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

D2 E1 Shea > Peds NEURO 2 - HA, Cerebral Palsy, Spina Bifida, Chiari > Flashcards

Flashcards in Peds NEURO 2 - HA, Cerebral Palsy, Spina Bifida, Chiari Deck (49)
Loading flashcards...
1

MCC of HA 

URI due to strep

2

The following are ___________ causes of HAs

 

Meningitis, encephalitis, cerebral abscess

Subarachnoid hemorrhage

Increase ICP

 

 

life-threatening

3

What are other causes of HAs? 

Toxin/substance abuse

Postictal phase

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

Psychogenic

Sleep deprivation

4

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

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

5

What are the 4 types of HA patterns?

Acute

Acute Recurrent

Chronic progressive

Chronic Nonprogressive/Daily

6

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

febrile illness

7

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

typical migraine

tension HA 

8

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

inc. ICP 

9

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

psych factors

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? 

A worrisome condition

11

If HA worse when lying flat, think increased _____.

If HA worse when lying flat, think increased ICP

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**

Migraines

13

Step 1 in management of migraines

Eliminate triggers: diet, menses, stress

Inc. exercise & sleep

HA diary 

14

Migraines: Acute treatment?

 

NSAIDs, acetaminophen

triptans (nasal sumatriptan approved >12 y/o)

antiemetics

15

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

for kids with frequent, prolonged or disabling HAs

<6yo: cyproheptadine

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

16

What is the prognosis for migraines? 

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

17

Etiology of what condition? 

 

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

Cause unknown (likely multifactorial)

 

Pseudotumor Cerebri AKA idiopathic intracranial hypertension (IIH)

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

 

Pseudotumor Cerebri (IIH)

19

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

What is the main complication of this condition? 

PE: Papilledema, abnormal visual field testing

Complication: vision loss 

20

Dx of Pseudotumor Cerebri (IIH)

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**

21

Why do we need to image before LP

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

22

Pseudotumor Cerebri (IIH) Management 

Goal: improve sx and preserve vision

Sometimes sx resolve after diagnostic LP

23

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

Meds: Acetazolamide, Topiramate

Surgery: Optic nerve sheath fenestration, CSF shunt

Lifestyle: dec. Na+ intake 

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? 

Cerebral Palsy

25

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

TRUE

Intellectual disability (50%), epilepsy, behavioral d/o, sleep d/o

Blindness, deafness, bladder control d/o, others

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

prenatal 

27

The following are _____ causes of CP

Stroke

Kernicterus

Trauma

Near-drowning

Toxins

Hypoxic brain injury

postnatal

28

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

1. Spastic (most common type, 70 – 80%)

2. Athetoid/Dyskinetic

3. Ataxic (most rare form)

4. Atonic

 

29

Sx of what type of CP? 

UMN lesions/sx

spastic CP (most common type)

30

Sx of what type of CP? 

slow, smooth, writhing movements that involve distal muscles

Athetoid CP