9 - Pediatric Neurology Flashcards
Only drug that may be used for benign infantile seizures
Phenobarbital
Most common type of benign epilepsy syndrome
Benign childhood epilepsy with centrotemporal spike
Triad of West syndrome
Infantile epileptic spasm
Developmental regression
EEG = hypsarrhythmia
Triad of Lennox-Gestaut syndrome
• Developmental delay
• Multiple seizure type
• EEG = 1-2Hz spike and slow waves, polyspike bursts in sleep and slow background in wakefulness
Simple febrile seizure
• Generalized
• Less than 15 mins
• No recurrence in the 1st 24 hours
• Absent focal signs in the post-ictal period
Lumbar puncture indications for first febrile seizure (CNSP, 2017)
All patients below 18 months old;
With clinical signs of meningitis
Major risk factors for recurrence of febrile seizures
<1 year old
Duration of fever <24 hours
Fever 38-39°C
Greatest risk factor for occurrence of subsequent epilepsy after a febrile seizure
Neurodevelopmental abnormalities
Most common seizure disorder in childhood
Simple febrile seizure
First step in management of status epilepticus
Securing airway, breathing, circulation
Initial emergent therapy for status epilepticus
IV diazepam or lorazepam
Most commonly associated viral infections with febrile status epilepticus
HHV-6 and HHV-7
Triad of imaging findings in TB meningitis
• Hydrocephalus
• Basal enhancements
• Infarcts
Absolute contraindications to lumbar puncture
• Signs of increased ICP
• Local infection at desired punctured site
• Radiological signs of obstructive hydrocephalus, cerebral edema or herniation, presence of intracranial lesion, or midline shift
Recommended treatment for Neisseria meningitidis invasive infections in the neonate
Cefotaxime
Most frequently identified symptom in meningococcemia
Fever
Drug of choice for meningococcemia
Penicillin G
Empiric antibiotic for bacterial meningitis in neonates
Ampicillin or Cefotaxime + Aminoglycoside
Empiric antibiotic for bacterial meningitis in 1mos-18 years old
Ceftriaxone or Chloramphenicol
Brain structure involved in Chiari I malformation
Cerebellar Tonsils
Brain structures involved in Chiari II malformation
Inferior vermis Brainstem
Treatment of migraine in children
• Analgesics: Acetaminophen or Ibuprofen
• Antiemetics: parenteral metoclopramide
Indications for cranial CT or MRI in a child with headache
• Abnormal neurologic signs
• Behavioral changes, recent school failure, fall- off in linear growth rate
• Headache that awakens from sleep
• Migraine and seizure occur in the same episode
• Focal neurologic signs
• Cluster headaches in <5yrs old
Treatment for status migrainosus
IV prochlorperazine
Indications for prophylactic therapy in children with migraine
• More than 2-4 episodes monthly
• Unable to attend school regularly
• PedMIDAS >20
Prophylactic treatment for migraine
Propranolol for >7 years old
Flunarizine
Candle-dripping appearance on neuroimaging
Tuberous sclerosis
NF-1
• Café au lait macules
• Axillary or inguinal freckling
• Lisch nodules
• Neurofibromas
• Osseous lesion
• Optic glioma
NF-2
• Acoustic neuroma
• Parent, sibling, or child with NF-2 and either acoustic neuroma or any 2 of the ff: neurofibroma, meningioma, glioma, schwannoma
Ash leaf lesions, shagreen patch
Tuberous sclerosis
Pattern of weakness in GBS
Ascending symmetric paralysis
Miller-Fisher syndrome
Acute ophthalmoplegia
Ataxia
Areflexia
CSF analysis in GBS
Albuminocytologic dissociation
Most common malignant brain tumor in children
Medulloblastoma
Most common location of brain tumors in children
Infratentorial
Most common cause of arterial ischemic stroke in children
Arteriopathy
Most common artery involved in pediatric stroke
Middle cerebral artery
Diagnostic of choice in cerebral sinovenous thrombosis
Contrast CT venography or MR venography
Drug of choice for pediatric depression
Fluoxetine
