Neurology Flashcards
1
Q
What cause of encephalitis typically occurs in warm climates and is carried by insects (mosquitoes)?
A
Arboviruses
2
Q
What are St. Louis and West Nile Virus examples of?
A
Arboviruses
3
Q
What type of virus causing encephalitis presents with generalized neurological findings and are transmitted from human to human?
A
Enteroviruses
4
Q
What should you think of when you have non-specific findings preceding confusing and irritability in encephalitis?
A
Enterovirus
5
Q
How does herpes encephalitis present?
A
Non-specific findings without a history of oral lesions
6
Q
How is herpes encephalitis best diagnosed?
A
DNA PCR
7
Q
What type of encephalitis presents with or after parotitis?
A
Mumps encephalitis
8
Q
What season does mumps encephalitis present?
A
Late winter or early spring
9
Q
What will be hints that should make you think of mumps encephalitis
A
Child/Teenager who is from another country or isn’t immunized
10
Q
Febrile toddle who is lethargic one hour after seizure. CBC normal, LP with negative gram stain and moderate WBCs- thinking viral meningitis, treatment choices?
A
Acyclovir to cover for possible HSV encephalitis (could also pick IV antibiotics to cover for bacterial meningitis)
11
Q
Teenager with a frontal headache or band-like pressure sensation?
A
Stress/Tension/Emotion headache
12
Q
What is treatment for a tension headache?
A
Eliminate the stressor
13
Q
For a headache, when are complicated studies usually not indicated?
A
If they describe a headache in the absence of a history of trauma and with no evidence of increased ICP
14
Q
What should you think of with a headache, malaise, excessive sleeping, and/or declining school performance?
A
Depression
15
Q
What type of headaches are episodic, with no symptoms between episodes?
A
Migraines
16
Q
Severe headache in any location, child stops activities and wants to lay down, photophobia, phonophobia, nausea, vomiting?
A
Migraine
17
Q
True or False: More concerning neurological signs such as hemiparesis and/or temporary visual deficits may be seen in certain migraines?
A
True
18
Q
True or False: All migraines have to have an aura?
A
False- they will likely not describe an aura for migraine
19
Q
Name some treatment options for migraine
A
- Ibuprofen
- Acetaminophen
- Fluids
- Rest
- Ergotamines
- Oral or intranasal sumatriptan (Imitrex)
20
Q
When do you use narcotics for migraine pain?
A
Never
21
Q
What are the 2 categories for treatment of migraines?
A
Abortive and prophylactic therapy
22
Q
What are the 2 most commonly used medications for migraine prevention?
A
- Cyproheptadine
2. Topiramate
23
Q
What psychiatric problem can trigger migraine?
A
Depression
24
Q
Headaches due to depression alone are described as…?
A
Chronic daily headaches without other signs associated with migraines
25
Name 5 lifestyle modifications that should be encouraged for headache prevention.
1. Regular exercise and activities
2. Regular sleep patterns
3. Regular eating patterns avoiding trigger foods such as cheese and chocolate
4. Good hydration
5. Avoid medication overuse
26
True or False: The most important recommendation for prevention of recurrent headaches is medication?
False- Lifestyle modifications
27
Minor head injury a few months ago, now presents with daily headaches not improved with acetaminophen, ibuprofen, or naproxen, pain is frontotemporal... Most appropriate next step in managing the patient?
Stop all medications- meds being used chronically lead to blunted effect
-No head CT as trauma was minor and headaches didn't start right after. Not migraines either because they are daily, not episodic
28
Name 5 clues to increased ICP
1. Visual disturbances
2. Worsening headaches
3. Abnormal eye movements
4. Deteriorating school performance
5. Ataxia
29
What should blurred vision occurring only before a headache make you think?
Migraine (v. increased ICP)
30
Name 3 red flags for headaches due to space-occupying lesions
1. Headaches worse in the morning
2. Vomiting with no nausea
3. Headaches relieved by vomiting
31
When is an LP contraindicated?
If there are symptoms of increased ICP
32
If you suspect increased ICP, what is the diagnostic test of choice?
CT with contrast urgently (MRI later when stable)
33
What is increased ICP of unknown etiology?
Pseudotumor cerebri
34
Why is pseudotumor cerebri considered to be benign?
Herniation doesn't occur
35
What can happen if pseudotumor cerebri isn't treated?
Lead to papilledema and eventual optic disc atrophy and blindness
36
What presents with double vision, papilledema, and evidence of increased ICP (headache/tinnitus)?
Pseudotumor cerebri
37
What causes double vision in pseudotumor cererbri?
6th nerve palsy
38
What makes the headache worse in pseudotumor cerebri?
Laying flat and/or with Valsalva maneuvers
39
What is a common cause of pseudotumor cerebri?
Megadose vitamin intake (particularly Vitamin A- including Retin A)
40
Name the clinical signs for increased intracranial pressure in infants
1. Irritability
2. Decreased PO intake
3. Failure to thrive
4. Macrocephaly with wide sutures
5. Bulging fontanel
6. Setting sun sign
41
What is the setting sun sign and what is it associated with?
Downward deviation of the eyes with hydrocephalus
42
Name clinical signs of increased intracranial pressure in children
1. HTN
2. Papilledema
3. Bradycardia
4. Abducens paresis (6th nerve palsy- double vision)
43
If you are presented with any findings suggestive of increased ICP, what is indicated?
Brain imaging studies
44
What must be done before an LP if you suspect increased ICP?
Head CT
45
Name contraindications to performing an LP
1. Evidence of increased ICP
2. Focal neurological signs
3. History of coagulopathy
4. Cardio-respiratory instability (ABCs before LP)
46
Name medications that may cause pseudotumor cerebri
1. Steroids
2. Thyroxine
3. Lithium
4. Some antibiotics
5. Vitmain A (Retin-A)
47
How can pseudotumor cerebri be treated?
With carbonic anhydrase inhibitors (acetazolamide)
48
In severe cases of pseudotumor cerebri where acetazolamide doesn't work, what can be used for treatment?
Steroids and possibly surgery to shunt CSF
*Steroids can be cause and treatment of pseudotumor cerebri*
49
What is Cushing's Triad?
1. Hypertension
2. Bradycardia
3. Abnormal respirations
50
What does Cushing's Triad indicate?
Late findings of increased ICP and usually indicate impending herniation
51
What is hydrocephalus?
Accumulation of excessive amounts of CSF in the brain
52
What is hydrocephalus usually associated with?
Increased ICP
53
What is the major risk factor for hydrocephalus?
Neural tube defect from Chiari malformation or myelomeningocele
54
Besides neural tube defects, what are other instances where hydrocephalus can be seen?
Brain malformations, congenital infections, intracranial bleeds, space-occupying lesions blocking CSF flow
55
How do infants present with hydrocephalus?
Rapid head growth (no fused sutures yet)
56
How do children present with hydrocephalus?
Headaches, papilledema, cranial nerve palsies (especially impairment of upward gaze- sundowning sign)
*Once sutures are fused*
57
When do most shunt infections occur?
In the first 6 months after shunt placement
58
When should you suspect a shunt infection?
In any patient with a shunt who presents with symptoms of hydrocephalus and persistent fever
59
What is done to treat a shunt infection?
IV antibiotics
| Remove infected shunt
60
How do shunt malfunctions present?
Symptoms of increased ICP, but no fever
61
Upper respiratory findings consistent with chronic sinusitis, severe unilateral headache with vomiting that doesn't improve with analgesics, focal neurologic deficits, papilledema, seizures?
Brain abscess
62
True or False: Fever is always seen in brain abscess?
False- not a common symptoms
63
What 3 groups are at increased risk for developing a brain abscess?
Patients with pulmonary, sinus, and cyanotic heart disease
64
What is the classic description for a brain abscess on CT?
Ring enhancing lesion
65
What are initial antibiotics of choice for a brain abscess?
Directed at organisms expected base on source of infection: Ceftazidime/cefepime, nafcillin/vancomycin, metronidazole, ceftriaxone
*Should be adjusted based on cultures obtained via CT-guided aspiration or surgical excision
66
What is the first thing to note in a patient with altered state of consciousness?
AGE
67
Besides sepsis workup, what else should you consider ordering for a non-responsive neoante?
Serum ammonia and organic acid levels
68
What should you think of with a cranial bruit in a neonate with hydrocephalus and history of CHF?
Vein of Galen malformation
69
In older kids, what is an important diagnosis for altered state of consciousness?
Encephalopathy
70
Child with altered state of consciousness, symptoms progressed over several hours, family member with condition that requires meds (depression/seizures/heart disease)?
Toxic ingestion
71
Abrupt onset of altered state of consciousness?
Consider head trauma
72
Abrupt onset of altered state of consciousness, no history of head trauma... initial study?
CT head- Trauma may have been unwitnessed
73
How do younger patients with Wilson's disease usually present?
Symptoms of liver disease
74
How do older patients with Wilson's disease usually present?
Neuro/psych symptoms
75
Name common neurological symptoms in Wilson's disease.
1. Tremors
2. Emotional problems
3. Difficulty with handwriting
4. Depression
5. Abnormal eye movements
76
Evidence of acute hepatic failure coupled with dystonia and mental status changes?
Wilsons
77
In a patient with suspected Wilson's disease who has neurological or psychiatric symptoms, what are you likely to find on exam?
Kaiser-Fleischer ring (greenish-yellow rings seen at edge of cornea best seen on slit-lamp exam)
78
Severe daytime sleepiness and sudden "sleep attacks"?
Narcolepsy
79
Name 3 manifestations of narcolepsy
1. Cataplexy
2. Sleep paralysis
3. Hypnagogic hallucinations (almost asleep)
80
What is cataplexy?
Sudden drops precipitated by sudden emotions like laughter
81
When does onset of narcolepsy typically occur?
Adolescence
82
How is narcolepsy diagnosed?
Overnight polysomnography and sleep latency test
83
Who should you refer patients with suspected narcolepsy to?
Sleep specialist
84
True or False: Patients with narcolepsy often have academic problems?
True
85
What is the most likely cause for acute onset ataxia?
Post-viral (varicella, EBV, mumps)
86
True or False: The prognosis of acute cerebellar ataxia after infections or vaccinations is generally excellent?
True
87
Name 5 causes of acute ataxia.
1. Toxic ingestion
2. Neoplasm
3. Trauma
4. Metabolic problems
5. Infections
88
How is ataxia telangiectasia inherited?
Autosomal recessive
89
What is the general problem in ataxia telangiectasi?
Defect in DNA processing and repair
90
What are capillary dilataions causing red blotches on the skin and conjunctiva?
Telangiectasias
91
What are 4 main things that ataxia telangiectasia effects?
1. CNS
2. Skin/Eyes
3. Immunologic sequelae
4. Intellectual disability (possibly)
92
What are the immunologic effects of ataxia telangiectasia?
Decreased levels of immunoglobulin and T-cell dysfunction
93
What are resulting symptoms from the immunologic effects of ataxia telangiectasia?
Frequent upper and lower respiratory tract infections
94
What happens once the ocular telangiectasia becomes advanced in ataxia telangiectasia?
- It can simulate conjunctivitis
| - Patients are unable to voluntarily make rapid eye movements
95
What 2 types of malignancy have a high incidence in ataxia telangiectasia?
1. Hodgkin lymphoma
| 2. Leukemia
96
What is the mneumonic to remember possible causes of ataxia?
TIN walk
- Toxic ingestion (ethanol or pesticides)
- Infection (Guillain Barre)
- Neoplasm (Glioma, Medulloblastoma)
*Other causes include cerebral hemorrhage and various metabolic disorders
97
What 3 types of medicines can cause ataxia?
1. Anticonvulsants
2. Alcohol
3. Thallium
98
What 5 meds can cause tremors?
1. Amphetamines
2. Valproic acid
3. Phenothiazines
4. Tricyclic antidepressants
5. Methylxanthines (caffeine and theophylline)
99
Pigmentation in the eye, decreased immunity, ataxia?
Ataxia telangiectasia
100
What happens to visual acuity and pupillary reflexes in ataxia telangiectasia?
They are often normal (despite other eye findings)
101
How is Friedreich ataxia inherited?
Autosomal recessive
102
What disorder accounts for about 1/2 of cases of inherited ataxia?
Friedreich Ataxia
103
When does Friedreich Ataxia typically present?
Late childhood or early adolescence
104
How does Friedreich Ataxia typically present in children?
Slow and clumsy gait
105
What two things cause the ataxia in Friedreich Ataxia?
1. Cerebellar component
| 2. Loss of proprioception
106
What problems might you see in Friedreich Ataxia that point to spinal cord or peripheral nerve problems?
1. Decreased strength in the feet
| 2. Decreased reflexes in the lower extremities
107
What are 3 clinical features that distinguish Friedreich ataxia from other forms of ataxia?
1. Elevated plantar arch
2. Absence of lower extremity deep tendon reflexes
3. Cardiomyopathy leading to CHF
108
Which presents first, Friedreich ataxia or ataxia telangiectasia?
Ataxia telangiectasia
109
What is the treatment for Friedreich ataxia?
Supportive
110
What are relatively rapid random repetitive purposeless movements?
Chorea
111
What are the 2 main types of chorea?
1. Sydenham
| 2. Huntington
112
What part of the brain is most often affected in movement disorders?
Basal Ganglia
113
What type of chorea is one of the major Jones criteria of rheumatic fever?
Syndenham
114
True or False: Normal ASO antibody titers rules out Sydenham chorea?
False
115
How is Huntington disease inherited?
Autosomal dominant
116
What is the triad for Huntington disease?
1. Chorea
2. Hypotonia
3. Emotional lability
117
When do symptoms of Huntington disease usually present?
Adulthood (after 35)
118
What % of patients can have juvenile Huntington chorea?
10%
119
How does juvenile Huntington chorea typically present?
Rigidity
120
What category of drugs are used as treatment for chorea?
Dopamine-blocking agents in the antipsychotic category
121
Which specific drug is effective for chorea?
Haloperidol
122
Which type of chorea is essentially self-limited?
Sydenham (but low does haloperidol can be used)
123
Besides haloperidol, what 3 medications could be considered for chorea?
1. Fluphenazine
2. Risperidone
3. Tetrabenazine
124
2 year old, fixed upward gaze, alert and appropriately frightened, airway patent, vital signs stable, toxic ingestion is a possibility... Which pharmacological treatment until ingestion can be confirmed?
Diphenhydramine- The upward gaze is a dystonic reaction (probably due to ingestion of promethazine or a related drug)
125
What types of movements characterize a dystonic reaction?
1. Neck hyperextension
| 2. Decreased extraocular moments
126
What is one type of medication that can especially cause an acute dystonic reaction?
Neuroleptics
127
What can reverse an acute dystonic reaction?
Diphenhydramine
128
What is one specific medication that is not always thought of as a neuroleptic, but is one and can cause an acute dystonic reaction?
Metoclopramide
129
10 year old with ADHD, on methylphenidate for past 3 years, briefly experienced eye blinking which since resolved with no intervention... Most likely explanation and appropriate further management?
Simple motor tic, no additional intervention
*Don't think tic disorder like Tourettes... tic was limited and resolved spontaneously even though he continued methylphenidate
130
What movements follow a pattern, are repetitive improve or disappear during purposeful movement, and may be suppressed (at least for short periods of time)?
Tics
131
What movements are random, increase during purposeful movement, and cannot be voluntarily suppressed?
Choreiform movements
132
What are rocking and hand flapping examples of?
Stereotypies
133
What 3 groups can you see stereotypies in?
1. Normal children
2. Autism
3. Rett Syndrome
134
True or False: Stimulant medications cause tics?
False- they may unmask an underlying tic disorder in predisposed patients
135
True or False: If a child develops tics, stimulant medications for ADHD have to be discontinued?
False- but parents need to know that stimulants may unmask an underlying tic disorder
136
How do simple motor tics typically present?
1. Eye blinking
| 2. Movements of the head, face, and/or shoulders
137
True or False: Simple motor tics are common and transient in many children without underlying conditions?
True
138
How long must tics be present to consider Tourette Syndrome?
At least one year
139
What 2 other problems does Tourette syndrome have a co-occurrence between?
1. ADHD
| 2. OCD
140
What is the best treatment for Tourette syndrome?
Habit reversal training
141
What does habit reversal training consist of?
Recognizing when tics are about to occur and starting a voluntary movement that will not allow the tic to occur
142
When is pharmacotherapy indicated for Tourettes?
Only when tics interfere with daily activities
143
Where are brain tumors in young children often located?
Posterior fossa
144
What is the triad that should make you think of an infratentorial tumor?
1. Headache
2. Vomiting
3. Abnormal gait
* in an afebrile child
* also note head tilt and torticollis
145
What is the most common type of solid tumor in children?
Brain tumors
146
What is the number one cause of death among all childhood cancers?
Brain tumors
147
What is the most common malignant brain tumor of childhood across all ages?
Medulloblastoma
148
Where does medulloblastoma arise from?
Tumor stem cells in the cerebellum
149
What is the triad for presentation of a medulloblastoma?
1. Headache
2. Ataxia
3. Obstructive hydrocephalus
150
What are 2 things you might see on a contrast MRI of a medulloblastoma?
1. Contrast-enhancing 4th ventricle mass
| 2. Hydrocephalus
151
Child under 1 who is vomiting, no diarrhea, dehydrated on exam (dry oral mucosa and decreased urine output), full anterior fontanelle. Gets 2 NS boluses and then postures (fully extends arms and legs)...best next step?>
IV dexamethasone (reduce ICP)
*This is a space occupying lesion, likely brain tumor
152
True or False: Craniopharyngioma usually presents rapidly
False- Over 1-2 years
153
What is the triad for presentation of a craniopharyngioma?
1. Endocrinopathoes (short stature, diabetes insipidus, early or delayed puberty)
2. Visual disturbances
3. Headache
154
What leads to the chronic progressive visual field deficits seen with craniopharyngioma?
Pressure on the optic tracts
155
What can cause hydrocephalus in craniopharyngioma?
Obstruction of the 3rd ventricle
156
What might you see on XR imaging that would make you think of a craniopharyngioma?
Skull film with calcification in the sella turcica
157
True or False: Craniopharyngioma is not a malignant tumor?
True- just in a bad location
158
What are the 2 main treatment options for craniopharyngioma?
1. Surgery
| 2. Radiation (possibly)
159
What type of doctor do kids with craniopharyngiomas need to follow-up with?
Endocrine (most patients do well)
160
What can optic nerve gliomas lead to?
Decreased vision
161
What are optic nerve gliomas associated with 25% of the time?
Neurofibromatosis
162
How does a brain lesion effect MSK system?
Contralateral face and body weakness
163
Name 2 examples of a brain lesion
1. Tumor
| 2. Abscess
164
How does a brainstem lesion effect MSK system?
1. Weak eye movements
2. Ipsilateral facial weakness
3. Contralateral body weakness
165
What is one example of a brainstem lesion?
Tumor
166
How does a spinal cord lesion effect MSK system?
1. Loss of motor and sensation function
2. Loss of bladder and bowel function
3. Increased reflexes
4. No eye involvement
167
Name 6 examples of things that cause a spinal cord lesion
1. Transverse Myelitis
2. Anterior spinal artery infarction
3. Spinal cord compression (tumors)
4. Epidural abscess
5. Tethered cord
6. Trauma
168
How does a chronic peripheral nerve process effect MSK system?
Loss of DTRs
169
Name 3 examples of chronic peripheral nerve processes
1. Chronic demyelinating polyneuropathy
2. Hereditary neuropathies
3. Leukodystrophy
170
How does an acute peripheral nerve process effect MSK system?
Loss of DTRs
171
Name 6 examples of acute peripheral nerve processes
1. Guillain Barre
2. Polio
3. Diptheria
4. Tick paralysis
5. Lead poisoning
6. Bell's Palsy
172
Name an example of a neuromuscular junction disorder that has a progressive onset
Myasthenia gravis
173
Name an example of a neuromuscular junction disorder that has a rapid onset
Botulism
174
What is the direction of the paralysis in botulism?
Descending
175
How do muscular disorders causing chronic weakness present in the MSK system?
Proximal weakness
176
Name 3 examples of muscular disorders causing chronic weakness
1. Muscular dystrophy
2. Mitochondrial myopathies
3. Congenital myopathies
177
How do muscular disorders causing acute weakness present in the MSK system?
Proximal weakness affecting the hips and shoulders
178
Name 3 examples of muscular disorders causing acute weakness
1. Polymyositis
2. Dermatomyositis
3. Electrolyte imbalance
179
Name 3 general categories of CNS causes of hypotonia
1. Hypotonic cerebral palsy
2. Genetic disorders (Prader-Willi, Angelman, Down)
3. Metabolic problems (leukodystrophies, peroxisomal disorders)
180
What test do you order if you have a patient presenting with symptoms consistent with a spinal cord lesion?
MRI spine
181
Name some signs and symptoms of an epidural abscess.
1. Spinal pain
2. Paresthesias
3. Weakness and/or paralysis
4, Fevers
5. Localized back pain (initial symptom)
6. Decreased anal tone
7. Reduced sensation in lower extremities
8. Increased reflexes
182
How can infection occur in an epidural abscess?
1. Direct extension from paraspinal tissues
| 2. Seeding from distant infection (UTI, dental abscess, central venous catheter)
183
Which population are particularly susceptible to epidural abscess?
IV drug users
184
What needs to be done if there is concern for an epidural abscess?
Urgent spinal imaging... if MRI isn't available, get a CT
185
What are the 2 parts of treatment for an epidural abscess?
1. Antibiotics
| 2. Emergency surgical decompression
186
What bug should your antibiotics target for a epidural abscess?
Staph
187
What is another name of acute transverse myelitis?
Post-infectious myelitis
188
What causes acute transverse myelitis?
Lymphocytic infiltration and demyelination of nerves/spinal cord secondary to inflammation
189
How does acute transverse myelitis present?
Fever and sudden onset of paralysis
190
What is seen on CSF studies in acute transverse myelitis?
Increased polys
| Negative gram stain
191
What should pain on palpation of the spinal cord make you think of?
Acute transverse myelitis
192
What does the MRI show in acute transverse myelitis?
Cord swelling
193
What is the main problem you worry about in acute transverse myelitis?
Respiratory arrest or compromise
194
What has to be done in acute transverse myelitis before the LP?
MRI with gadolinium
195
Child with abrupt onset of weakness, hypotonia, decreased reflexes followed by increased tone and hyperreflexia. Also with bowel/bladder dysfunction...?
Acute transverse myelitis
196
What is the prognosis for acute transverse myelitis?
Most have spontaneous recovery over a few months
197
Child with an extrinsic spinal cord mass lesion what do you do?
Immediate treatment with high dose IV dexamethasone (reduce pain, edema, and risk for ischemia)
198
What type of disease is Werdnig-Hoffman?
Spinal muscle atrophy (SMA type 1)
199
What causes Werdnig-Hoffman disease?
Degeneration of the anterior horn cells
200
What is typically affected in Werdnig-Hoffman disease- Motor, sensory, or both?
Motor- Anterior horn cells are what's degenerated
201
How is Werdnig-Hoffman disease inherited?
Autosomal recessive
202
How does Werdnig-Hoffman disease usually present?
In infancy with severe hypotonia and weakness
203
How is Werdnig-Hoffman disease diagnosed?
Muscle biopsy
204
What is the prognosis for Werdnig-Hoffman disease?
Most kids die by age 2, there is no treatment
205
What are 3 key phrases to look for in Werdnig-Hoffman disease?
1. Hypotonia
2. Poor suck
3. Tongue fasciculations
206
What distinguishes Werdnig-Hoffman disease from infantile botulism?
Tongue fasciculations
207
What is a protrusion of the spinal cord and surrounding membranes through a defect in the vertebral column?
Myelomeningocele
208
What do children with myelomeningocele often have as well that requires then to often require a VP shunt?
Hydrocephalus
209
If you suspect myelomeningocele in the newborn period, who do you need to consult early?
1. Orthopedics
| 2. Urology
210
What age group do children with myelomeningocele typically do well through?
Preschool years
211
After the preschool years what problems will children with myelomeninocele commonly have with learning?
1. Difficulty with organization
2. Difficulty with memory
3. Other leaning skills
4. Low-average IQ
212
Patient with headache, nausea/vomiting, gaze disturbance, academic or behavior changes, or new onset seizures (or change in occurrence or type of seizure)?
Consider shunt malfunction (especially in kids with spina bifida and shunt), and/or worsening hydrocephalus
213
What are some of the more subtle findings suggestive of a spinal dysraphism?
1. Lipoma
2. Patch of hair
3. Hemangioma
4. Discoloration
5. Sacral dimple
6. Leg length discrepancy
7. Elevated arches
8. Gait abnormalities
214
What are some of the more alarming signs associated with an occult spinal dysraphism?
1. Diminished sensation in the perineal area
2. Urinary and/or stool incontinence
3. Recurrent UTIs
215
What should be ordered if spinal dysraphism is suspected?
MRI of the spine
216
How is spinal trauma usually described?
Focal pain along the spine following trauma. May see weakness and/or sensory deficits. Can have loss of bowel and bladder function as well.
217
If you are suspicious for spinal trauma, what 2 things should you do?
1. Immobilizing the cervical and lower spine
| 2. Give 30mg/kg methylprednisolone over an hour
218
What steroid is indicated for spinal cord compression?
Dexamethasone (not methylprednisolone)
219
What steroid is indicated for spinal trauma?
Methylprednisolone (not dexamethasone)
220
In the setting of spinal trauma, when would you give mannitol?
Only if there are signs of increased intracranial pressure
221
What is an acquired idiopathic facial nerve paralysis?
Bell's palsy
222
How do kids with Bell's palsy present?
Sudden onset of unilateral facial paralysis
223
How is diagnosis of Bell's palsy made?
Clinically
224
What are the 2 treatment options for Bell's Palsy?
1. Prednisone for 5 days (best if started within first 3 days of symptoms)
2. Antivirals like acyclovir and valacyclovir (for severe cases)
225
What is facial paralysis associated with painful vesicles in the ear canal
Ramsay Hunt Facial Paralysis
226
What causes Ramsay Hunt facial paralysis?
Reactivation of the VZV virus
227
What causes progressive motor weakness as well as areflexia?
Guillain Barre Syndrome
228
How does Guillain Barre Syndrome present?
Leg weakness and/or unsteady gait, pain
229
How does the weakness progress in Guillain Barre Syndrome?
Starts in the lower extremities and progresses upward in a symmetric fashion (ascending paralysis)
230
What is often noted in preceding history for Guillain Barre syndrome?
Preceded by a viral illness or another illness like campylobacter jejuni
231
What is typical of the physicial exam in Guillain Barre?
Cranial nerve findings and dysautonomia (tachycardia, orthostatic hypotension, and/or dizziness)
232
What finding is ALWAYS seen in Guillain Barre syndrome?
Areflexia- If reflexes are present in lower extremities, it's not GBS
233
What are classic findings in the CSF with Guillain Barre?
Increased protein with a normal cell count
234
A child with difficulty rising from a sitting position or one who can't shrug their shoulders or one who is suddenly clumsy and falling...?
Proximal muscle weakness- Guillain Barre
235
What is the biggest risk in Guillain Barre syndrome?
Respiratory failure secondary to ascending paralysis
236
What has to be followed very closely in Guillain Barre syndrome?
Lung function
237
What testing needs to be monitored very closely in Guillain Barre syndrome?
Lung functions: Vital capacity, negative inspiratory force, or PFTs
*NEVER O2 Sats*
238
True or false: O2 sats are adequate monitoring for lung function in patients with Guillain Barre syndrome?
False: These only decline once the patient is severely compromised
239
What are the 3 parts to treatment for Guillain Barre Syndrome?
1. Supportive measures (intubation, ect.)
2. Plasmapheresis
3. IVIG
240
What is the prognosis for Guillain Barre Syndrome?
Most patient who survive have a full recovery, but there is permanent disability in about 10% of cases
241
When do you give steroids in Guillain Barre Syndrome?
Never- they have no proven benefit in treatment
242
What is something else you should consider if you suspect Guillain Barre syndrome (especially if presenting in the summer months)?
Tick paralysis- Caused by a neurotoxin secreted by the tick
243
How does tick paralysis present?
Exactly like GBS (with ascending paralysis)
244
How does the paralysis in botulism progress?
Descending paralysis (v. GBS and tick which is ascending)
245
What is an autoimmune disorder in which the patient develops antibodies against the acetylcholine receptor in the neuromuscular junction?
Myasthenia gravis
246
What causes myasthenia gravis?
Unknown
*In some cases penicillamine is known to cause it*
247
What can exacerbate symptoms in myasthenia gravis?
Drugs and illnesses
248
Describe the weakness in myasthenia gravis
Worse with activity and improves with rest
249
What do patients with myasthenia gravis typically describe their day as?
Feel good in the morning and get tired as the day goes on
250
What is a common exam finding in myasthenia gravis that often causes patients to first present?
Ptosis
251
If you diagnose someone with myasthenia gravis, what else should you look for?
Thymoma
252
What test can be done to confirm a diagnosis of myasthenia gravis?
Tensilon test
253
How does the tensilon test work in myasthenia gravis?
Uses edrophonium which is a very short acting acetylcholinesterase inhibitor
254
True or False: Edrophonium can be used as treatment for myasthenia gravis?
False- It is short acting and only used to testing
255
What are 3 other things besides the Tensilon test that can support a diagnosis of Myasthenia gravis?
1. Test for anti-acetylcholine receptor antibody
2. Test for anti-Smith antibodies
3. EMG
256
What is the mainstay of therapy for myasthenia gravis?
Pyridostigmine (Mestinon)
257
How does pyridostigmine work?
Inhibits acetylcholinesterase- this increases acetylcholine in the NMJ
258
Besides pyridostigmine what are 2 other treatment options that can be used?
1. Plasmapheresis
| 2. Plasma exchange
259
True or False: Prednisone and immunomodulators are commonly used to treat myasthenia gravis?
False- These are less commonly used
260
What surgical intervention is often some in myasthenia gravis?
Thymectomy (especially in kids)
261
True or False: A thymectomy can be curative for myasthenia gravis?
True
262
How does the botulism toxin act on the NMJ?
It blocks the release of acetylcholine from the NMJ
263
Describe the direction of paralysis in botulism v. Guillain Barre syndrome
Botulism: Descending
GBS: Ascending
264
What type of botulism looks similar to myasthenia gravis?
Infantile botulism
265
How can you differentiate myasthenia gravis from infantile botulism?
Botulism in rapid onset within hours
| Myasthenia gravis is more progressive (over weeks)
266
How is Duchenne muscular dystrophy inherited?
X-linked recessive (only boys get it)
267
What is the cause of Duchenne muscular dystrophy?
Absence of dystrophin
268
How is Duchenne muscular dytrophy diagnosed?
Muscle biopsy
269
True or False: Children with Duchenne muscular dystrophy are typically symptomatic from birth?
False- usually achieve baby milestones at correct times
270
What might be the first sign of Duchenne muscular dystrophy observed in infants?
Poor head control
271
How might a toddler with Duchenne muscular dystrophy present?
Weakness in hip muscles, lordoctic posture (to compensate for gluteal weakness), can't walk up stairs (will crawl or cry to be carried)
272
What is Gower's sign?
When a child walks his hands up his legs for support in order to stand up- Associated with proximal muscle weakness
273
What might you mind on your lower extremity MSK exam for a child with Duchenne muscular dystrophy?
Hypertrophied calves (pseudohypertrophy)
274
What causes pseudohypertrophy seen in Duchenne muscular dystrophy?
Fat deposition and proliferation of collagen
275
What are the effects of Duchenne muscular dystrophy on intellect?
Most have some intellectual disability, but it is mild in most
276
What lab study can help to point towards Duchenne muscular dystrophy?
CPK elevation (this is elevated even at birth and before weakness appears)
277
What is the appropriate gene testing for Duchenne?
Xp21 gene testing
*Remember Duchenne (duXchenne) is carried on the X chromosome (x-linked recessive) to pick this choice*
278
How is Becker dystrophy compared to Duchenne dystrophy?
Becker has later onset, milder severity, and slower deterioration
279
What is a finding in history that might point to Becker dystrophy?
Severe cramps on exertion
280
What finding might be more severe in Becker dystrophy compared to Duchenne?
Cardiac involvement
281
What are two exam findings that distinguish Duchenne muscular dystrophy from other neuromuscular disorders?
1. Absence of tongue fasciculations
| 2. Absence of eye muscle involvement
282
True or False: In Duchenne muscular dystrophy, the mother is always a carrier?
False: In 1/3 of cases, Mom is not a carrier- there is a significant spontaneous mutation rate
283
What lab finding might be abnormal in an asymptomatic female carrier of Duchenne muscular dystrophy?
CPK (it can be elevated)
284
What are 3 common causes of death in patients with Duchenne muscular dystrophy?
1. Heart failure
2. Respiratory failure
3. Pneumonia
285
What causes the heart failure seen in patients with Duchenne muscular dystrophy and at what point in their lives does this typically become a problem?
```
Cardiomyopathy
3rd decade (when they are in their 20s)
```
286
What types of muscle does myotonic muscular dystrophy affect?
Striated and smooth
287
What systems does myotonic muscular dystrophy affect?
Skeletal, heart, GI tract (multiple besides skeletal muscle due to affect on striated and smooth muscle)
288
What age does myotonic muscular dystrophy typically present?
Around 4-5
289
What is typically seen initially in patients with myotonic muscular dystrophy?
Muscles have slow relaxation after contraction (especially in the hands)
290
What is myotonia?
Slow muscle relaxation after contraction (typically seen in hand)
291
What other organ system besides MSK are there commonly problems in with myotonic muscular dystrophy?
Endocrine
292
Where is the muscle wasting in myotonic muscular dystrophy?
Distal (most other neuromuscular disorders are proximal)
293
What happens to the CPK in myotonic muscular dystrophy?
It can be normal (always elevated in Duchenne)
294
How is myotonic muscular dystrophy inherited?
Autosomal dominant
295
How is myotonic muscular dystrophy diagnosed?
Muscle biopsy
296
What is another name for Steinert disease?
Myotonic muscular dystrophy
297
What are three parts to note for in history of a pseudoseizure?
1. Happen during day
2. Occur with other people around
3. Absence of post-ictal state
298
How will tics be differentiated from seizures?
The patient can suppress movements with tics, not with seizures
299
How can you differentiate seizure from syncope?
Seizures occur suddenly with maybe an aura before. Syncope is preceded by dizziness, loss of color, or blurry vision
300
What is an abnormal, sudden electrical discharge of nerve cells from the gray matter, which progresses to the white matter having a measurable effect on the innervated organ?
Seizure
301
What is the name for something that looks like a seizure, but isn't associated with concurrent EEG changes?
Paroxysmal non-epileptic event
302
When do neonatal seizures occur?
Within the first month of life
303
What are some causes of neonatal seizures?
1. Birth defects
2. Perinatal hypoxia
3. Drug effects
304
What type of seizures occur during a rapid rise in body temperature, usually in response to a common infection like otitis or other URI?
Febrile seizure
305
What % of kids will have a febrile seizure?
2-5% (very common)
306
What type of seizures are focal and only involve part of the brain?
Partial seizures
307
What are the 2 main types of partial seizures?
1. Simple partial
| 2. Complex partial
308
What type of seizure has a localized motor component limited to one part of the body?
Simple partial
309
True or False: A simple partial seizure can progress to other parts of the body?
True
310
True or False: Children are unresponsive during a simple partial seizure?
False- they remain awake (Jacksonian seizure)
311
What describes a complex partial seizure?
Involve motor activity, but the child in unaware of what he or she is doing
312
What is the name for a non-focal seizure?
Generalized seizure
313
What are 3 main categories of generalized seizures?
1. Absence
2. Infantile spasm
3. Conculsive/Tonic/Tonic-Clonic
314
What type of seizures are short episodes in which the child stares into space with no awareness of their environment?
Absence (petit-mal)
315
What age group do infantile spasms usually affect?
Children under a year
316
What is the prognosis for infantile spasms?
Very poor, usually have intellectual disability
317
What type of seizures usually last around 5 minutes and have a post-ictal period?
Conluvsive, Tonic, Tonic-Clonic
318
What is defined as seizure activity of more than 30 minutes in duration, or repeated seizures without a return to normal in between?
Status epilepticus (medical emergency)
319
Name 5 common causes of metabolic-related seizures, especially in the newborn period
1. Pyridoxine deficiency
2. Hypoglycemia
3. Hyponatremia
4. Hypocalcemiea
5. Urea cycle disorders
320
Kid with seizure despite being on anti-convulsants.. what do you do first?
Obtain drug levels
321
What are 3 important reasons to get drug levels in a kid with breakthrough seizures?
1. Adolescents with poor medication compliance
2. Weight gain causing kid to outgrow the dose
3. Problem with absorption
322
What is the most common type of seizure seen in children?
Febrile
323
What type of seizures occur in kids after 1 month of age, are associated with febrile illness but no caused by CNS infection, and are unassociated with previous neonatal or other seizures?
Febrile
324
What age range do febrile seizures typically occur?
6 months to 5 years
325
What % of kids with febrile seizures have a family history of febrile seizures?
25%
326
What is the most common type of febrile seizure?
Simple
327
What are the 3 features that describe a simple febrile seizure?
1. Generalized seizure type
2. Duration less than 15 minutes
3. Only one seizure per 24 hour period
328
True or False: A normal EEG rules out epilepsy?
False- Normal EEG doesn't rule out epilepsy and an abnormal EEG doesn't confirm a diagnosis of seizure disorder
329
True or False: There are kids with abnormal EEGs who don't have seizures?
True
330
True or False: Medications aren't indicated after a first unprovoked seizure?
True
331
When do you get routine labs for a first unprovoked seizure?
You don't- just need a finger stick glucose
332
What should be done for all parents with a child who has had a first unprovoked seizure?
Educate them on safety- Helmet while biking, no bathing without supervision, ect.
333
True or False: A child can swallow their tongue during a seizure
FALSE- don't put anything in their mouth
334
True or False: Seizures cause brain damage
False- Seizures don't cause brain damage unless they last longer than 20-30 minutes
335
True or False: You should obtain an EEG after a first unprovoked seizure?
False- EEG is not indicated after a first unprovoked seizure
336
Which patients with febrile seizure are at increased risk for developing epilepsy?
Patients experiencing a complex febrile seizure first (as opposed to a simple first febrile seizure)
337
What are the 3 characteristics of a complex febrile seizure?
1. Lasts longer than 15 minutes
2. Recurs within 24 hours
3. May be focal
338
How many kids with febrile seizure will go on to have a second febrile seizure?
About 1/3
339
What are 4 risk factors for recurrence of febrile seizure?
1. Low fever at time of first seizure
2. Young age
3. Family history of febrile seizures
4. Short period of time between onset of fever and seizure
340
What % of kids with febrile seizures go on to develop epilepsy?
5%
341
What are 3 risk factors for the development of epilepsy in kids with febrile seizures?
1. Family history of epilepsy
2. Children with complex febrile seizures
3. Children with neurodevelopmental abnormalities
342
What work up is indicated in simple febrile seizures?
Non- don't do blood tests, EEG, or head CT
*With a complex febrile seizure doing a workup is more subjective
343
Which 4 groups should you consider a LP in with febrile seizure?
1. Infants
2. Kids with complex partial seizures
3. Kids with febrile status epilepticus
4. Kids partially treated with antibiotics
344
Name 6 medications known to cause seizures
1. Cyclosporin
2. Intrathecal methotrexate
3. Isoniazid
4. Insulin/Oral hypoglycemic
5. Buproprion (and other psych meds)
6. Theophylline
345
What illicit drug is known to cause seizures?
Cocaine
346
What seizures consist of brief staring spells where the child is not responsive?
Absence seizures
347
True or False: There is no postictal period in absence seizures?
True
348
Child who frequently spaces out and blinks, with no recollection of the event?
Absence seizure
349
What is the EEG description for absence seizure?
3 per second spike and wave
350
Why are absence seizures called "potato chips" seizures?
Can't stop with one (they come in clusters)
351
What other type of seizure can absence seizures be difficult to distinguish between?
Complex partial seizures
352
What are 3 ways to distinguish absence seizure from complex partial seizure?
1. Absence seizure is abrupt in onset (CPS may start as a simple partial seizure where child is aware)
2. Absence seizures are usually short (under 30 seconds)
3. Absence seizures end abruptly (CPS end gradually progressing into the postictal period)
353
What can induce an absence seizure that is a diagnostic maneuver?
Hyperventilating
354
What are 3 meds used to treat absence seizures?
1. Ethosuximide (specific for this)
2. Lamotrigine
3. Valproic acid
355
Which children are more likely to respond to therapy for absence seizures and remain seizure free even after therapy is discontinued?
Younger children
356
What side effects can valproic acid have?
1. Depressed platelet counts
2. Elevated LFTs
3. Elevated pancreatic enzyme levels
357
What tests need to be monitored in kids on valproic acid?
1. CBC
2. LFT
3. Pancreatic function tests
358
What types of seizures can patients have an aura or prodrome before (can be minutes, hours, or even days before seizure)?
Tonic-clonic or Generalized Tonic-Clonic
359
What are 3 key components of a tonic-clonic seizure?
1. Loss of consciousness
2. Loss of bladder control
3. Full body tonic clonic movements
360
What are the 3 phases of a generalized tonic-clonic seizure?
1. Tonic
2. Clonic
3. Post-ictal
361
Describe the tonic phase of a generalized tonic-clonic seizure
Flexion of trunk, extension of back/arms/legs- Typically lasts less than 30 seconds
362
True or False: Loss of bladder control occurs during the tonic phase of a generalized tonic-clonic seizure?
False
363
Describe the clonic phase of a generalized tonic-clonic seizure
Clonic convulsive movements along with tremors that alternate with short periods of atonia (where child may boid)
364
Which phase of a generalized tonic-clonic seizure is the child apneic?
Clonic
365
How long does the clonic phase of a generalized tonic-clonic seizure last?
1-2 minutes
366
Describe the post-ictal phase of a generalized tonic-clonic seizure
Initially unconscious then sleepy/confused. Gradually awaken and become more oriented. Unable to recall events of seizure. (Similar to someone coming out of anesthesia)
367
What is the treatment of generalized tonic clonic seizures?
Anti-epileptic drugs
368
What is the drug of choice for treatment of generalized tonic clonic seizures?
Valproic acid
369
Besides valproic acid what are other anti-epileptics used in generalized tonic clonic seizures?
1. Phenytoin
2. Carbamazepine
3. Lamotrigine
4. Phenobarbital (falling out of favor)
5. Phenytoin (used less frequently due to side effects)
370
What is a potential side effect of lamotrigine?
SJS
371
What type of epilepsy is Juvenile Myoclonic Epilepsy (JME)
Generalized idiopathic epilepsy
372
What are the 3 features in classic presentation of JME?
1. Myoclonic jerks upon awakening
2. Generalized tonic-clonic seizures in most patients
3. Absence seizures in 1/3 of patients
373
True or False: EEGs show generalized slowing in JME?
False- Most EEGs don't pick up the seizures in JME (so if you have EEG findings, this isn't JME)
374
What are the 2 drugs used to treat JME?
1. Valproic acid
| 2. Levetiracetam
375
What is a single or repetitive contraction of an isolated group of muscles?
Myoclonic seizures
376
What 2 conditions are myoclonic seizures typically seen in?
1. JME
2. Lennox-Gastaut
(Outside of these two these types of seizures are relatively rare)
377
What is another name for West Syndrome?
Infantile spasms
378
What is the triad for West Syndrome?
1. Infantile spasms
2. Hypsarrhythmia (on interictal EEG)
3. Developmental delay
379
What % of epilepsy is infantile spasms?
2%
380
What % of epilepsy seen in the first year of life is infantile spasms?
25%
381
When do most kids typically present with infantile spasms?
Between 3 and 9 months
382
Describe the spasms seen in infantile spasm?
Happen in clusters- 20-30 in a row. Sudden flexion or extension of the body (like a Moro in a kid too old to have a Moro)
383
True or False: Almost all patients with infantile spasms have developmental delay?
True
384
Repetitive flexing of the head, trunk, and extremities. EEG shows hypsarrythmia...?
Infantile spasms
385
What type of seizure disorder is Tuberous Sclerosis associated with?
Infantile spasms
386
How is Tuberous Sclerosis inherited?
Autosomal dominant
387
What presents with various tumors (cardiac/kidney), ash-leaf spots, and seizures?
Tuberous Sclerosis
388
What is first line treatment for infantile spasms?
ACTH
389
What is the prognosis in infantile spasms dependent upon?
Developmental status before onset of seizures...if there was developmental delay present prior to onset of seizures, then prognosis is poor
390
Besides ACTH, what are some other treatment options in infantile spasms?
1. Steroids
2. Benzodiazepines
3. Anti-epileptic drugs
4. Can consider focal resection
391
True or False: After treatment of infantile spasms, most kids develop other seizure types?
True
392
What is a general description for partial seizure?
Focal seizure
393
What does simple partial seizure mean?
Consciousness is maintained
394
Describe a simple partial seizure
1. Motor activity in the extremities (usually arms) or face
2. Occur as patient falls asleep or wakes up
3. Movement may "march" to other locations
4. Can be sensory seizures or autonomic seizures
5. Consciousness is maintained
395
What is the drug of choice for simple partial seizures?
Carbamazepine
396
True or False: Treatment is not always necessary for simple partial seizures
True- Many cases remit during adolescence
397
What do complex partial seizures entail?
Alteration in consciousness
398
What is typically described in a complex partial seizure?
Facial movements- can appear like they are responding to auditory or visual hallucinations, may have lip smacking
399
True or False: Patients with complex partial seizure and unresponsive
False- Consciousness may not be impaired completely (patients may respond to simple commands)
400
What is a movement or vocalization that accompanies complex partial seizures like moaning or simple talking?
Automatisms
401
What type of seizures might you see automatisms in?
Complex partial
402
What two things are part of the workup for a complex partial seizure?
1. Head MRI
| 2. EEG
403
What is the treatment for a complex partial seizure?
Anti-epileptic drugs (surgery is only rarely used)
404
What is another name for benign childhood epilepsy with centrotemporal spikes?
Benign Rolandic Epilepsy
405
What is the most common form of partial epilepsy in childhood?
Benign Rolandic Epilepsy
406
What type of epilepsy has self-limited seizures involving the face
Benign Rolandic Epilepsy
407
When do most seizures occur in Benign Rolandic Epilepsy?
At night (when sleeping)
408
What other problem do patients with Benign Rolandic Epilepsy commonly have?
Migraine headaches
409
Is there altered level of consciousness in Benign Rolandic Epilepsy if a seizure occurs while the child is awake?
No- Fully aware, but unable to speak
410
In addition to the facial motor seizure seen in Benign Rolandic Epilepsy, what else is commonly seen?
Unilateral sensory involvement (usually one side of the tongue)
411
When do you treat for Benign Rolandic Epilepsy?
After 3+ seizures
412
What medication is given in Benign Rolandic Epilepsy?
Many medications are equally effective
413
Does Benign Rolandic epilepsy have an inheritance patent?
Yes- dominant trait (look for family history)
414
What is the prognosis for Benign Rolandic Epilepsy?
Most seizures usually resolve by 16
415
What is the EEG pattern in Benign Rolandic Epilepsy?
Biphasic focal centrotemporal spikes and slow waves
416
How can you differentiate between complex partial seizures (that involve weird facial movements) and Benign Rolandic seizures?
Complex partial seizures occur during the day (awake)
Benign Rolandic seizures occur at night (sleep)
*In reality, Rolandic can be awake or sleep- only 1/2-2/3 occur exclusively during sleep)
417
Toddler with temper tantrum, turns blue, passes out, then awakens.. what do you do?
Reassure parents... Cyanotic breath holding spell (benign)
418
True or False: You can see a post-ictal state in cyanotic breath holding spells?
FALSE
419
What is status epilepticus?
Repeated or continued seizures for 30 minutes without recovery
420
What is the first thing to do in status epilepticus?
ABCD's
421
What is the first drug to give in status epilepticus?
Ativan (short acting but rapid onset)
422
If Ativan doesn't work in status epilepticus, what do you give next?
IV fosphenytoin
423
Why do we give IV fosphenytoin v. phenytoin?
Fosphenytoin is the inactive precursoe and less likely to cause skin necrosis (purple glove syndrome) seen with phenytoin
424
If you do not have IV access, what can you give for a patient in status epilepticus?
Rectal diazepam
425
True or False: Patients with active epilepsy can bathe and swim?
True- but they must be supervised by an adult
426
What sports restrictions exist for children with active epilepsy?
No contact sports that can cause head injury
427
What outdoor activity restrictions exist for children tih active epilepsy?
They can ride bikes with helmets on
| Should not climb trees
428
What driving restrictions exist for children with epilepsy?
Can drive unaccompanied (even if on anticonvulsant medications) as long as they have been seizure free for 3-12 months (this varies state to state, will likely be >12 months on boards)
429
When can you attempt to discontinue anti-convulsant medication?
If the patient has been seizure free for 2 years
430
What is a static encephalopathy characterized by gross and fine motor abnormalities evident early in life?
Cerebral Palsy
431
What causes cerebral palsy?
Unknown in most cases, can be due to birth asphyxia in about 10% of known cases
*Consider clinical scenario and look for other etiologies that could have affected the developing brain
432
What is the most common risk factor for cerebral palsy in premature newborns?
Perinatal infection
433
True or False: All children with CP are intellectually disabled?
False- many have normal or above normal intelligence
434
What type of CP will you have bilateral spasticity of the legs, delayed walking, and tip-toe walking?
Spastic diplegia
435
Which type of CP has associated with normal cognitive function without seizures and is more likely to involve the lower extremities?
Spastic diplegia
436
What type of CP will have spasticity of half of the body (left or right), involving the arm, trunk, and leg?
Spastic hemiplegia
437
If what subtype of CP occurs before age 2 is it considered to be CP?
Spastic hemiplegia
438
What subtype of CP is associated with 1/4 being cognitively impaired and may involve the upper extremity more than the lower?
Spastic hemiplegia
439
What subtype of CP has increased tone in all 4 extremities with lower worse than the upper?
Spastic quadriplegia
440
What subtype of CP is more likely to be associated with intellectual disability, seizures, feeding difficulties, speech difficulties, and visual difficulties?
Spastic quadriplegia
441
What subtype of CP has increased tone in all 4 extremities with lower worse than upper in addition to dystonia and strange movements?
Dyskinetic
442
What is another name for dyskinetic CP?
Athetoid CP
443
What subtype of CP has a combination of spastic and dyskinetic movements?
Mixed CP
444
What subtype of CP has hypotonia seen in the trunk and extremities with retention of primitive reflexes and/or hyperactive reflexes?
Hypotonic CP
445
Afebrile child with a headache and neck pain who develops focal paralysis?
CVA
446
Patient with CVA confirmed with CT... what is the next test to identify a specific diagnosis?
Cerebral angiography
447
Child comes in with acute unilateral hemiparesis, did have blunt trauma to chest day before during football, no other history. What diagnostic study is most helpful in making the diagnosis?
Carotid angiography: CVA caused by blunt trauma to chest causing carotid dissection leading to an embolic stroke
448
Clinical history consistent with stroke, elevated lactate level, sensorineural deafness...?
Mitochondrial disorder
449
Clinical history consistent with stroke, elevated lactate level, sensorineural deafness... what is the best diagnostic step to establish the underlying diagnosis?
Molecular analysis of mitochondrial DNA (think of a mitochondrial disorder)
450
What are most common causes of hemorrhagic stroke in children?
Vascular malformations (including AV and cavernous malformations)
451
How do vascular malformations causing stroke typically initially present?
1. Severe headache
| 2. Mental status change
452
What is the acuity of an MRI of the head?
Non-urgent
453
What is the acuity of a CT of the head?
Urgent
454
What is the acuity of an US of the head?
Non-urgent
455
Name 2 indications for MRI of the head
1. Partial seizures
| 2. Herpes encephalitis (confirmed with HSV polymerase)
456
Name 3 indications for CT of the head
1. Hemorrhage
2. Tumors
3. Abscess
457
Name 1 indication for head ultrasound
1. Infants with accelerating head circumference across percentiles
