Lecture 10: Peds Neuro

Question 1

Febrile seizures: main facts

Answer 1

• most common seizures of childhood
• occur in children 6 mnths-5 yrs of age
• occur in absence of intracranial infxns, metabolic disturbances or h/o febrile seizures

Question 2

Simple Febrile Seizures

Answer 2

• duration < 15 min
• generalized in nature
• single occurrence in 24 hr period
• no previous neuro problems

Question 3

Risk Factors for febrile seizures

Answer 3

• developmental delay
• discharge from neonatal unit after 28 days
• daycare attendance
• viral infxn
• fam hx
• certain vaccines: flu, tetanus, DTP, measles, mumps, rubella
• possible Zn and Fe deficiency

Question 4

Causes of Febrile seizures

Answer 4

• URI
• pharyngitis
• otitis media
• pneumonia
• gastreoenteritis
• roesela infantum
• noninfectious illness

Question 5

Febrile seizure tx

Answer 5

• IV lorazepam

- buccal midazolam if IV not possible

Question 6

Risk factors for recurrence of febrile seizures

Answer 6

• age < 18 mnths
• duration of fever < 1 hr before seizure onset
• first degree relative with hx
• temp < 104

Question 7

Risk factors for future Epilepsy after Febrile Seizures

Answer 7

• complex febrile seizure
• fam hx
• fever duration < 1 hr before seizure onset
• neurodevelopmental abnormality

Question 8

Cerebral palsy

Answer 8

• chronic, static impairment of muscle tone, strength, coordination or movements
• nonprogressive and originated from some type of cerebral insult/injury before birth, during delivery or in perinatal period

Question 9

Most common form of Cerebral palsy

Answer 9

• spasticity of limbs

- monoplegia, hemiplegia, paraplegia (both legs, no arms), quadriplegia

Question 10

Second most common form of CP

Answer 10

• ataxia

- affects fine coordinated motor mvmnts of UE, may also involve LE and trunk

Question 11

Other deficits of Cerebral palsy

Answer 11

• seizures
• mild mental retardation
• severe mental retardation
• disorders of language, speech, vision, hearing and sensory perception

Question 12

PE findings in CP

Answer 12

• spasticity, hyperreflexia, ataxia, involuntary mvmnts
• microcephaly (head is smaller for their age)
• affected limbs in hemiplegia are shorter than others

Question 13

Tx/management of CP

Answer 13

• try to maintain max phys fxn
• get PT occupational and speech therapy, ortho monitoring and special ed involved
• botox may help with spasticity

Question 14

Neurofibromatoses : 2 forms

Answer 14

• Type 1: multiple hyperpigmented macules and neurofibromas; due to mutation of NF 1 gene
• Type 2: 8th CN tumor, often accompanied by other intracranial or intraspinal tumors; mutation in NF 2 gene on chromosome 22

Question 15

Neurofibromatoses findings

Answer 15

• neuro presentation with sx’s of tumor
• multiple neurofibromas present and may involve spinal or cranial nerves (8 CN)
• superficial cutaneous nerves show palpable mobile nodules
• axillary freckling, patches of pigmentation
• malignant degen of neurofibromas may lead to peripheral sarcoma
• meningiomas, glioma, bone cysts, pheochromocytomas, scoliosis, and obstructive hydrocephalus may occur