE
103
Short and dirty of when to scan concussion?
```
seizures
cannot awake
vomiting
confusion
unusual behavioral change
irritability
LOC > 30sec
```
104
Concussion tx?
```
REST: BOTH PHYSICAL AND COGNITIVE
-no hmwk
-no texting/comp
-no bright lights
no same day play
observe 24-48hrs
```
105
When to refer concussion?
sx after 14 days
many RF
severe injury
106
What are the steps for concussion tx?
```
step 0 - NOTHING but rest
step 1- light aerobic
step 2- mod exercise
step 3- non contact exercise
step 4 - prac
step 5 - play
DO NOT CONTINUE IF NOT SX FREE FOR 24HRS
```
