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Unit 2 Peds II > L7: Pediatric neurology > Flashcards

L7: Pediatric neurology Flashcards

1
Q

Cerebral palsy subtypes

A

Spastic (most common) → stiff and tight
Ataxic→ shaky, affects balance and sense of positioning
Dyskinetic→ involuntary movements
Mixed

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2
Q

Cerebral palsy is caused by

A 
Hypoxia
Trauma
Premature birth
Infection
Toxins
Structural abnormalities
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3
Q

Most kids sit by ____ and walk by ____

A

8 months

18 months

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4
Q

Cerebral palsy presentation

A 
Motor impairment
Not reaching milestones
Excessive irritability
Poor feeding, drooling
Poor visual attention
Difficult to hold, cuddle
Retained primitive reflexes
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5
Q

Asymmetrical tonic neck reflex (ATNR)

A

Primitive reflex retained in cerebral palsy

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6
Q

Moro reflex

A

Primitive reflex retained in cerebral palsy

startle on suddenly being released (normally gone at 4-6 mos)

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7
Q

Meds for cerebral palsy

A

anti-spasmodics

botulism toxin

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8
Q

In infants who die less than 1 year old

A

40% have congenital malformations of the CNS

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9
Q

Chiari Type I

A

Cerebellar tonsils displaced caudally below the foramen magnum +/- syringomyelia → fluid filled cyst within spinal cord
presents as a teen or adult

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10
Q

Chiari Type II

A

Cerebellar tonsils displaced caudally below the foramen magnum + myelomeningocele

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11
Q

Loss of abdominal reflex

A

Chiari type I

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12
Q

What causes neurological symptoms in chiari type I

A

presence of a syringomeylia

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13
Q

Chiari type II signs/symptoms

A

Hydrocephalus
Dysphagia
Upper extremity weakness
Apneic spells and aspiration

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14
Q

Spina bifida oculta

A

incomplete closure of the spinal canal, lower back most common

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15
Q

Spina bifida: meningocele

A

outpouching of the spinal fluid + meninges through vertebral cleft → mild problems with sac protrusion

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16
Q

Spina bifida: myelomeningocele

A

most severe. Spinal cord and/or nerve protrude from vertebral cleft.

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17
Q

Spina bifida oculta signs/symptoms

A

no/mild signs: hairy patch, dimple, dark spot, swelling at site of gap

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18
Q

Spina bifida: meningocele signs/symptoms

A

mild problems with sac protrusion

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19
Q

Spina bifida: myelomeningocele signs/symptoms

A

most severe→ weakness, loss of bladder/bowel control, hydrocephalus, inability to walk, learning problems

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20
Q

causes of spina bifida

A

Genetic
Medications during pregnancy
Low folate
Poorly managed DM

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21
Q

What can be done for spina bifida?

A

shunt, surgery

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22
Q

Hydrocephalus

A

Increased volume of CSF → ventricular dilation and increased intracranial pressure
Obstructive: blockage
Non-obstructive: impaired absorption, rarely overproduction

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23
Q

Hydrocephalus is caused by

A 
CNS malformations
Infection
Intraventricular hemorrhage
Genetic defects
Trauma
CNS tumors
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24
Q

Hydrocephalus symptoms

A 
Asymptomatic
Bradycardia, hypertension
Altered respiratory rate
HA, N/V
Behavioral changes
Papilledema, diplopia
Macrocephaly
Spasticity
Spinal abnormalities
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25
Q

How do you diagnose hydrocephalus in infants/newborns?

A

Ultrasound

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26
Q

How do you diagnose hydrocephalus in infants/older children?

A

MRI or CT

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27
Q

Hydrocephalus management

A

refer to a neurosurgeon +/- shunt

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28
Q

Microcephaly and macrocephaly are treated by

A

Neurology referral
→ labs, imaging

Treat underlying cause

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29
Q

Microcephaly definition

A

Head circumference >2 standard deviations below mean, or <5th percentile

Primary (congenital)
→ lack of brain development
→ abnormal development due to timing of insult

Secondary (postnatal)
→ injury/insult to previously normal brain

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30
Q

Macrocephaly definition

A

Head circumference >2 standard deviations above mean, or >95th percentile

→ due to increase in size of any components of cranium: brain, CSF, blood, bone

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31
Q

Microcephaly is caused by

A 
Genetic
Pre/peri/post-natal injury
Craniosynostosis
Metabolic
Toxin exposure
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32
Q

Microcephaly presentation

A 
Delayed milestones
Seizures
Spasticity
\+/- early fontanelle closure
\+/- prominent sutures
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33
Q

Rapid growth in macrocephaly suggests

A

increased intracranial pressure

34
Q

Catch-up growth macrocephaly occurs in

A

premature infants who are neurologically intact

35
Q

Normal growth rate in macrocephaly suggests

A

familial macrocephaly or megalencephaly

36
Q

Neurofibromatosis genetics

A

Autosomal dominant

NF1 most common form

37
Q

Neurofibromatosis neurological abnormalities

A

macrocephaly
seizures
cognitive deficits

38
Q

Neurofibromatosis signs

A 
Cafe-au-lait macules by 1st year
Axillary/inguinal freckling by 3-5 years
Lisch nodules
Optic glioma
Neurofibromas
39
Q

Primary headaches

A

migraine, tension

40
Q

Secondary headaches

A

due to acute febrile illness

41
Q

Migraine vs tension headache: location

A

Migraine: focal, unilateral or bilateral
Tension: diffuse, frontal or temporal

42
Q

Migraine vs tension headache: duration

A

Migraine: 2-72 hours
Tension: 30 mins-1 week

43
Q

Migraine vs tension headache: intensity

A

Migraine: moderate/severe
Tension: mild/moderate

44
Q

Migraine vs tension headache: quality

A

Migraine: pulsatile/throbbing
Tension: pressure/non-throbbing

45
Q

Migraine vs tension headache: activity

A

Migraine: aggravated with activity or reduced activity
Tension: not aggravated with activity

46
Q

Concerning headaches signs/symptoms

A

Abnormal neurologic/visual exam
Vomiting
Daily symptoms with progressive worsening
Increased with coughing or bending
Acute onset without previous history
Severe upon awakening/awaken in middle of night

47
Q

Pseudotumor cerebri

A

idiopathic intracranial hypertension without mass or hydrocephalus

48
Q

Who gets Pseudotumor cerebri

A

obese teenage girls

49
Q

Classic signs of Pseudotumor cerebri

A

HA + papilledema= hallmark
Visual field loss, acuity loss
Pulsatile tinnitus

50
Q

Acetazolamide

A

Treatment for Pseudotumor cerebri

reduce rate of CSF production

51
Q

Topiramate

A

Treatment for Pseudotumor cerebri

Control HA, adjust weight

52
Q

Furosemide

A

Treatment for Pseudotumor cerebri to reduce fluid and pressure

53
Q

Other options for treatment of Pseudotumor cerebri

A

Shunting
Optic nerve fenestrations
Weight loss + low sodium

54
Q

Lumbar puncture of Pseudotumor cerebri has

A

elevated opening pressure

55
Q

Seizure

A

sudden, transient disturbance of brain function→ involuntary sensory, motor, autonomic symptoms +/- LOC

56
Q

Epilepsy

A

> 2 seizures more than 24 hours apart

57
Q

Absence seizure

A

Sudden impairment in consciousness without loss of tone. Genetic

58
Q

Febrile seizure

A

Convulsion with temp > 38 C (100.4 F)
6 months- 5 years
Virus

59
Q

2 types of febrile seizures

A

Simple: most common, lasts <15 minutes

Complex: focal, last >15 minutes or occurs 2+ times in 24 hours

60
Q

Absence seizures presentation/history

A

Provoked by hyperventilation
Ages 4-10 years old
Arrest in activity lasts 9-10 seconds, may occur 10x/day

61
Q

only do an EEG for febrile seizures if

A

there is a risk of developing epislepsy

62
Q

Ethosuximide

A

first line treatment for absence seizures

63
Q

If a febrile seizure lasts longer than 5 minutes:

A

IV benzodiazepines

64
Q

What’s the long term prognosis for absence seizures?

A

spontaneously remit by puberty

65
Q

Guillain-Barre syndrome

A

Illness (campylobacter) → acute immune mediated polyneuropathy

66
Q

Botulism

A

Honey, home canning → ingestion of clostridium botulinum spores→ neurotoxin binds ACh receptors

67
Q

Guillain-Barre syndrome vs botulism: weakness

A

Guillain-Barre syndrome: ascending

Botulism: descending

68
Q

Who gets botulism

A

kids <6 months

69
Q

Most common cause of acute flaccid paralysis in healthy kids

A

Guillain-Barre syndrome

70
Q

Guillain-Barre syndrome treatment

A

Hospitalization

IVIG or plasma exchange

71
Q

Botulism treatment

A

Hospitalization
Monitoring

Botulism immune globulin (BIG-IV or BabyBIG)

72
Q

Guillain-Barre syndrome diagnostics

A

EMG
CSF analysis: increased protein with normal WBC
Spinal MRI w/ and w/o contrast:
→ enhancement of spinal nerve roots and cauda equina

73
Q

Botulism diagnostics

A

Spores in stool sample

EMG

74
Q

Duchenne muscular dystrophy genetics

A

X-linked recessive defect in genes responsible for muscle function

75
Q

Gower’s sign

A

Duchenne muscular dystrophy

use of hands to push up from floor

76
Q

Duchenne muscular dystrophy vs Becker muscular dystrophy: onset

A

Duchenne muscular dystrophy: 2-3 years

Becker muscular dystrophy: later

77
Q

Duchenne muscular dystrophy vs Becker muscular dystrophy: creatinine kinase levels

A

Duchenne muscular dystrophy: 10-20X

Becker muscular dystrophy: >5X

78
Q

Duchenne muscular dystrophy vs Becker muscular dystrophy: cardiomyopathy

A

Duchenne muscular dystrophy: +/-

Becker muscular dystrophy: more predominant

79
Q

Duchenne muscular dystrophy treatment

A

glucocorticoids

80
Q

Duchenne muscular dystrophy progression

A

Onset ages 2-3
Wheelchair bound by 13
Mortality 18-20 years
Progressive weakness: proximal→ distal, lower extremities→ upper extremities

81
Q

Duchenne muscular dystrophy: other signs/symptoms

A

Pesudohypertrophy of calves
growth delay
+/- orthopedic complications
+/-cognitive impairment

Unit 2 Peds II (5 decks)

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