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Peds PM&R > CNS Disorders > Flashcards

CNS Disorders Flashcards

1
Q

Multiple Sclerosis

A

Autoimmune progressive demyelinating dz of the CNS

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2
Q

MS Clinical features

A 
Optic neuritis
Fatigue
Bladder dysfunction
Uhohoff's phenomenon: heat causes worsening sx
Muscle weakness
Sensory deficits
Ataxia
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3
Q

MS Testing

A

Oligoclonal bands and inc IgG in CSF

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4
Q

What Criteria do you use to Dx MS?

A

McDonald’s Criteria

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5
Q

Myelomeningocele

A

Dev birth defect of the neural tube resulting in spinal deformity involving SC, nerve roots, vertebrae and skin often in lumbar or sacral spine

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6
Q

Anencephaly

A

Cephalic end of neural tube fails to close resulting in absence of large portion of brain, skull and scalp

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7
Q

Spina bifida oculta

A

Defect in posterior bony elements of spine only, often asx

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8
Q

Meingocele

A

Protrusion of meninges through bony defect w/o accompanying nervous tissue

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9
Q

RF of neural tube defects

A

Maternal:

  • Folic acid deficiency
  • Obesity
  • Diabetes
  • Hyperthermia
  • Meds: Valporic acid, Carbamazepine
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10
Q

Penatal Dx of Neural tube defects

A

Maternal serum AFP
Prenatal US
Amniocentesis can confirm ABN results

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11
Q

Red flags in Neural tube defects

A 
Pain
HA
Inc difficulty in school
Rapidly advancing scoliosis
Chang in strength, ton or sensation
Change in bladder fx or sx
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12
Q

What can apnea, stridor or severe dysphagia represent in pts with neural tube defects?

A

Syrinx
Tethered cord
AC II manifestation
Shunt malfunction

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13
Q

Plagiocephaly

A

ABN shape of the had resulting from external forces

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14
Q

Brachycephaly

A

Back of the head has flattened uniformly

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15
Q

Scaphocephaly (dolichochephaly)

A

Head w/ long, narrow shape

Common in premature babies

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16
Q

Plagiocephaly RF

A 
Multiple gestation pregnancy
Assisted delivery
1st born child
Male sex
Prolonged supine positioning
Infrequent tummy time
SCM imbalance
Torticollis
Slow achievement of  motor milestones
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17
Q

Simple Partial Seizure

A

no LOC and generally short duration

Can have sensory, motor, autonomic or psychic sx

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18
Q

Complex partial seizure

A

Classically has an aura, associated w/ an impaired level of consciousness and automatism

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19
Q

Generalized Tonic/clonic (gand mal) seizure

A

Associated aura
LOC
Tonic/clonic bilateral movement patterns
Postictal phase

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20
Q

Tonic seizure

A

Tonic muscle contraction

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21
Q

Clonic seizure

A

Jerking motion

Can be asymmetric

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22
Q

Atonic seziure

A

Drop attacks
Loss of muscle tone
Impaired consciousness only last a few seconds
Head may drop forward

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23
Q

Absence or petite mal seizure

A

Sudden lack of awareness and lack of motor activity
Tone preserved
Seem “spaced out”

24
Q

Myoclonic seizures

A

Brief sudden contraction of muscle or group of muscles

25
Q

Vagal nerve stimulator

A

Implantable device which attaches to the left vagus nerve w/ a goal to prevent or interrupt a seizure

26
Q

Paraplegia

A

Paralysis of both lower limbs due to an injury or ABN of the thoracic, lumbar or sacral SC

27
Q

Expected bladder capacity

A

age in years + 2= ounces (x30 equals cc)

28
Q

Age to initiate bowel/bladder management in SCI

A

3 yo

29
Q

Age to begin self-cath and bowel program

A

Developmental age 5 yo

30
Q

Level of SCI o become a community ambulator

A

L3 o lower injury and preserved lower limb ROM

31
Q

Tetraplegia

A

Paralysis of both lower limbs due to an injury or ABN cervical SC

32
Q

How many levels of motor function will patients with complete C4 tetraplegia gain in the first year?

A

On motor level

33
Q

What age can SCI children use a sliding board for transfers?

A

5-7 yo

34
Q

Transverse Myelitis

A

Monofocal monophasic inflammatory d/o of the SC

35
Q

Diseases Associated with Transverse Myelitis

A 
CT d/o
Sarcoidosis
Bechet's dz
Sjogren's synd
SLE
Lyme dz
HIV
Mycoplasma
Herpes
Leukemia/lymphoma virus-1
Syphilis
36
Q

Transverse Myelitis Testing

A

Gadolinium enhanced MRI
LP for CSF analysis for WBC
Determine infectious cause
R/O compressive SC lesion

37
Q

Treatment of Transverse Myelitis

A

IV high dose steroids for 5 days then taper
PLEX if no improvement after 5-7 days of steroids
IV cyclophosphamide may be considered for aggressive or non responsive TM

38
Q

Prognosis of Transverse Myelitis

A

Most pts experience spontaneous recovery w/in 6 mo w/ additional improvement up to 2 years
Age at onset

39
Q

Anoxic Brain Injury/Hypoxic Ischemic Encephalopathy

A

Result of interrupted blood flow or oxygen supply to the brain

40
Q

Neuronal ATP depleted w/in ___ of anoxia

A

3-5 min

41
Q

Areas of greatest susceptibility to ischemia in the brain

A 
Vascular end zones (watershed)
Highest metabolism
Hippocampus
Cerebellum (purkinje cells)
Insular cortex
Basal ganglia
42
Q

Findings associated w/ poor outcomes w/ anoxic brain injury

A 
Ongoing CPR on arrival to ED
Absent brainstem reflexes at 24 hours
Anoxia >25 min
Water temp >10 deg celcius
Initial GCS 24 hours
Absent N20 waves on SEPs
Diffusion restriction in basal ganglia and cortex on MRI
43
Q

Infectious causes of Encephalopathy

A

Enteroviruses >80% of cases
Arboviruses
Herpesviruses

44
Q

Parainfectious causes of Encephalopathy

A

Acute demyelinating encephalomyelitis (ADEM)

45
Q

EEG findings in Viral Encephalitis

A

Diffuse, high voltage delta slowing

46
Q

EEG findings in Herpes Encephalitis

A

Periodic lateralized epileptiform discharges

47
Q

EEG findings in ADEM

A

High voltage slowing or normal EEG

48
Q

Tx of Herpes Encephalitis

A

Acyclovir

49
Q

Tx of ADEM

A

High dose steroids
IVIG
PLEX

50
Q

Shaken Baby Syndrome CF

A 
Retinal hemorrhages
Marks or bruises in unusual locations
Irritability
AMS
Apnea/resp compromise
Seizures
Poor feeding
Lethargy
Skull or other fx
51
Q

Mild TBI

A

Trauma-induced AMS hat may or may not involve LOC

GSC > or =13 w/o neuroimaging ABN

52
Q

Mild TBI CF

A

HA and dizziness MC

53
Q

TBI Red flags

A 
Focal neuro deficits
Mental status disorientation
Seizures
Significant vomiting
Dramatic worsening of HA
Skull fx or hematoma
History of high velocity trauma
Age
54
Q

Moderate to Severe TBI

A

Severe: GSC = 8 and duration of LOC >24 hours
Moderate: GSC 9-11 and duration of LOC 1-23 hours

55
Q

Second impact syndrome

A

Severe brain swelling after potentially mild TBI while individual is still sx from prior concussion

56
Q

Amyblyopia

A

Functional reduction in visual acuity from disuse during visual development

57
Q

Most CN injuries from trauma resolve w/in

A

6 mo

Peds PM&R (15 decks)

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