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Flashcards in Peds - Neuro Deck (44):
1

Mechanisms of headache pain (4)

o VASCULAR dilation - migraine, fever
o MUSCULAR contraction - tension
o TRACTION - space-occupying lesion - tumor, hematoma, ICP
o INFLAMMATION - infection

2

OLD CARTS

Onset
Location
Duration
Characteristics
Aggravating
Relieving
Treatment
Severity

3

Diagnostic testing for headache with fever
(when meningitis is suspected)

Lumbar puncture --> CSF analysis

4

CSF findings in meningitis (4)

o cloudy
o WBCs present
o increased protein -- bacteria are protein
o decreased glucose -- bacteria eat sugar

5

Differential for headache which is worst in the morning followed by vomiting, usually increasing in frequency.

brain tumor

6

Caution when considering lumbar puncture.

Do not perform if any suspicion of ICP. May cause brain herniation. :-(

7

Which type of migraine has an aura?

classic

8

Which type of migraine has NO aura?

common

9

Is migraine unilateral or bilateral?

unilateral and localized

10

What age does classic (w/ aura) migraine usually occur?

> 10 years old

11

When should prophylactic therapy be used for migraine?

when occurring more than 3-4 times per month or are interfering with work or school

12

Typical age range for bacterial meningitis?

1 month to 5 years

13

Typical age range for brain tumor in children?

4 to 11 years

14

Typical location for brain tumor in children?

infratentorial, brain stem tumors
(lots of space to grow undetected)

15

Migraine baseline studies
4 bw + 1 imaging

For exclusion of other causes --
CMP - complete metabolic panel
CBC - complete blood count (r/o anemia)
VDRL - venereal disease research (r/o syphilis)
ESR - erythrocyte sedimentation rate
CT - cat scan

16

Agents used for prophylaxis of migraine (5)

o NSAIDS - chronic low dose
o propanalol (Inderal) -- beta blocker
o amatriptyline (Elavil) -- antidepressant
o imipramine (Tofranil) -- antidepressant
o topiramate (Topamax) -- antiepileptic
o verapamil (Calan) -- calcium channel blocker

17

Management of acute migraine

o NSAIDS
o -triptans

18

These drugs are examples of what class?

Imitrex
Maxalt
Axert
Zomig

TRIPTANS

almotriptan
rizatriptan
sumatriptan
zolmitriptan

19

Caution for use of triptans?

avoid in children at risk for HEART DISEASE because they can cause heart block

20

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

Seizure disorder

21

Which type of seizure occurs in only one hemisphere?

partial seizures

22

Variant syndromes of migraine in children usually involve what?

The abdomen - nausea, vomiting

23

Which triptan is limited to those age 12 and up?

almotriptan (Axert)

24

Which triptan is available as a nasal spray?

zolmitriptan (Zomig)

25

When should triptans be taken?

At the first sign of headache

26

What are the two overarching categories of seizures?

Partial
Generalized

27

What are the two types of partial seizures?

simple partial
complex partial

28

Which type of partial seizure involves the loss of consciousness?

complex partial

29

What are the four types of generalized seizures?

Absence
Tonic
Tonic-clonic
Atonic

30

Which category of seizures involves both hemispheres of the brain?

generalized seizures

31

What are some potential causes of seizures? (6)

o congenital
o metabolic
o trauma
o tumor
o infectious
o fever

32

What are some symptoms of a simple partial seizure?

motor
autonomic
sensory

** NO loss of consciousness **

33

Which seizure exhibits a sudden increase in muscle tone producing a number of characteristic postures?

Tonic

34

Is consciousness lost during a TONIC seizure?

It may or may not be

35

Which seizure is characterized by a sudden loss of consciousness, arrested respirations, and increased muscle tone followed by bilateral rhythmic jerks?

Tonic-clonic

36

Which type of seizure is characterized by sudden loss of muscle tone, often resulting in head drop or fall to the ground?

Atonic

37

What drug class is used to stop convulsive seizures?

benzodiazepines

o lorazepam (Ativan)
o diazepam (Valium)

38

Peak incidence of febrile seizure?

1 to 3 years

39

When is an-illness related seizure more likely due to infection than fever?

> 24 hours after the onset of the fever

40

A progressive, autosomal dominant, neuro-cutaneous syndrome characterized by numerous cafe au lait spots and nerve tumors

Neurofibromatosis / von recklinghausen disease

41

Neuro-fibromatosis --
Typical signs and symptoms (6)

o multiple cafe au lait spots
o seizures
o neurofibromatomas
o axillary or inguinal freckling
o lisch nodules
o distinctive osseous lesions

42

Medications which may be associated with tics. (3)

o methylphenidate
o pemoline
o amphetamines

43

Distinction of complex from simple motor tics

complex include VOCAL tics

44

The most common type of headache with onset in adolescence is:

tension