Peds Neuro

Question 1

What are considered worrisome signs of Headaches

Answer 1

All indicate ICP

1. Headache is so severe it wakes at night
2. Exacerbated by coughing, bending or valsalva movements
3. Progressive daily worsening of headache

Question 2

What are migraines accommodated with?

What usually relieves them

Answer 2

accommodated with vomiting

relieved by rest/sleep

Question 3

What are typical pediatric symptoms seen with Migraines in peds?

Answer 3

Frontal, bitemporal or unilateral throbbing for 2-72 hrs.

Symptoms are relieved by sleep

Possible visual aura

N/V, abdominal pain, phono/photophobia

Question 4

What is a good way to eliminate migraine triggers?

Answer 4

HA DIARY!

Triggers- diet, menses, stress.

Increase exercise, sleep, routines

Question 5

How are migraines in peds acutely treated?

Answer 5

NSAIDS,
APAP,
triptans (nasal sumitriptan approved >12 y/o),
antiemetics (Compazine-Benadryl-Toradol)

Question 6

What are prophylactic treatments for migraines in children younger than 6 and older than 6?

What supplement can also be used for prevention

Answer 6

< 6 years old : cyproheptadine

> 6 years old propranolol, amitriptyline, topiramate, others

Non pharmacological options: Vitamin B12 (riboflavin) 25-400mg once daily (w/ food)

Question 7

What is Idiopathic Intercranial Hypertension

Answer 7

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

Question 8

What do IIH not have?

What is the most common risk factor in getting these?

Answer 8

No space occupying lesion

obesity

Question 9

What are signs associated with Idiopathic Intracranial Hypertension?

Answer 9

Headache 
Transient visual obscurations
Intracranial noises (pulsatile tinnitus) 
Diplopia
Back pain
Di

Question 10

What diagnostic criteria must be met to diagnose IIH?

Answer 10

• 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

Question 11

What is contraindicated when trying to diagnose IIH? Why?

What diagnostic test should be done further?

Answer 11

Lumbar puncture!
Increased ICP may cause cerebral herniation when LP is performed if obstructive hydrocephalus or mass

Imagine before LP!

Question 12

What is the main complication seen in IHH/Pseudo Tumor Cerebri?

Answer 12

Vision loss

Question 13

What is Cerebral Palsy?

Answer 13

Cerebral palsy (CP) refers to a heterogeneous group of conditions involving permanent non-progressive central motor dysfunction that affect muscle tone, posture, and movement-

Question 14

What are postnatal causes of Cerebral Palsy?

Answer 14

Stroke
Kernicterus
Trauma
Near-drowning
Toxins
Hypoxic brain injury

Question 15

What are prenatal causes of Cerebral Palsy

Answer 15

Prematurity
Intrauterine growth restriction
Intrauterine infection

Question 16

What are the most common milestones not reached in kids with Cerebral palsy?

Answer 16

Not sitting by 8 mo
Not walking by 18mo
Early asymmetry of hand function (hand preference) before 1yr

Question 17

Most common classification of cerebral palsy?

What type of motor neuron lesion is this?

Answer 17

Spastic
(most common type, 70 – 80%)

features of an upper motor neuron syndrome

Question 18

Treatment goals of CP?

Answer 18

Social and emotional development and MORE ON SLIDE

Question 19

What is Spina bifida?

Answer 19

Neural tube disorder (NTD)= defective closure of the caudal neural tube early in gestation (about week 4)

Question 20

What spinal levels are seen with spina bifida?

Answer 20

May be just defect of L5 and S1 vertebral arch

Question 21

What is Meningomyelocele?

Answer 21

Meninges and spinal cord exposed;

Question 22

What is Meningocele

Answer 22

Spinal canal and meninges are exposed, underlying spinal cord is intact

Question 23

What is Spina bifida occulta?

Answer 23

Skin intact but underlying defects in bone and spinal canal present. May see sinus tract, dimple or tuft of hair.

Question 24

How is spina bifida prevented?

Answer 24

Folic acid?

Question 25

What two things need to be seen to diagnose Spina Bifida?

Answer 25

Routine screening w/ alpha-fetoprotein (AFP) level (16-18 w) in maternal serum

US (12-14 w & 18-20 w)

Question 26

How is Spina Bifida treated?

Answer 26

Surgical closure

VP shunt

Question 27

What is chiari malformations?

Answer 27

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 cana

Question 28

What spina bifida formations also tend to have chiari malformations?

Answer 28

myelomeningocele

Question 29

Difference between communicating and non-communicating hydrocephalus?

Answer 29

Communicating: CSF circulates through the ventricular system & into the subarachnoid space w/o obstruction

Non communicating: an obstruction blocks the flow of CSF w/in the ventricular system or blocks the egress of CSF from the ventricular system into the subarachnoid space

Question 30

What are signs and symptoms related to Hydrocephalus?

What are signs and symptoms seen in infants?

Answer 30

HA, vomiting, altered mental status, visual changes, ocular nerve palsies, and focal neurologic findings.

vomiting, lethargy, irritability, bulging fontanelle, or poor feeding, macrocephaly, excessive rate of head growth

Question 31

What are both temporary and surgical treatments for Hydrocephalus

Answer 31

Temporary: Loop diuretic and Acetazolamide

Surgery: remove obstruction or VP SHUNT