CLIPP 19 Flashcards
what ages is toxin ingestion most likley
9m and 3y
epilepsy defn
2+ unprovoked seizures
30-40% kids with meningitis can present w/ __ and may only see _ on exam
seizure activity - may only see fever and irritability on exam
common causes of encephalitis in kids are
enterovirus, herpes
intussusception is usually involving
TI telescoping into colon and in between colicky states can have lethargy and near-unresponsiveness, as well as vol loss due to vomiting and third spacing–>AMS ~ to dehydration
breath holding spells can lead to
syncope - there is a precip event typically that upsets child and this leads to crying and hyper vent and expiratory apnea –>pale and cyanotic and brief LOC and limp
- typically these self resolve but occ., can lead to brief ten seizure due to hypoxia
- no post octal state in syncope due to beaht holding
most common type of seizure in kids
tonic clonic aka grand map -this type of seizure event begins abruptly with tonic (rigid) stiffening of all extremities and upward deviation of the eyes.
Clonic jerks of all extremities follow the tonic phase.
Finally, the child becomes flaccid and urinary incontinence may occur.
simple partial
start in one extremity or on one side but can spread making it hard to distinguish from tonic clonic
complx partial
alteration of consciousness is hallmark -
Signs and symptoms of this type of seizure tend to localize around the eyes (glassy-eyed), the mouth (lip-smacking, drooling, gurgling), and the abdomen (nausea and vomiting).
Automatisms are quasi-purposeful motor or verbal behaviors that are repeated inappropriately and commonly accompany complex partial seizures.
Complex partial seizures often last 30 seconds to 2 minutes and are associated with a postictal phase of confusion, sleep, or headache.
Secondary generalization can occur in up to one third of children, so it is important to question witnesses about initial features to help differentiate a complex partial seizure from a generalized seizure
what age ~ do petit mal seizures start
3 yo, characterized by loss of environmental awareness (“staring off into space”) and automatisms (e.g., eye-fluttering or lip-smacking).
While these are generalized seizures, children usually regain their consciousness more quickly than the postictal phase seen in a generalized tonic-clonic seizure.
Absence seizures are not associated with loss of tone or urinary continence.
Absence seizures can be precipitated by hyperventilation or photic stimulation.
petit mal =
absence
which type of seizure is typically not assoc w loss of tone or urianry incont
absence/petit
things that can help u distinguish seizure from seizure like activity
A history of alteration of consciousness or loss of consciousness
Incontinence
Deviation of the eyes
Often rhythmic motor movements that cannot be stopped by touching or holding the child
A postictal state.
To address these issues, you may want to ask whether the child was distractible, and if the event could be interrupted. In addition, children who are old enough to verbalize may describe an aura or “premonition” prior to the onset of a seizure, or caregivers may be able to articulate unusual behavior just prior to the even
febrile seizures are /are not tonic clonic - typical ages, what does presence of fever mean, assoc between fever and seizure
are tonic clonic, 6m to 5y, fever may cause seizure or may coincidentally be there, can be viral benign infectetion that causes fever that causes seizure, or can have infection that causes not just fever but also seizure
if pt w seizure has a fever you must
investigate both the sources of seizure and of fevr
rapid seizure recovery makes this unlikely
hypoglycemia
presence of fever means these measurement
(temperature > 38 degrees C or 100.4 degrees F)
what time periods are key for things that can cause seiure
prenatal, peri and neonatal
stoops and recovers, uses 4-6words consistently, follows basic commands, uses spoon and cup w/ occas. spilling = by which age should you reach all these
Abnormalities in neurodevelopmental maturation could suggest serious underlying disease in a child with seizures. On the other hand, you would expect most children with febrile seizures to be developmentally normal.
Pre-existing developmental abnormalities are a risk factor for subsequent epilepsy.
Pre-existing developmental abnormalities are a risk factor for subsequent _
epilepsy
are febrile seizures hereditary
yes- 8q13-21 (often called FEB1), 19p (FEB2), 2q 23-24 (FEB3) and others.
febrile seizures often occur on fever day _ w/ fever > degrees and are often this type of seizure
1, 38, generalized
seizure related to head injury typically occurs _ hours after injury
1-2
symptomatic vs idiopathic epilepsy
symptomatic = kid w/ epilepsy w/ developmental delay due to development, congenital or acquired disorders idiopathic = kid w/ epilepsy who is developmentally normal
duration of seizures w/ breath holding spells
generally quite brief
seizure from brain tumor or other intracranial mass typically presents as this type of seizure
partial
occult bacteremi
febrile kids w/o discernible foci of infection may have this - usually due to strep pneumo. hib uncommon here now due to vaccine. undiagnosed, can lead to serious bacterial infxn (septic arhtirirst, osteomyel, pneumonia, uti, bacterial gastro, meningitis. occult is also a type of sbi)
meningitis in young kids
clinical signs and sx of this can be subtle thus it stays on the ddx even if meningieal signs are (-)
viral culture thing to remember
takes at least 2 days to return. can do direct antigen testing etc that is faster if needed
when doing UA/UC
specimen only is as good s the samepl -thus have to cath typically. typically do in females <12 months if not circ.
Sometimes a _ is performed before a lumbar puncture in the work-up for infection. This is only necessary when there are concerns for elevated intracranial pressure.
CT
_ and _ have characteristic EEG findings of _ and _
absence seizures and infantile spasms have characteristic EEG findings such as 3-Hz spike-and-wave pattern and hypsarrhythmia,
CT vs MRI in epilepsy work up
CT for calcifications like in tuberous sclerosis, CMV
MRI frequently performed in epilepsy evaluation - more likely to be abnormal in kids w/ focal rather than generalized or febrile seizures, and has better rez than CT thus can better ID temporal sclerosis, vascular malformation and parnecyhmal malformation
LP - spine level, what you feel as dr, opening pressure
L3-4 or L4-5, feel a pop except in neonates, drip the fluid into tubes don’t aspirate it ,opening pressure not of value of pt is struggling , and less accurate if neck nd thighs are flexed
meningitis complicatiosn
stroke, subdural effusion, siadh. also sequelae like dvpt delay, seizure, hearing loss
meningits tx
3rd gen IV ceph + vanc for 7-14 days. often given pending culture results and in serious cases, even before cultures drawn
cause of bacterial men in immunized 2 month to 2 yo=
and in yonger infants =
SP, NM
Ecoli, GBS (agalactie)
truamatic tap
needle penetrates blood vessel. wbc typically mean infection but in traumatic tap mean its from blood contaminant. hard to sometimes differentiate traumatic from hemorrhage. if can’t determine if the tap is truatmic or truly illness, admit for iv abx til csf culture is neg.
Often a RBC/WBC ratio of approximately 250:1 is used. This can be generated by looking at the patient’s CBC and dividing the RBC count (in millions/microliter) by WBC (in thousands/microliter). - helps determine true deg. of csf leukocytosi but is rough estimator.
viram meningitis LP results in terms of csf protein, glucose, wbc, csf glucose:blood glucose ratio
protein, glucose and ratio are normal
wbc are high
Patients with viral meningitis (often caused by enteroviruses) will have a CSF pleocytosis (D), usually with a CSF WBC count ranging from 20 to 200 WBC/hpf.
Lymphocytes are generally predominant, but some patients may have a predominance of CSF polymorphonuclear cells in the first 24 to 48 hours of their infection.
Patients with meningoencephalitis due to herpes virus may also have an elevated RBC count in the CSF.
classification of febrile seizure
simple vs complex (not the same as simple and partial!)
simple= more common, less tha n15 min, once in a 24h period , generalized
if kid has first febrile seizure under 12 months, risk of recurrence is _ vs if after 12 montsh
50%, 30%
epilepsy and debrile seizures
if many recurrent early febrile seizures, can up the chance of epilsepy . This is to be compared to essentially the same risk as the normal population in a child with one or two simple febrile seizures and no other features.
This medication is effective in preventing recurrence of simple febrile seizures but also has a high side effect profile.
primidone
This medication is effective in preventing recurrence of simple febrile seizures but carries with it the dreaded side effect of hepatotoxicity.
valproic acid
Has not been shown effective in preventing febrile seizure recurrence.
carbamez, phentyotin
given at the start of the febrile illness, can be effective in preventing recurrent febrile seizures.
diazepam - but since some fevers might have sizure as presenting sx, its not always effective - also the SE profile can cloud impacts of CNS disease thus it is not reocmmended
– is effective in preventing recurrence of simple febrile seizures when given regularly and the drug levels remain in therapeutic range.
Studies have shown that there is poor adherence to therapy and serious side effects in at least 20% of patients.
phenobarb
do ibu and tylnole help rpevent recurrent febile seizure
no
bulging fontanelle can mean
roseola
common febrile rash illness of infants and young children under 2 years of age.
roseola aka Roseola infantum (also known as exanthem subitum, or sixth disease or hhv6)
Primary– infection is associated with approximately 20% to 30% of first febrile seizures in children.
HHV6
ABsence vs generalized seiure recovery
both are generalized seizures but in absence, you recover within 30ish seconds
ETEC
is the strain of E. coli that commonly causes traveler’s diarrhea, a noninvasive infection without WBCs in the stool. Diarrhea is typically watery and contains no blood.
organism that can –>seizure
Shigella sonnei causes bloody diarrhea and WBCs in the stool on Wright stain. Rarely, children infected with Shigella can suffer from seizures due to neurotoxin release.
is rota virus assoc w/ seiure
Rotavirus is the most common cause of infectious gastroenteritis. It is an RNA virus that does not cause WBCs to appear in the stool, and typically does not cause bloody diarrhea. Diagnosis is made using ELISA. Rotavirus is not associated with seizures.
eeg indicatiins
recuuent focal or complex seizure
