CLIPP 20 - Astrocytoma

Question 1

DDX HA (5)

Answer 1

• increased ICP (forceful vomiting, after lying down, awakens from sleep, worse with valsalva)
• ICH (sudden onset)
• meningitis/encephalitis (photophobia, fever)
• migraine
• intracranial abscess

Question 2

DDX Ataxia (10)

Answer 2

• post-infectious cerebellitis
• infectious cerebellitis (fever, AMS)
• medication/toxin ingestion
• intracranial mass (cerebellum or frontal lobe)
• opsoclonus-myoclonus syndrome (neuroblastoma paraneoplastic syndrome)
• migraine
• hydrocephalus (insidious, headache + vomiting)
• metabolic disease (maple syrup urine, pyruvate decarboxylase)
• neurodegenerative disease (loss of developmental milestones, ataxia-telangiectasia, Friedrich ataxia)
• Psychiatric Illness (conversion disorder)

Question 3

Common Childhood brain tumors (4)

Answer 3

• brain stem gliomas
• ependymomas
• astrocytomas
• medulloblastomas

Question 4

Tension HA (trigger and 5 features)

Answer 4

• stress
• episodic
• worsens throughout day
• mild to moderate intensity
• band around head +occipital area
• posterior neck muscle tenderness

Question 5

Migraine HA (4 triggers, 6 features, alleviator)

Answer 5

• severe pain
• throbbing
• photophobia, phonophobia, abdominal pain, N/V
• stress, bright lights, odors, foods
• relieved by sleep

Question 6

Migraine variant periodic syndromes (3)

Answer 6

• cyclical vomiting
• abdominal migraines
• benign paroxysmal vertigo

Question 7

“classic” vs “common” migraine

Answer 7

Classic: accompanied by an aura
Common: more frequent type, no aura, unilateral/frontal/temporal

Question 8

VS associated with serious infectious process (3)

Answer 8

fever + tachycardia + headache

Question 9

Cushing’s Triad

Answer 9

• increased blood pressure, bradycardia, irregular respirations
• suggestive of increased ICP

Question 10

Physical Findings associated with allergies (4)

Answer 10

• allergic “shiners” (undereye swelling)
• allergic salute (nose crease)
• Dennie’s lines (undereye creases)
• Cobblestoning (eyes and oropharynx)

Question 11

Cerebellar lesions (3)

Answer 11

• vermis (dysarthria, truncal ataxia, gair abnormalities)
• hemispheres (ipsilateral limb abnormalities, nystagmus, tremor/dysmetria)
• deep cerebellar nuclei (resting tremor, myoclonus, opsoclonus)
• fall towards side of lesion and nystagmus when looking to that side

Question 12

Neurologic exam findings (4)

Answer 12

• infratentorial = cerebellar signs, increased ICP
• Cerebellar hemispheric = hypotonia and hyporeflexia
• supratentorial = focal motor and sensory abnormalities on contralateral side
• brain stem = cranial nerve and gaze palsies

Question 13

Complications of childhood brain tumors (5)

Answer 13

• neurocognitive defects
• ADD
• learning disabilities
• endocrine abnormalities
• stroke

Question 14

Components of HA diary (7)

Answer 14

• character of HA
• duration
• location
• associated symptoms
• activity at time of onset
• potential triggers
• alleviating factors