Peds NEURO 2 - HA, Cerebral Palsy, Spina Bifida, Chiari

Question 1

MCC of HA

Answer 1

URI due to strep

Question 2

The following are ___________ causes of HAs

Meningitis, encephalitis, cerebral abscess

Subarachnoid hemorrhage

Increase ICP

Answer 2

life-threatening

Question 3

What are other causes of HAs?

Answer 3

Toxin/substance abuse

Postictal phase

HTN (*consider pre-eclampsia in adolescent females & nephrotic syndrome)

Psychogenic

Sleep deprivation

Question 4

What must you ask about when trying to figure out the cause of a child’s HA?

Answer 4

**Ask about pattern, school absences, changes at home**

Question 5

What are the 4 types of HA patterns?

Answer 5

Acute

Acute Recurrent

Chronic progressive

Chronic Nonprogressive/Daily

Question 6

Acute HA pattern (single episode w/o prior hx) is usually due to what?

Answer 6

febrile illness

Question 7

Acute recurrent HA pattern (episodes separated by pain-free intervals) is usually due to what?

Answer 7

typical migraine

tension HA

Question 8

Chronic progressive pattern (most concerning pattern) is usually due to what?

Answer 8

inc. ICP

Question 9

Chronic Nonprogressive/Daily pattern (>4 mo or >15 mo) is usually due to what?

Answer 9

psych factors

Question 10

Most severe on awakening, awaken in middle of night

Severely exacerbated by coughing or bending

Acute onset without previous history

Present daily with progressive worsening

Accompanied with vomiting

Focal neurologic signs

Aggravated by Valsalva-like maneuvers

What do these sx describe?

Answer 10

A worrisome condition

Question 11

If HA worse when lying flat, think increased _____.

Answer 11

If HA worse when lying flat, think increased ICP

Question 12

Sx of what?

_**Frequently begins in childhood**_

•Periodic headaches w/vomiting and relieved by rest

Frontal, bitemporal or unilateral pounding/throbbing for 2-72h

Sx relieved by sleep

Possible visual aura 15-30 minutes prior

**N/V, abd pain, phono/photophobia**

Answer 12

Migraines

Question 13

Step 1 in management of migraines

Answer 13

Eliminate triggers: diet, menses, stress

Inc. exercise & sleep

HA diary

Question 14

Migraines: Acute treatment?

Answer 14

NSAIDs, acetaminophen

triptans (nasal sumatriptan approved >12 y/o)

antiemetics

Question 15

When would you use prophylaxis for migraines and what is it?

Answer 15

for kids with frequent, prolonged or disabling HAs

<6yo: cyproheptadine

>6yo: propranolol, amitriptyline (TCA), topiramate, others (PAT)

Question 16

What is the prognosis for migraines?

Answer 16

Good; improve with time, some may continue to have HAs

Question 17

Etiology of what condition?

Inc. ICP w/o space-occupying lesion or obstruction

Cause unknown (likely multifactorial)

Answer 17

Pseudotumor Cerebri AKA idiopathic intracranial hypertension (IIH)

Question 18

Clinical Px of which condition?

MC in females of childbearing age; occurs in peds 11+

Inc. ICP sx: HAs, blurred vision, diplopia, vision loss

HA worse at night, aggravated by sudden movement

neck stiffness, tinnitus, dizziness, paresthesias

Answer 18

Pseudotumor Cerebri (IIH)

Question 19

What is seen on PE of Pseudotumor Cerebri (IIH)?

What is the main complication of this condition?

Answer 19

PE: Papilledema, abnormal visual field testing

Complication: vision loss

Question 20

Dx of Pseudotumor Cerebri (IIH)

Answer 20

Diagnosis of exclusion: R/O all other causes of inc. ICP

MRI and MR venography r/o venous sinus thrombosis

LP: inc opening pressue & normal composition

_**IMAGING BEFORE LP**_

Question 21

Why do we need to image before LP?

Answer 21

inc. ICP may cause cerebral herniation when LP is performed if obstructive hydrocephalus or mass

Question 22

Pseudotumor Cerebri (IIH) Management

Answer 22

Goal: improve sx and preserve vision

Sometimes sx resolve after diagnostic LP

Question 23

Pseudotumor Cerebri (IIH) Tx (meds)/surgery/lifestyle

Answer 23

Meds: Acetazolamide, Topiramate

Surgery: Optic nerve sheath fenestration, CSF shunt

Lifestyle: dec. Na+ intake

Question 24

Non-progressive clinical syndrome characterized by motor and postural dysfunction

Results from brain injury or malformation (before birth, during or after delivery)

What condition is this?

Answer 24

Cerebral Palsy

Question 25

**T/F:** CP is often accompanied by other disorders of cerebral function.

Answer 25

TRUE **Intellectual disability (50%),** epilepsy, behavioral d/o, sleep d/o Blindness, deafness, bladder control d/o, others

Question 26

The following are _______ causes of CP Prematurity Intrauterine growth restriction Intrauterine infection Antepartum hemorrhage Severe placental pathology Multiple pregnancy Hypoxic brain injury Stroke Cerebral dysgenesis

Answer 26

**pre**natal

Question 27

The following are _____ causes of CP Stroke **Kernicterus** Trauma **Near-drowning** **Toxins** Hypoxic brain injury

Answer 27

**post**natal

Question 28

What are the **4 major classifications that reflect the area of brain injury** in CP?

Answer 28

1. Spastic (**most common type, 70 – 80%**) 2. Athetoid/Dyskinetic 3. Ataxic (**most rare form**) 4. Atonic

Question 29

Sx of what type of CP? UMN lesions/sx

Answer 29

spastic CP **(most common type)**

Question 30

Sx of what type of CP? ## Footnote **slow, smooth, writhing movements that involve distal muscles**

Answer 30

Athetoid CP

Question 31

Sx of what type of CP? ## Footnote **decreased spontaneous movement, hypotonia, and suppressed primitive reflexes**

Answer 31

**Dyskinetic**

Question 32

Sx of what type of CP? ## Footnote **Wide-based gait, intention tremor, slow, jerking movements**

Answer 32

Ataxic **(most rare form)**

Question 33

Sx of what type of CP? ## Footnote **Severe hypotonia, never stand or walk. May have cerebral dysgenesis, microcephaly, profound intellectual disability**

Answer 33

Atonic

Question 34

Cerebral Palsy **Tx**

Answer 34

Social and emotional development Communication Education Nutrition Mobility **Maximal independence in activities of daily living** **PT/OT/ST**

Question 35

Cerebral Palsy Prognosis

Answer 35

varies based on severity of dz

Question 36

This is a description of what condition? **Neural tube disorder (NTD)** = defective closure of the caudal neural tube early in gestation (about week 4) **Anomalies** **may vary** depending on degree of closure defect May be just **defect of L5 and S1 vertebral arch** **Most severe form results in exposure of meninges & spinal cord**

Answer 36

**Spina bifida**

Question 37

What type of spina bifida? Meninges and spinal cord exposed; **total paralysis, loss of bowel/bladder control, accompanying Chiari II malformation\*** **spinal cord is enclosed in the cyst** _**\*\*Most serious type of spina bifida\*\***_

Answer 37

**Myelomeningocele**

Question 38

What type of spina bifida? **Spinal canal and meninges are exposed, underlying spinal cord is intact** _**\*\*2nd most serious type\*\***_

Answer 38

**Meningocele**

Question 39

What type of spina bifida? **Skin intact** but **underlying defects in bone and spinal canal** present May see s**inus tract, dimple or tuft of hair.** May have **neuro deficits** Discovered only on **x-rays or scans** & most ppl never become aware of their condition _**\*\*least serious\*\***_

Answer 39

Occulta

Question 40

Spina Bifida Prevention

Answer 40

Folic Acid supplements pre-pregnancy & during pregnancy

Question 41

Dx of Spina Bifida

Answer 41

Routine screening for **_AFP level_ @ _16-18_ wks in _maternal serum_** ## Footnote **_US_ @ _12-14_ wks & _18-20_ wks**

Question 42

Spina Bifida Management

Answer 42

**Surgical closure** **VP shunt** **Adjunct therapies**: Cognitive disabilities, self-catheterization

Question 43

Almost all patients with a myelomeningocele have the \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_, and most have associated \_\_\_\_\_\_\_\_\_\_\_.

Answer 43

Almost all patients with a myelomeningocele have the **_Chiari II malformation**_, and most have associated _**hydrocephalus_**.

Question 44

**heterogeneous group** of disorders that are defined by **anatomic anomalies of the cerebellum, brainstem, and craniocervical junction,** with **downward displacement of the cerebellum,** either alone or together with the lower medulla, into the spinal canal What condition does this describe?

Answer 44

Chiari Malformation

Question 45

What type of Chiari? ## Footnote **downward displacement of medulla & cerebellar tonsils** **syringomyelia**

Answer 45

Chiari 1

Question 46

What type of Chiari? Herniation of the cerebellar tonsils **hydrocephalus** **kink in medulla** **myelomeningocele** syringomyelia

Answer 46

Chiari 2 **(Arnold-Chiari Malformation)**

Question 47

What type of Chiari? Further **herniation of the cerebellum below the foramen magnum** forming an **encephalocele in addition to spina bifida**

Answer 47

Chiari 3

Question 48

What type of chiari? ## Footnote **hypoplasia/aplasia of the cerebellium with spina bifida**

Answer 48

Chiari 4