Pediatric Neurology Flashcards Preview

AANP FNP: Pediatrics > Pediatric Neurology > Flashcards

Flashcards in Pediatric Neurology Deck (19):
1

Possible causes of febrile headache

Meningitis
Brain abscess
Encephalitis
Sinusitis
Associated infection (strep, flu, mono, rubeola)

2

Is bacterial meningitis or viral meningitis more common in pediatrics?

Viral

3

When do you not do a lumbar puncture?

When there are signs of increased intracranial pressure. May cause brain stem herniation.

4

Incidence of types cancer in pediatrics:

1. leukemia
2. relapsed leukemia
3. brain tumors

5

Possible causes of afebrile headaches

hemorrhage/ischemia
severe hypertension
postictal
space-occupying lesion (brain tumor, hydrocephalis)
acute dental disease
acute glaucoma/inflammatory disease of the eye/orbit
vascular (migraine)
muscular contraction (tension)

6

Partial seizures

One hemisphere of the brain
Simple partial: No LOC
Complex partial: impaired consciousness, staring >20 seconds

7

Generalized seizures: Absence (petit mal)

Brief staring episode (10-20 seconds)
Almost always begin in childhood

8

Generalized seizures: Tonic

increase in muscle tone, characteristic postures
usually consciousness is partially or completely lost
brief (several minutes) postictal state

9

Generalized seizures: Tonic-clonic (grand mal)

sudden LOC
increased muscle tone, jerking, followed by flaccid coma
incontinence may occur
postictal state for up to an hour, headache

10

Generalized seizures: Atonic

"drop seizure"
sudden loss of muscle tone
may result in head drop or falling to the ground

11

Diagnosis of seizures

- Investigate underlying cause with labs, LP (with fever)
- CT or MRI head for all new onset seizures
- EEG to determine classification

12

Consider referring patient with seizures if...

Seizures continue despite therapeutic drug levels.
Regression of developmental skills or cognitive function occurs.
Side effect of meds is not tolerable.

13

Febrile seizures

- majority are tonic clonic
- most last less than 5 minutes
- rule out meningitis
- acetaminophen, cooling measures for fevers

14

Neurofibromatosis (von Recklinghausen disease)

- progressive neurocutaneous disorder that does not affect intelligence
- cafe au lait spots, Litsch nodules (in iris), axillary/inguinal freckling, seizures

15

Names and functions of the cranial nerves

CN I: Olfactory: smell (S)
CN II: Optic: vision (S)
CN III: Oculomotor: up and down (M)
CNIV: Trochlear: down and out (M)
CN V: Trigeminal: mastication, neuralgia (B)
CN VI: Abducens: looking sideways (M)
CN VII: Facial: scrunch face, anterior taste (B)
CN VIII: Vestibular/acoustic: hearing, balance (S)
CN IX: Glossopharyngeal: gag reflex, posterior taste (B)
CN X: Vagus: swallow, carotid reflex, talking (B)
CN XI: Spinal accessory: shrug shoulders (M)
CN XII: Hypoglossal: moves tongue (M)

"Some say marry money but my brother says big boobs matter most"
"On Old Olympus Towering Tops A Fin And German Viewed Some Hops"

16

Meningitis

- fever, bulging fontanel, irritability, lethargy, poor feeding, vomiting, nuchal rigidity, headache, cranial nerve palsy, ataxia, hyperesthesia, Kernig's sign (bend Knees up, neck goes up), Brudzinski's sign (bend neck up, knees go up)
- CSF shows increased protein, decreased glucose

17

Brain tumor

- increased head circumference, bulging fontanel, irritability, loss of developmental milestones, headache (worst in AM, vomiting, increase in frequency), ataxia, hemiparesis, cranial nerve palsies, seizures, papilledema, positive Babinski's (over 1 year old)
- CT/MRI
-refer to neurosurgery

18

Migraines

- dilation and pulsation of external carotid artery
- common (no aura) and classic (with aura)
- family history, triggers
- unilateral, dull or throbbing headache, insidious
- may have n/v, aphasia, numbness/tingling, vision field defects, photophobia, phonophobia
- CT, VDRL/RPR, ESR, CMP, CBC
- headache diary, improve general health, medications

19

Medications for migraines

Prophylactic therapy if more than 3-4 episodes per month
- propranolol, amitriptyline, verapamil, imipramine, Topamax
For acute attack: tylenol/ibuprofen, triptans (avoid in children at risk for heart disease)