Module 8 - Neurologic Disorders

Question 1

Reduction or alteration in cognitive and affective mental functioning and in arousability or attentiveness.

Acute onset.

Answer 1

Altered States of Consciousness (AMS; Coma)

Question 2

Coma is defined by the -1- of -2- with the environment for at least -3-.

Answer 2

1. complete absence
2. wakefulness and interaction
3. 1 hour

Question 3

Persistent or permanent vegetative state (PVS) denotes a chronic condition (persistent if -1-; permanent if -2-, depending on etiology) in which sleep-wake cycles are -3-, but the patient has -4- of self or the environment.

Answer 3

1. > 4 weeks
2. > 3–12 months
3. preserved
4. no awareness

Question 4

Minimally conscious state (MCS) denotes patients who demonstrate -1- and -2- of interaction with the environment.

Answer 4

1. sleep-wake cycles

2. some residual degree

Question 5

Brain death (death by neurologic criteria) refers to -1- who have -2- brain function, including -3-, and -4-.

Answer 5

1. patients in coma
2. cessation of all
3. cortical activity, brainstem reflexes
4. spontaneous respirations

Question 6

Infection (most common cause of -1- in childhood)

2. Gram-negative meningitis, enterovirus, herpes encephalitis, sepsis
3. Bacterial meningitis, viral encephalitis, postinfectious encephalitis, sepsis, typhoid, malaria

Answer 6

1. Coma
2. Common responsible organisms in newborns
3. Common responsible organisms in older children

Question 7

If severe head trauma, intracranial hemorrhage, or increased intracranial pressure is suspected, …

Answer 7

…an emergency CT scan or MRI is necessary.

Question 8

-1- describes patients who are conscious (awake and aware) but cannot demonstrate interactiveness with their environment due to -2- of motor function, typically from a lesion -3-.

Answer 8

1. Locked-in syndrome
2. a massive loss
3. in the pons

Question 9

-1- denotes a patient who is awake and aware, but does not speak, initiate movements, or follow commands, typically due to lesions of -2-.

Answer 9

1. Akinetic-mutism

2. the frontal lobes

Question 10

-1- refers to patients with abnormal alertness and awareness (though typically not completely absent) secondary to -2-.

Answer 10

1. Catatonia

2. psychiatric illness

Question 11

Recurrent, unprovoked, sudden, transient disturbances of brain function, manifested by involuntary motor, sensory, autonomic, or psychic phenomena, alone or in any combination, often accompanied by alteration or loss of consciousness or a single such disturbance with an EEG and/or risk factors suggesting high risk for recurrent events.

Often, inter-disturbance EEG changes.

Answer 11

SEIZURES

Question 12

Two seizures that are separated by at least 24 hours or a single seizure associated with a greater than 60% risk of recurrence

Answer 12

Epilepsy

Question 13

AoO: Birth–2 wk
CMs: Can be any seizure type, can be very subtle.
S/P: Neurologic insults (hypoxia/ischemia;
intracranial hemorrhage) present more in first 3
days or after 8th day; metabolic disturbances alone between 3rd and 8th days; hypoglycemia, hypocalcemia, hyper- and hyponatremia.

Answer 13

Neonatal Seizures

Question 14

Causes of neonatal seizures include:
-1- present more in -2- or -3-; -4- alone between -5- days; hypoglycemia, hypocalcemia, hyper- and hyponatremia. Drug withdrawal. Pyridoxine dependency. Other metabolic disorders. CNS infections. Structural abnormalities. Genetic causes increasing recognized.

Answer 14

1. Neurologic insults (hypoxia/ischemia; intracranial hemorrhage)
2. first 3 days
3. after 8th day
4. metabolic disturbances
5. 3rd and 8th

Question 15

A seizure [is] -1- if it occurred in a child 6 months through 5 years of age without a history of epilepsy, in association with -2-, without evidence of an intracranial infection. -1- seizures are considered -3- if they are focal, prolonged (>10–15 minutes), or occur more than once in a 24-hour period

Answer 15

1. febrile
2. a fever (temperature >100.9° F [>38.3°C])
3. complex

Question 16

The purpose of obtaining an EEG early in the
evaluation of a seizure is multifold: assessment for background abnormalities, which might suggest -1-; evaluation of -2- that could help confirm a seizure; exclusion of more -3- seizures; evaluation of risk of -4-; identification of abnormalities that would -5-; …

Answer 16

1. a focal lesion
2. epileptiform abnormalities
3. frequent but subtle
4. seizure recurrence
5. prompt additional testing

Question 17

The purpose of obtaining an EEG early in the
evaluation of a seizure is multifold: … -1- of an epilepsy syndrome; and -2- management. Some, but not all, studies have shown a higher yield if EEG is performed -3- of the seizure.

Answer 17

1. classification
2. guidance for medication
3. within 24 hours

Question 18

-1- should be performed in cases of neonatal seizures because the most common etiologies are -2-, such as hypoxic-ischemic encephalopathy, infarction, hemorrhage, and, less commonly, cortical malformations. An -1- is also strongly recommended for new-onset, afebrile seizures before age 3 years.

Answer 18

1. MRI

2. structural changes

Question 19

Of children with epilepsy onset before 3 years of age who underwent …, causal mutations were found in 40% and yields of greater than 15% were found regardless of delay, seizure type, or age at onset.

Answer 19

genetic testing

Question 20

-1- and -2- are common in children with epilepsy, but there are 2 differences from the general pediatric population. First, the -3- -4- of -2- is more common in children with epilepsy. This -4- causes less disruption in the classroom and diagnosis can be
delayed compared with those who are also -5-.

Answer 20

1. Attentional issues
2. ADHD
3. inattentive
4. subtype
5. hyperactive

Question 21

…there are 2 differences in -1- from the general pediatric population… Second, the sex ratio is equal in children with epilepsy, with -2- affected as commonly as -3-. -1- is most common with comorbid intellectual and developmental disabilities and in patients with drug-resistant epilepsy. It is recommended that all children with epilepsy be screened for -1- starting at school entry, with screening repeated annually.

Answer 21

1. ADHD
2. girls
3. boys