Lecture 10: Neurology Flashcards
4 classifications of headaches
which is most often benign and which is most worrisome
- Acute = mostly benign
- Acute Recurrent (Episodic)
- Chronic non-progressive
- Chronic progressive = most worrisome
What is the definition of Acute Recurrent (Episodic) HA
chronic daily headache > 15 days/month for 3 mo
What is a/w tension HA?
What is NOT a/w tension HA?
mild-mod pulsating press/tightness
NOT a/w: N/V or photo/phonophobia
2 challenges about Dx Migraines?
- Vomiting and vertigo more prominent Sxs (dont report HA)
2. Bilateral = more in kids but can be unilateral
Migraine w/OUT aura criteria:
How many migraines needed?
- how long do HA last:
- Two of following (4):
- one of following (2):
At least 5 migraines
- Lasts 1-72 hrs
- need at least 2:
- unilateral
- pulsing
- mod-severe pain
- aggravated by activity - need at least 1:
- Photophobia
- N/V
Migraine w/aura criteria:
How many migraines needed?
- Aura w/one of following:
- when does migraine start:
least 2 migraines
- Aura w/one of following:
- Visual Sxs or vision loss
- Sensory Sxs (pins/needles, numb)
- dyphasic speech disturbance - Migragine = dura aura or w/in 60 min after
6 Red flags of HAs that are concerning for intracranial pressure
- Sleep related HA
- A/w cough/defecation
- Explosive/sudden onset
- Progessive
- Neuro Sxs
- Systemic sxs
* Vomiting»_space;»>nausea
What is the imaging modality of choice for eval HAs?
MRI (diffusion weighted)
When is eval NOT indicated for HAs?
When should it be considered (2)?
- NOT indicated if recurrent HA + normal PE
- Consider if abn exam, have seizures or both
- consider if recent onset of severe HA, change in HA type, neuro dysfxn
if suspect child has ICP what is imaging study done? what also must be done 1st?
ICP –> LP
- MUST DO MRI first to r/o mass
- if dont –> herniation w/LP
Nemonic for lifestyle management of HAs
"SMART" Sleep Meals (diet) Activity Relaxation Trigger avoidance
2 Tx options for Acute HA
When do you consider Triptans?
- OTC Tx
- add caffeine < 9 days/mo
Triptans if > 6 y/o
- if NSAID use > 2-3x/wk
- Acute Tx of Triptans or caffeine < 10 days/mo
When is preventative therapy considered for HAs?
Med?
when > 4 debilitating HAs/month
Topiramate
What types of seizures are more common in kids than adults
generalized seizures
vs focal - affects 1 side
Can a norm EEG r/o seizures?
When is the only time an abn EEG can Dx seizure?
- how are they useful?
(Main method of Dx seizures)
Norm EEG CANT r/o seizures
Abn EEG –> Dx of seizure if actual seizures recorded
- help classify type of epilespy
main method = Hx
- Weird baby movements
- Sleep myoclonus
- Syncope
- Breath holding spells
- Movement d/o
- Behavioral - daydream, temper tantrum, night terror
- Parasomnias
- Pseudo-seizures
Paroxysymal Non-epileptic Events (not seizures)
What is a febrile seizure?
- age range & peak?
- 3 RFs (1/2 = no RFs)
Note: MC neuro d/o of infants + young kids
convulsion a/w temp > 38 C
- age range: 3 mo - 6 yrs
- peak = 12-18 mo
RFs
- FHx (1st deg relative)
- Neurodevelopmental delays
- incr exp to HSV-6
3 differences b/t simple and focal febrile seizures
which is MC?
Simple = MC
- generalized
- shorter duration ( < 15 min)
- 1 in 24 hrs
Complex
- focal (one side of body)
- longer duration > 15 min
- 1+ in 24hrs
Two abn things on PE for seizure that require further workup?
non-focal exam –> no Dx testing
- Meningmus
2. Bulging fontanelles
3 reasons to do LP in workup of seizures? 3 for Neuroimaging?
What type of testing usu NOT recommended
LP
- < 12 mo
- meningitis or CNS infxn
- on ABX
Neuro-imaging
- macrocephayl
- persistent abn neuro exam
- incr ICP
EEG usu not recommended
What is the Tx for recurrent or prolonged febrile seizure?
What does NOT help?
Why are daily ppx anti-epiletics NOT recommended
- Rectal Diazepam (short term)
Anti-pyretics NOT helpful
ppx anti-epiletics dont decr likelihood of progression (epilepsy, non-febrile)
When is there a slightly higher risk of seizures progressing to epilepsy? (3)
- Complex febrile seizures
- FHx of epilepsy
- Neurodev abn
Definition of status epilepticus (SE)?
How long til worry about long term damage?
What is the purpose of Broselow tape in SE
5+ min of continous seizure activity or intermittent convulsions w/out regaining consciousness
30+ min –> long term damage
Broselow tape = determine ht/wt –> dose meds
Pt in ER has been having continous seizures that have gone on for 7 min. What 3 initial steps in managing this pt (3)?
- ABCs
- obtain IV access (can give meds IM, rectally too)
- check BG
If pt in SE is HYPOglycemia what should be done?
give IV dextrose–> likely stops the seizure
What type of meds are 1st line for SE? what drug specifically used MC?
Pt still seizing after 5 min what should be done? max dosing?
What if pt still seizing after max dosing?
BZs = 1st line tx
- Lorazepam
Give repeat dose of BZs –> max = 3 doses
give other meds
- phenytoin
- phenobarbital
Definition of epilepsy
> 2 unprovoked Afebrile seizures
note: most kids w/ 1 unprovoked abef seizure never have another
When give anti-epileptic drugs? for how long?
When is the greatest risk of recurrence?
Anti-epileptic drugs
- Give after 2+ afebrile seizures
- for least 2yrs after last seizure
greatest risk of recurrence = first 2 yrs after stop meds
What should peds pts w/SE avoid?
Edu for teens/adults?
peds pts w/SE avoid:
- contact sports
- ride bike w/out helmet
- swimming unsupervised
EtoH/drugs lower seizure threshold
Med for tachy rhythms
Meds for brady rhythms
Tachy –> adenosine, vagal manuevers
Brady –> atropine, IV epi
S/s of concussion/TBI
- main
- w/in mins - hrs:
- w/in hrs - days:
- main:
- confusion + amnesia
(+/- LOC before it) - w/in mins - hrs:
- HA, dizzy, lack awareness, N/V - w/in hrs - days:
- mood/cognitive/sleep disturbances
- light/noise sensitivity
- Orientation
- Immed memory
- Concentration
- Delayed recall
- Neuro screening
- Exertional Manuever
are components of:
SAC
- standardized assessment of concussion tool
What is the PECARN rule in concussion assessment?
What type of imaging used in kids for TBI?
Findings a/w LOW risk of signif TBI –> no imaging recommended
CT
Falls of what height in < 2 y/o = severe MOA? For > 2 y/o?
< 2 y/o = falls > 3 ft
> 2/o = falls > 5 ft
Early vs late signs of basilar skull fractures?
Early signs
- CSF rhino/otorrhea
- Hemotypanum
Late signs
- raccoon eyes
- battle sign
What is return to school protocol for concussion/TBI
must be able conc & tolerate visual/auditory stim for 30-45 min
4 requirements for return to play protocol?
- return to school
- no meds
- normal neuro exam
- back at baseline fxning
How do Zurich guidelines for return to play work?
Stages 0 - 5
- must pass all before returning to play
