CLIPP 20 Flashcards
nature of tension headaches
episodic, worse throughout day, band like with accompanying tenderness of posterior neck
most common cause of recurrent headache in kids
migraine
classic vs common migraine
classic = w/ aura common = w/o aura - is most common type seen in kids
signs of increased ICP in terms of HA sx
HA + projectile vomiting, HA worsening w recumbency, HA awaken from sleep, HA worse w/ valsalva/cough,
headache in child w/ photo and phono phobia
could be migraine but also could be meningitis/encephalities
dennie’s lines
nfraorbital transverse creases and are associated with mild chronic inflammation of the conjunctivae, as in allergic conjunctivitis
cobblestoning
Refers to the 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
romberg test
The Romberg test is performed by asking the patient to stand with feet together and arms extended anteriorly, palms upward.
Romberg test is abnormal (+) with eyes opened and eyes closed.
cerebellar pathology
the Romberg test will be + only with eyes closed; vision helps the patient compensate for the loss of sensation
dz resulting in abnormal position sense
things causing pseudo tumor cerebri
Tetracycliens, vit A, galactosemia, hypothy, obesity,
dx criteria pseudotumor cerebri
Increased intracranial pressure (with associated symptoms such as headache and vomiting)
Normal brain anatomy
Normal cerebrospinal fluid.
The diagnostic test is an elevated CSF opening pressure during a lumbar puncture.
major sequelae of PTC
blindness resulting from transmission of elevated CSF pressure to the optic nerve sheath.
when would you not need brian mri in context of bad headache
normal physical and neurologic examinations and lack of symptoms associated with increased intracranial pressure
ataxia
lack of coordination of muscle movements and is a non-specific neurologic sign which can result from dysfunction in various parts of the nervous system that coordinate movement, such as the cerebellum, the inner ear, and the dorsal columns.
Ataxia can be congenital or acquired.
most common cause of acute cerebellar ataxia in kids
post infectious cerebelitis aka acute cerebellar ataxia, happens in 1-3yo, dx of exclusion, follows a viral infxn like vaicella or cocksackie and leads to AI demyelination of cerebellum.
- will see vom, nystag, ataxia suddnely but few if any systemic sx
- csf can show pleocytosis, w maybe high prot
- most kids recover on own within a few months
infectious cerebellitis
fever often , as well as AMS
-can be bacterial or viral
types of meds that can lead to ataxia and how it presents
xposure to a medication such as an anticonvulsant, or to a toxin such as alcohol (or even to sedating anthistamines) can lead to acute ataxia.
The ataxia may be accompanied by nystagmus and dysmetria and is usually bilateral, owing to diffuse involvement of the cerebellum including the vermis and the cerebellar hemispheres.
opsoclonus myoclonus syndrome
araneoplastic 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).
what kind of headaches are due to ataxia and how do they present
Basilar artery migraines or hemiplegic migraines can cause recurrent intermittent episodes of acute ataxia.
Accompanying symptoms may include intermittent loss of vision, change in speech, headache and vomiting.
hydrocephalus ataxia
insidious onset, vomiting, headache
taxia may be intermittent or chronic with intermittent exacerbations when it is due to–
metabolic dz
his gait is wildly erratic and involves lurching of the body which requires extraordinary balance.
The child is generally able to sit without difficulty, but when put in a standing position, immediately begins to sway at the waist.
consider conversion disorder
can stress rxn or tension HA cause ataxia
no but conversion disorder can
vermis/ midline cerebellar lesiosn
dysarthria, truncal ataxia, and gait abnormalities.
cerebellar hemispheric lesions
ipsilateral limb abnormalities, nystagmus, tremor/dysmetria and tend to spare speech.
what lesions spare spech
cerebellar hemispheric lesiosn
Patients fall _ the side of the lesion and have worse nystagmus when they look _ the side of the lesion.
toward, tworad
Lesions of the - cause resting tremor, myoclonus, and opsoclonus such as that seen in children with a -.
deep cerebellar nuclei, NB
where do germ cell brain tumors typically present and they make what?
pineal or suprasellar region
make b hcg or AFP
cause visual or CN deficits
focal motor and sensory abnormalities, on the side opposite to the lesion
supratentorial
cerebellar signs and raised ICP
infratentoiral
CN and gaze palsies
brainstem tumors
change in muscle tone/DTR and hyporeflex and hypoton
cerebellar hemispheriec lesions
Brain tumors are the _solid tumor in children and are the _ form of childhood cancer behind leukemia.
most common, second most common
Deaths caused by childhood brain tumors are the _ among all childhood cancer deaths.
highest
incidence of brian tumors peaks in
1st decade
gender brain tumor
typically males esp for ependymoma and medullo
location of tumor and age
Supratentorial tumors are more common in the first 2 years of age; for the rest of the first decade, infratentorial tumors predominate.
In adolescence and adulthood, supratentorial tumors once again become more common.
RF brain tumros
ionizing radio
genetics like li fraumeni, TS, NF
most common brain tumors
Medulloblastoma (20%),
Juvenile pilocytic astrocytoma (20%)
Low-grade astrocytoma (15%)
High-grade astrocytoma (7%)
ependymoma
arises from the 4th ventricle , lead to hydroceph
best prognosis of all infratent
astrocytoma
which tumor has cystic component
astrocytoam
most common peds brian tumor infratent
medulo PNET
which tumor can specifically be noted to metast to extracran sites
medullo
which tumor is noted to specifically use chemo along w/ rads/surg
med
5 most common complications of brain tumor
Neurocognitive defects Attention deficit disorder Learning disabilities Endocrine abnormalities, and Stroke
most common location of peds brian tumros
posterior fofssa
