Exam 2: Neurologic Disorders Flashcards
When in neural tube development?
first 3 to 4 wks gestation
Why is a babies brain at an increased risk for hemorrhage?
bc it is highly vascular
A child is at high risk for cervical spine injury why?
Spinal cord is mobile
True of False in a child’s neurological system their myelination isn’t complete.
true
What is hypotonia and who is it often seen in?
decreased muscle tone; down syndrome.
What is trauma or hypoxia to the brain or spinal cord known as?
neurologic insult
name the state of consciousness: limited responses to the environment, falls asleep unless stimulation is provided.
obtunded
name the state of consciousness: child cannot be aroused, even with painful stimuli
coma
name the state of consciousness: awake, alert, oriented x3, age appropriate behaviors.
full consciousness
name the state of consciousness: only responds to vigorous stimulation.
stupor
name the state of consciousness: disorientation exists, alert but responds inappropriately to questions.
confusion
what are the three categories of the Glasgow coma scale? what is it used for?
eye, verbal, motor responses; to define child’s LOC
Fluoroscopy and cerebral angiography are both used to ?
look at blood flow in the brain
True or False if patient is heavily sedated EEG are unless.
true
What position should a patient receiving a lumbar puncture be placed in?
side-lying, with legs pulled up and head bent down onto the chest.
What are some common meds to treat neuro disorders?
antibiotics, anticonvulsants, benzodiazepines, analgesics, osmotic diuretics, corticosteroids.
What are ketogenic diets?
high protein, low carb
When observing pts with neurological disorders what is the first thing we look for?
change in LOC
What are some early signs of increased ICP?
HA, vomiting, dizziness, blurred vision, decreased pulse and respirations, increased blood pressure, sunset eyes(can see white above pupils and iris), seizure. infant: bulging fontanels, wide sutures, high-pitched cry
What are some late signs of increased ICP?
decreased LOC, decreased motor and sensory responses, bradycardia, irregular respirations, cheyne-strokes respirations, decerebrate or decorticate positioning
What is hydrocephaly? what are the two classes?
diseases/disorders that cause an imbalance in the production and the absorption of CSF; obstructive/ non-communicating or non-obstructive/ communicating
What is obstructive hydrocephaly?
flow of CSF is blocked within the ventricular system
What is non-obstructive hydrocephaly?
flow of CSF is blocked after it exists from the ventricles.
What are some causes of obstructive vs non-obstructive?
meningitis, trauma, tumors; defective absorption of CSF, subarchnoid hemorrhage, intrauterine infections
What type of posture occurs with damage to the cerebral cortex?
decorticate
What type of posture occurs with damage at the level of the brain stem?
decerebrate
true or false decorticate is extension posturing.
false: flexion
true or false: in both types of posturing rigid muscle tone occurs.
true
When do you teach at an 8th grade level?
Consent or medical handbook
When do you teach to the patients level?
during clinical teaching
What are some risk factors for seizures?
family hx of epilepsy, any prenatal complications, delays in development, any recent illness, trauma, or toxin exposure.
What is the most common type of seizure?
tonic-clonic
What type of seizure is: generalized lasting < 15 mins, occurring once in 24 hours, & accompanied by fever without any CNS infection?
febrile seizures
what are some characteristics of febrile seizures?
most common childhood seizure disorder, peaks 12-18 months, most common in boys, core temp 102.2
During febrile seizure what to do give child?
rectal diazepam
when are neonatal seizures common?
first four wks of life generally but most common in first 10 days of life.
True or false ocular deviation maybe seen with neonatal seizures.
true
true or false: tonic-clonic seizures can occur within the first 4 wks of life.
false
What is a neonates response to stress?
stop breathing
What is the med of choice for neonate seizures?
phenobarbital
What is important in management of neonatal seizures?
adequate ventilation
What is vertebral bodies without protrusion of the spinal cord or meninges? what would u see in assessment?
spinal bifida occulta; normal variant, noticeable dimpling or patch of hair or discoloration of skin.
What is less serious then SB cystica occur when meninges herniate through defect in the vertebrae.
meningocele: skin over sac is intact
What is the most serious form and the spinal cord often ends at the point of the defect?
myelomeningocele
True or false: your bladder requires nerves.
true
true or false: decerebrate posturing is rigid extension and pronation of the arms and legs, rigid muscle tone overall.
true
What type of meds improve bladder capacity?
oxybutynin chloride (Ditropan)
What is a small or missing brain/skull/scalp called?
anencephaly
What is a protrusion of the brain and meninges through a skull defect know as?
encephalocele
what is it called when the head circumference is greater than 3 standard deviations below mean for age and gender of infant?
microcephaly
Patient has ICP, which of the following are trends in vitals?
increasing temp, decreasing pulse & respirations, increasing blood pressure.
True or false: Type two Arnold-chiari malformation is associated with hydrocephalus and myelomeningocele.
True(obstruction of CSF)
What are symptoms of type 1 Arnold-chiari malformation?
neck pain, recurrent HA, lower extremity spasticity, & urinary frequency.
True or false: type 2 Arnold-chiari malformation infants have weak cry, stridor, & apnea, aspiration, gagging, prolonged feeding times, & weight loss.
true
True or false: intracranial arteriovenous malformation has a possibility of hemorrhage.
true
What is premature closure of the cranial sutures known as?
craniosynostosis
What is a condition with clinical symptoms characterized by abnormal motor patterns and postures caused by nonprogressive abnormal brain function?
cerebral palsy: most common neurologic disease
What are some important factors in post op care for craniosynostosis patients?
H&H and blood loss, prevent infection, comfort measures.
For plagiocephaly it is important to assess patients neck for?
torticollis
name the two classifications of cerebral palsy:
present after forced dorisiflexion. CP infants demonstrate a prolonged standing on their toes when supported in an upright position.
increased resistance to dorsiflexion and passive hip abduction.
clonus;
hypertonicity
What type of CP is being described:
hypertonicity, permanent contractures, most common form, poor posture, balance, movement.
spastic
What type of CP is being described:
abnormal involuntary movements, slow worm like movements, affect all four extremeties, face/neck/tongue,
increase movements with stress.
athetoid or dyskinetic
What type of CP is being described:
affects balance & depth perception, rare form, poor coordination
ataxic
What are the two most common mixed CP?
spastic and athetoid.
What three therapies are important for CP?
physical, speech, occupational
What are the common causes of head trauma in children?
falls, motor vehicles accidents, bicycle accidents, child abuse.
What are the causes of non-accidental head trauma?
SBS, blows to head, banging head on wall, floor, etc
What are some risk factors for birth trauma?
multiple deliveries, LGA, infants w. extreme prematurity, Infants with big heads and congenital anomalies.
What are some signs of cerebral vascular disorders?
weakness on one side or hemiplegia, facial droop, slurred speech.
What is the most common reason why children miss school?
HA
What is a common behavior of 1-3 yr olds in response to stress?
breath holding.
What disorder affects the spinal nerves ability to communicate with the muscles?
Spinal Muscular Atrophy
True or false: in SMA distal muscles are affected more than proximal muscles.
false: proximal are affected more.
true or false in SMA emotional, mental development, and sensation are unaffected.
true
What lab test do you do in SMA?
Creatine kinase, genetic testing, muscle biopsy.
When do you do surgery for scoliosis patients?
when breathing is affected.
What test would you do to detect neural tube defect in fetus?
ultrasound
What is the most common movement disorder of childhood?
CP
true or false: tonic seizures are rare in neonatal period.
false: myoclonic
