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Flashcards in Pediatric neurological Deck (46):
1

CNI name and major function

Olfactory, smell

2

CNII name and major function

Optic, vision

3

CNIII name and major function

Oculomotor, most EOMS, opening eyelids, papillary constriction

4

CNIV

Trochlear nerve, downward and inward eye movement

5

CNV

Trigeminal; muscles of mastication; sensation of face, scalp, cornea, mucus membranes, and nose

6

CNVI

abducens nerve- lateral eye movement

7

CN VII

facial nerve; move face, closes mouth and eyes, taste (anterior 2/3), saliva and tear secretion

8

CNVIII

Acoustic; hearing and equilibrium

9

CNIX

Glossopharyngeal nerve; phonation (one third) gag reflex, carotid reflex, swallowing/ taste (posterior)

10

CNX

vagus nerve: talking, swallowing, general sensation from the carotid body, carotid reflex

11

CNXI

Spinal accessory nerve: Movement of the trapezius and sternomastoid muscles (shrug shoulders)

12

CN XII

hypoglossal nerve, moves the tongue

13

Eye movement cranial nerves

II, IV, VI

14

Cranial nerve affected by Bells palsy

facial: CNVII

15

Tongue nerve

XII

16

Mechanism of headache: Vascular dilation. What are its causes?

Cranial artery distention (migraine, fever, vasodilator drugs, metabolic disturbance, systemic infection

17

Mechanism of headache: Muscular contraction. What are its causes

Head and neck muscle contraction (tension or psychogenic)

18

Mechanism of headache: Traction. What are its causes

Space occupying lesion (brain tumor, mass lesions, abscess, hematoma, increased intracranial pressure)

19

Mechanism of headache: inflammation

Infection (meninges, sinuses, and teeth)

20

Consider this in the pediatric patient with a headache as well as febrile

Meningitis, brain abscess, encephalitis, sinusitis, associated infection such as strep throat, influenza, mono, or rubeola

21

Age ranges for meningitis

6-12 months are highest risk
90% of cases occur in 1month-5 years

22

Positive Kernig's sign

tests for meningitis. Flexion of the hip at 90 degrees, pain on extension of leg

23

positive Brudzinskis sign

involuntary flexion of legs when neck is flexed

24

classic migraine

migraine with aura, usually with older than 10 years of age

25

Common migraine

migraine without aura,

26

Migraine symtoms

UNILATERAL, lateralized dull or throbbing headache that occurs episodically, insidious onset, focal neurological disturbances may proceed or accompany classic migraines (e.g. field defects, luminous visual hallucinations) aphasia, numbs tingling clumsiness or weakness may occur, N/V, photophobia and phono phobia

27

definition of confusional migraine

More common in younger children; period of confusion and disorientation followed by vomiting and deep sleep, waking feeling well; H/A may not be described

28

Abdominal headache

Episodic abdominal pain with nausea, vomiting followed or accompanied by headache

29

Baseline studies for migraine headaches

blood chem, CMP
CBC, VDRL, ESR, Ct scan of head

30

When to initiate prophylactic therapy for migraines for pediatric patients and what kinds of prophylactic therapy is there?

Prophylactic therapy if attacks occur more than 3-4 times per month, or if migraines interfere with daily functioning or school
NSAIDS
Other agents: Propanolol (inderal), Amitriptyline (Elavil), Topiramate (topamax), Imipramine (Tofranil), Verapamil (calan)

31

Management of an acute migraine attack

rest in dark quiet room
Simple analgesic tylenol or ibuprofen(7.5-10mg/kg for younger children, max 800mg/ dose in older teens) (preferred) right away
Antiemetics

32

triptan use for migraines- when to use and age appropriate, and how to

When OTC analgesics not enough
Almotriptan (axert) (approved for children 12 and older)
Rizatriptan (Maxalt)
Sumatriptan (imitrex) nasal or tablet
Zolmitriptan (Zomig) nasal
May take at first sign of headache then repeat 2 hours later if needed

33

most evidence for triptan for 6yo-11yo

Maxalt 5mg or imitrex nasal 5mg

34

Caution Triptan use in children…..

at risk of heart disease bc it can cause a heart block

35

Definition of seizure

A transient disturbance of cerebral function due to an abnormal paroxysmal neuronal discharge in the brain

36

Partial seizures: origin

Focal origin; one hemisphere

37

Types of partial seizures

Simple partial seizures- no loss of consciousness, a variety of other symptoms (e.g. motor, autonomic, and sensory). remain conscious
Complex partial seizures- Impaired consciousness: staring >20seconds before, during, or after the symptoms described above

38

Generalized seizures: origin

bilateral, involving both hemispheres

39

Types of generalized seizures

1) absence (petit mal)- bref starking 10-20 seconds, onset and germination are very brief, almost always begin in childhood
2) tonic- sudden increase in muscle tone- posturing, consciousness is partially or completely lost, postictal alteration of consciousness is usually brief; may last several minutes
3) tonic-clonic (grand mal)- sudden loss of consciousness with arrested respirations. clonic phase involves increased muscle tone followed by bilateral rhythmic jerks lasting 2-3minutes, followed by facial coma. urinary/ fecal incontinence may occur. Postictal state characterized by deep sleep for up to an hour, HA, disorientation, muscle discomfort, and nausea (minutes to hours)
4) Atonic (without tone, drop) sudden loss of muscle tone, may result in head drop of falling

40

Consider referral for seizures if

Seizures continue despite therapeutic monitoring through anticonvulsant levels
Regression of developmental skills occurs
Regression of cognitive function occurs
Side effect profile is unacceptable

41

S/sx of febrile seizure

1-3 yo
Majority are tonic-clinic
most episodes last

42

recurrence rate for seizures

30-50%

43

Neurofibromatosis definition

von Recklinghausen disease, a neurocutaneous syndrome characterized by numerous cafe au lair spots on the body and nerve tumors on the skin and in the body. Progressive disorder, does not affect intelligence. Severity is highly variable

44

s/sx of neurofibromatosis

Multiple cafe au lairs spots
seizures

45

Diagnostic criteria for neurofibromatosis

MUST HAVE AT LEAST 2:
1) six or more CLS >5mm in prepubertal child or >15mm in post pubertal
2) 2 or more cutaneous neurofibromas
3) axially or inguinal freckling
4) 2 or more iris Lisch nodules
5) distinctive osseous lesions
6) Autosomal dominant; present in a first degree relative

46

what are the 2 types of tics

simple motor tics and complex motor tics (includes vocal tics and copropraxia)