Peds Neuro Flashcards
(31 cards)
What are considered worrisome signs of Headaches
All indicate ICP
- Headache is so severe it wakes at night
- Exacerbated by coughing, bending or valsalva movements
- Progressive daily worsening of headache
What are migraines accommodated with?
What usually relieves them
accommodated with vomiting
relieved by rest/sleep
What are typical pediatric symptoms seen with Migraines in peds?
Frontal, bitemporal or unilateral throbbing for 2-72 hrs.
Symptoms are relieved by sleep
Possible visual aura
N/V, abdominal pain, phono/photophobia
What is a good way to eliminate migraine triggers?
HA DIARY!
Triggers- diet, menses, stress.
Increase exercise, sleep, routines
How are migraines in peds acutely treated?
NSAIDS,
APAP,
triptans (nasal sumitriptan approved >12 y/o),
antiemetics (Compazine-Benadryl-Toradol)
What are prophylactic treatments for migraines in children younger than 6 and older than 6?
What supplement can also be used for prevention
< 6 years old : cyproheptadine
> 6 years old propranolol, amitriptyline, topiramate, others
Non pharmacological options: Vitamin B12 (riboflavin) 25-400mg once daily (w/ food)
What is Idiopathic Intercranial Hypertension
Disorder defined as symptoms and signs isolated to those produced by increased intracranial pressure (eg, headache, papilledema, vision loss), elevated intracranial pressure with normal cerebrospinal fluid composition, and no other cause of intracranial hypertension
What do IIH not have?
What is the most common risk factor in getting these?
No space occupying lesion
obesity
What are signs associated with Idiopathic Intracranial Hypertension?
Headache Transient visual obscurations Intracranial noises (pulsatile tinnitus) Diplopia Back pain Di
What diagnostic criteria must be met to diagnose IIH?
- Papilledema OR sixth (abducens) nerve palsy (unilateral or bilateral)
- Normal neurologic examination, except for papilledema and cranial nerve abnormalities
- Neuroimaging shows normal brain parenchyma without evidence of hydrocephalus, mass, structural lesion, or meningeal enhancement
- Normal cerebrospinal fluid (CSF) composition
- Elevated lumbar puncture opening pressure
What is contraindicated when trying to diagnose IIH? Why?
What diagnostic test should be done further?
Lumbar puncture!
Increased ICP may cause cerebral herniation when LP is performed if obstructive hydrocephalus or mass
Imagine before LP!
What is the main complication seen in IHH/Pseudo Tumor Cerebri?
Vision loss
What is Cerebral Palsy?
Cerebral palsy (CP) refers to a heterogeneous group of conditions involving permanent non-progressive central motor dysfunction that affect muscle tone, posture, and movement-
What are postnatal causes of Cerebral Palsy?
Stroke Kernicterus Trauma Near-drowning Toxins Hypoxic brain injury
What are prenatal causes of Cerebral Palsy
Prematurity
Intrauterine growth restriction
Intrauterine infection
What are the most common milestones not reached in kids with Cerebral palsy?
Not sitting by 8 mo
Not walking by 18mo
Early asymmetry of hand function (hand preference) before 1yr
Most common classification of cerebral palsy?
What type of motor neuron lesion is this?
Spastic
(most common type, 70 – 80%)
features of an upper motor neuron syndrome
Treatment goals of CP?
Social and emotional development and MORE ON SLIDE
What is Spina bifida?
Neural tube disorder (NTD)= defective closure of the caudal neural tube early in gestation (about week 4)
What spinal levels are seen with spina bifida?
May be just defect of L5 and S1 vertebral arch
What is Meningomyelocele?
Meninges and spinal cord exposed;
What is Meningocele
Spinal canal and meninges are exposed, underlying spinal cord is intact
What is Spina bifida occulta?
Skin intact but underlying defects in bone and spinal canal present. May see sinus tract, dimple or tuft of hair.
How is spina bifida prevented?
Folic acid?
