Module 8 - Neurologic Disorders Flashcards
Reduction or alteration in cognitive and affective mental functioning and in arousability or attentiveness.
Acute onset.
Altered States of Consciousness (AMS; Coma)
Coma is defined by the -1- of -2- with the environment for at least -3-.
- complete absence
- wakefulness and interaction
- 1 hour
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.
- > 4 weeks
- > 3–12 months
- preserved
- no awareness
Minimally conscious state (MCS) denotes patients who demonstrate -1- and -2- of interaction with the environment.
- sleep-wake cycles
2. some residual degree
Brain death (death by neurologic criteria) refers to -1- who have -2- brain function, including -3-, and -4-.
- patients in coma
- cessation of all
- cortical activity, brainstem reflexes
- spontaneous respirations
Infection (most common cause of -1- in childhood)
- Gram-negative meningitis, enterovirus, herpes encephalitis, sepsis
- Bacterial meningitis, viral encephalitis, postinfectious encephalitis, sepsis, typhoid, malaria
- Coma
- Common responsible organisms in newborns
- Common responsible organisms in older children
If severe head trauma, intracranial hemorrhage, or increased intracranial pressure is suspected, …
…an emergency CT scan or MRI is necessary.
-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-.
- Locked-in syndrome
- a massive loss
- in the pons
-1- denotes a patient who is awake and aware, but does not speak, initiate movements, or follow commands, typically due to lesions of -2-.
- Akinetic-mutism
2. the frontal lobes
-1- refers to patients with abnormal alertness and awareness (though typically not completely absent) secondary to -2-.
- Catatonia
2. psychiatric illness
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.
SEIZURES
Two seizures that are separated by at least 24 hours or a single seizure associated with a greater than 60% risk of recurrence
Epilepsy
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.
Neonatal Seizures
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.
- Neurologic insults (hypoxia/ischemia; intracranial hemorrhage)
- first 3 days
- after 8th day
- metabolic disturbances
- 3rd and 8th
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
- febrile
- a fever (temperature >100.9° F [>38.3°C])
- complex
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-; …
- a focal lesion
- epileptiform abnormalities
- frequent but subtle
- seizure recurrence
- prompt additional testing
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.
- classification
- guidance for medication
- within 24 hours
-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.
- MRI
2. structural changes
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.
genetic testing
-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-.
- Attentional issues
- ADHD
- inattentive
- subtype
- hyperactive
…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.
- ADHD
- girls
- boys