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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
How do you diagnose hydrocephalus in infants/newborns?
Ultrasound
26
How do you diagnose hydrocephalus in infants/older children?
MRI or CT
27
Hydrocephalus management
refer to a neurosurgeon +/- shunt
28
Microcephaly and macrocephaly are treated by
Neurology referral → labs, imaging Treat underlying cause
29
Microcephaly definition
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
30
Macrocephaly definition
Head circumference >2 standard deviations above mean, or >95th percentile → due to increase in size of any components of cranium: brain, CSF, blood, bone
31
Microcephaly is caused by
``` Genetic Pre/peri/post-natal injury Craniosynostosis Metabolic Toxin exposure ```
32
Microcephaly presentation
``` Delayed milestones Seizures Spasticity +/- early fontanelle closure +/- prominent sutures ```
33
Rapid growth in macrocephaly suggests
increased intracranial pressure
34
Catch-up growth macrocephaly occurs in
premature infants who are neurologically intact
35
Normal growth rate in macrocephaly suggests
familial macrocephaly or megalencephaly
36
Neurofibromatosis genetics
Autosomal dominant | NF1 most common form
37
Neurofibromatosis neurological abnormalities
macrocephaly seizures cognitive deficits
38
Neurofibromatosis signs
``` Cafe-au-lait macules by 1st year Axillary/inguinal freckling by 3-5 years Lisch nodules Optic glioma Neurofibromas ```
39
Primary headaches
migraine, tension
40
Secondary headaches
due to acute febrile illness
41
Migraine vs tension headache: location
Migraine: focal, unilateral or bilateral Tension: diffuse, frontal or temporal
42
Migraine vs tension headache: duration
Migraine: 2-72 hours Tension: 30 mins-1 week
43
Migraine vs tension headache: intensity
Migraine: moderate/severe Tension: mild/moderate
44
Migraine vs tension headache: quality
Migraine: pulsatile/throbbing Tension: pressure/non-throbbing
45
Migraine vs tension headache: activity
Migraine: aggravated with activity or reduced activity Tension: not aggravated with activity
46
Concerning headaches signs/symptoms
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
Pseudotumor cerebri
idiopathic intracranial hypertension without mass or hydrocephalus
48
Who gets Pseudotumor cerebri
obese teenage girls
49
Classic signs of Pseudotumor cerebri
***HA + papilledema= hallmark*** Visual field loss, acuity loss Pulsatile tinnitus
50
Acetazolamide
Treatment for Pseudotumor cerebri | reduce rate of CSF production
51
Topiramate
Treatment for Pseudotumor cerebri | Control HA, adjust weight
52
Furosemide
Treatment for Pseudotumor cerebri to reduce fluid and pressure
53
Other options for treatment of Pseudotumor cerebri
Shunting Optic nerve fenestrations Weight loss + low sodium
54
Lumbar puncture of Pseudotumor cerebri has
elevated opening pressure
55
Seizure
sudden, transient disturbance of brain function→ involuntary sensory, motor, autonomic symptoms +/- LOC
56
Epilepsy
>2 seizures more than 24 hours apart
57
Absence seizure
Sudden impairment in consciousness without loss of tone. Genetic
58
Febrile seizure
Convulsion with temp > 38 C (100.4 F) 6 months- 5 years Virus
59
2 types of febrile seizures
Simple: most common, lasts <15 minutes Complex: focal, last >15 minutes or occurs 2+ times in 24 hours
60
Absence seizures presentation/history
Provoked by hyperventilation Ages 4-10 years old Arrest in activity lasts 9-10 seconds, may occur 10x/day
61
only do an EEG for febrile seizures if
there is a risk of developing epislepsy
62
Ethosuximide
first line treatment for absence seizures
63
If a febrile seizure lasts longer than 5 minutes:
IV benzodiazepines
64
What's the long term prognosis for absence seizures?
spontaneously remit by puberty
65
Guillain-Barre syndrome
Illness (campylobacter) → acute immune mediated polyneuropathy
66
Botulism
Honey, home canning → ingestion of clostridium botulinum spores→ neurotoxin binds ACh receptors
67
Guillain-Barre syndrome vs botulism: weakness
Guillain-Barre syndrome: ascending | Botulism: descending
68
Who gets botulism
kids <6 months
69
Most common cause of acute flaccid paralysis in healthy kids
Guillain-Barre syndrome
70
Guillain-Barre syndrome treatment
Hospitalization | IVIG or plasma exchange
71
Botulism treatment
Hospitalization Monitoring Botulism immune globulin (BIG-IV or BabyBIG)
72
Guillain-Barre syndrome diagnostics
EMG CSF analysis: increased protein with normal WBC Spinal MRI w/ and w/o contrast: → enhancement of spinal nerve roots and cauda equina
73
Botulism diagnostics
Spores in stool sample | EMG
74
Duchenne muscular dystrophy genetics
X-linked recessive defect in genes responsible for muscle function
75
Gower's sign
***Duchenne muscular dystrophy*** | use of hands to push up from floor
76
Duchenne muscular dystrophy vs Becker muscular dystrophy: onset
Duchenne muscular dystrophy: 2-3 years | Becker muscular dystrophy: later
77
Duchenne muscular dystrophy vs Becker muscular dystrophy: creatinine kinase levels
Duchenne muscular dystrophy: 10-20X | Becker muscular dystrophy: >5X
78
Duchenne muscular dystrophy vs Becker muscular dystrophy: cardiomyopathy
Duchenne muscular dystrophy: +/- | Becker muscular dystrophy: more predominant
79
Duchenne muscular dystrophy treatment
glucocorticoids
80
Duchenne muscular dystrophy progression
Onset ages 2-3 Wheelchair bound by 13 Mortality 18-20 years Progressive weakness: proximal→ distal, lower extremities→ upper extremities
81
Duchenne muscular dystrophy: other signs/symptoms
Pesudohypertrophy of calves growth delay +/- orthopedic complications +/-cognitive impairment

Unit 2 Peds II (5 decks)

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