Neuro Flashcards
Epilepsy
single unprovoked seizure with known risk for future seizures OR 2 unprovoked seizures >24 hours apart OR diagnosis of epilepsy syndrome. absence seizures can be diagnosed by 3 minutes hyperventilation triggering seizure. diagnostics: do CBC, LFTs, blood glucose, LP if <6mo or concerns, EEG. MRI if focal seizure/ concerns/cognitive issues past postictal/ seizure >15 minutes/ <6month old/new onset neurological deficits. Diff: breath holding, inattentive staring, benign movements, Tics, migraine, GERD, conversion disorder, metabolic problems, CNS problem. Tx: refer out. if unmanaged with 2 meds, intractable. can do keto diet (increased fat/carb low protein often 4:1, AE: vitamin/mineral deficiency, abdominal pain, constipation/diarrhea, fatigue, slowed growth, kidney stones. Surgery, or VNS possible. Seizure first aid for everyone.
Seizures
Migraine Headaches
> 5 attacks fulfilling criteria, lasting 2-72 hours. C: two of following: bilateral or unilateral, frontal/temporal, pulsating quality, moderate/severe intensity aggravated by normal activity + n/v or photophobia/phonophobia. Not attributable to other disease.
Neurofibromatosis
type 1: most common neurocutaneous syndrome. 2+ of following: 6+ cafe=au=lait macule >5mm prepuberty or >15mm post puberty; 2+ neurofibromas, axillary/inguinal freckling; optic glioma; 2+ Lisch nodules; osseous lesion; first-degree relative with it. often short/macrocephaly, bone issues. can have tumors of CNS. Learning disabilities/behavior problems. Some renal artery stenosis. Type 2: autosomal dominant inherited bilateral acoustic neuromas. s/s start teens/20s d/t pressure causing impaired auditory discrimination, hearing loss, tinnitus, unsteadiness, facial weakness, presenile lens opacities.
Tuberous Sclerosis
autosomal dominant d/t 2 genes (TSC1 and 2). d/t dysfunctional tumor suppressor activity. ash-leaf spots, seizures, retardation, autism, intracranial calcification, tumors, cutaneous lesions like angiofibroma (red papule over nose and malar region by 3 years old). shagreen patch. often hamartomas over convolutions of cerebral hemispheres below ependymal lining of lateral/third ventricles, seen on MRI. SEGAs > obstructive hydrocephalus at foramen of Monro. can get seizures. Can get cardiac rhabdomyomas that regress after a few years of life. renal disease most common cause of death.
Tics
involuntary, sudden, repetitive movements or vocalizations, typically wax and wane. up to 25% kids may have a transient simple tic lasting less than one year. multiple tics >1 year vocal and motor is criteria for Tourette syndrome.
Meningitis
causes increased ICP by causing edema and impairing reabsorption of CSF. usual presentation is seizures, behavioral change, altered LOC. associated with fever, malaise, lethargy, vomiting, irritability, nuchal rigidity, bulging fontanelle, delirium, stupor, seizures, sometimes DIC and shock.
Head injuries
most TBI d/t acceleration/deceleration or rotational forces; more long term issues with developing kids. open head trauma = More focal injuries. closed head trauma = more multifocal/diffuse damage. often d/t falls, sports, MVCs, violence. higher risk 0-4year and 15-24 years. can cause fracture, concussion, seizure, hematoma, edema, penetrating injury. suspect NAT when no history of fall or relatively low height, skeletal survey for <3 years old. Exam: check vitals to see shock/ ICP, GCS, concussion s/s, (raccoon eye, Battle sign = ER), all GCS <12 needs CT.
Cluster Headaches
Tension Headaches
10 episodes on <1 day /month is infrequent, chronic is >15days/month average for >3 months. Last 30min-7 days. 2 of following: bilateral, pressing/tightening quality, mild/moderate, not aggravated by activity. + no n/v and no more than one of photo/phonophobia.
Head injury diagnostics
CT for: basilar injury/penetrating trauma, altered LOC, loss of consciousness >1 minute, amnesia, focal neurological deficits, vomiting >3 x, seizures, history of coagulopathy. Detects acute hemorrhage well, edema, displacements, hydrocephalus, loss of tissue, and most fractures. BTI blood test that predicts intracranial lesions and need for CT. Differentials: get good history. Intracranial lesions,
Mild concussion s/s
headache, n/v, balance issues, vision changes, dizziness, light/sound sensitive, paresthesias, dazed, confusion, altered concentration, altered memory, forgetful, slow, irritability, sadness/emotional, drowsiness, changes in sleep
Head Injury Classification
Mild: GCS 13-15, no neuro deficit, no loss of conscious or <30 min, may have linear skull fx. Moderate: GCS 9-12, focal neurological deficits, variable LOC, can have intracranial hemorrhage. Severe: GCS <8, focal neurological deficits, prolonged LOC, often have fx and hemorrhages.
Head trauma management
prompt identification. Minor: observation. wake child q2-4h first 24h to ensure easy waking, make sure they move easily, give only Tylenol. Moderate: admit overnight observation or until stable mental status. Severe needs immediate admit and critical care. Admit: changes in vitals, seizures, altered LOC, prolonged unconsciousness >30 sec. , persisting mental or neurological deficits, depressed fx, persistent headache, recurrent vomiting, fever, unexplained injury, concerned CT findings. generally changes won’t improve after 12 months cognitively, but speech; motor difficulties can improve.
Syncope
transient loss of consciousness d/t decreased cerebral blood flow; most is benign in children. Simple fainting, or cardiac cause r/t obstruction of LV filling (comes without prodrome symptoms or with palpitation). Neurocardiogenic syncope (simple) neurally mediated with systemic vasodilation, vaguely induced bradycardia, hypotension. 95% vasovagal. can also be neurologic, psychiatric, metabolic, or breath holding spells. Dx: thorough history (triggers, prior incidence, associated injury, seizure like movements, vertigo, associated chest pain, palpitations, abnormal HR, family history of sudden death/QT syndrome/syncope, use of drugs, stress, standing, nausea/visual changes, post episode s/s, recovery time.)neuro/cardiac exam. orthostatic vitals; >30 mmHG drop in BP with standing or baseline <80. CBC, glucose, EKG, echo, treadmill exercise test. Tx: if cardiac, restrict sports until cardiac eval. good hydration, antigravity techniques, can have fludrocortisone, beta blockers, vagolytic agents, SSRIs 1 year then wean. Diff: migraines, seizures, hypoglycemia, hyperventilation, poison, Cardiac.
