20- HA Flashcards
tension headache presentation
is most often episodic
generally worsens throughout the day
is of mild to moderate intensity
may feel like a band around the head or involve the occipital area with accompanying tenderness of the posterior muscles of the neck
tension HA triggers
emotional stress (at home, school or related to peer interactions), fatigue, lack of sleep, and other stressors.
atypical migraine examples
cyclical vomiting
abdominal migraines
benign paroxysmal vertigo
hints for life threatening HA
forceful vomiting- increased ICP
awaken from sleep- increased ICP
Worsens with cough or Valsava- ICP
sudden onset- intracranial hemorrhage.
+ fever, photophobia- infectious etiology such as meningitis or encephalitis.
progressively worsens
Post-infectious cerebellitis
kids 1-3
autoimmune –> cerebellar demyelination.
several weeks after a viral infection
ataxia, vomiting, nystagmus
recover completely within a few months
CSF- elevated protein
most common cause of acute ataxia in children.
Post-infectious cerebellitis
Infectious cerebellitis
viral-mumps, enteroviruses and Epstein-Barr virus.
bacterial- Streptococcus pneumoniae, Neisseria meningitidis and Haemophilus influenzae type B.
fever, mental status change
Opsoclonus-myoclonus syndrome
A paraneoplastic syndrome that occurs most often with neuroblastoma, generally occurs in the younger child (6 months-3 years).
Ataxia is accompanied by intermittent jerking movements (myoclonus) and erratic, jerky conjugate movements of the eyes (opsoclonus).
causes of ataxia
Opsoclonus-myoclonus syndrome Infectious cerebellitis Post-infectious cerebellitis meds, toxins intracranial mass migraine hydrocephalus metabolic disease neurodegenerative disease psych - conversion disorder
Basilar migraine
uncommon migraine variant.
young women or children, first develop
bilateral visual phenomena, transient cortical blindness may also occur.
Vertigo, ataxia
Incoordination of the limbs
Dysarthria, and
Bilateral limb and perioral paresthesias.
sometimes followed by transient LOC –> occipital throbbing headache + nausea and vomiting.
cerebellar lesions
Lesions within the vermis (midline) cause dysarthria, truncal ataxia, and gait abnormalities.
Cerebellar hemispheric lesions cause ipsilateral limb abnormalities, nystagmus, tremor/dysmetria and tend to spare speech.
Patients fall towards the side of the lesion and have worse nystagmus when they look towards the side of the lesion.
Lesions of the deep cerebellar nuclei cause resting tremor, myoclonus, and opsoclonus such as that seen in children with a neuroblastoma.
Infratentorial lesions
cerebellar signs and signs of raised intracranial pressure (ICP).
Cerebellar hemispheric lesions
changes in muscle tone and DTRs, but usually lead to hypotonia and hyporeflexia.
Supratentorial lesions
focal motor and sensory abnormalities on the side opposite to the lesion
Brain stem tumors
cranial nerve and gaze palsies
supretentorial vs infratentorial ages
supra- under 2, and teens, and adults
infra- kids over 2
effects of brain radiation /chemo
Neurocognitive defects Attention deficit disorder Learning disabilities Endocrine abnormalities, and Stroke.
risk factors for decreased IQ after brain radiation
Younger age at time of treatment Longer time elapsed since treatment Female gender Hydrocephalus Use of radiation therapy and its extent and dose.
Cobblestoning
sign of allergies
fine granular appearance of the palpebral conjunctivae resulting from edema and hyperplasia of the papillae.
Cobblestoning of the pharynx occurs with chronic nasopharyngeal drainage of allergic rhinitis and represents areas of lymphocytic hyperplasia.
brain stem gliomas
either quite aggressive, resulting in diffuse infiltration of the pons, or may be low-grade in nature, resulting in a focal tumor in the midbrain or medulla.
Surgical resection alone is required for low-grade gliomas. good prognosis
ependymomas
arise from within the fourth ventricle (from the ependymal lining) and cause symptoms related to hydrocephalus.
Treatment generally includes surgical resection, followed by radiation. 50% prognosis
astrocytoma of cerebellum
cystic
best prognosis
treatment: *surgery, or radiation (for high grade)
medulloblastoma
most common child brain tumor
capable of mets
tx: surgery, radiation, chemo
