neuro Flashcards
key features of GBS
tpes of microcephaly
whats worse congenital microcephally or post natala
nb formicrophaly epilspesy
- SUDDEN ONSER
- SYMMETERICAL
- ASCENDING
symeteircal - everythign low
asymeterical - just head - more common and clincially relavnt
post natal
nb! monogenic
other symptoms of GBS
may have pain esp in shoulders, back , thigh
may have cranial nerve involvement
absent deep tendon reflexes vs MG
CAUSE language regression
autism
epilepsy
cerebellar mutsism
does gbs affect sensory nerves
yes it can affect infect sensory symptoms may be the presenting part of the disease, so patients have report parestheisas
what kind of disease is GBS
lower motor neurone
polyneuropathy
what systems does gbs affect
sensory motor autonomic
autonomic problems gbs
~~~
urinary retention
cardiac arrhythmia
dry eyes
blurred vision
stomach pain
labile hypertension
treatment of gbs
plasmapheresis (if severe)
iv immunoglobulin IV 2 G/KG 1st line
when would kerning and brudinzki show
after 2 years
signs of increased intracrhail pressure
can cause disorders in breathing and heart rate!
vomitting
lethargy
refusal to eat
central facial palsy
the opposite lower quadrant
peripheral facial palsy
half the face
causes of torticollois
tumour
traumatic birth injury
early sign of hemiplegic CP
TESTS FOR MEASURING AXIAL MUSCLES TONE
traction
landau
What is contraindicated in GBS
corticosteroids
sunset eyes
sign of increased ICP such as hydrocephalus and it affects the region of the brain that controls eyes movement as cranial nerves 3, 4, 6 get affected
which muscles affected more in SMA and signs of sma
PROXIMAL MORE THAN DISTAL
floppy baby
scarf sign
knee to ear
ventral susupesion
tongue fasiculates +/fingertrtips?
frog leg positon
bell shaped abdomen
which is the disease of anterior horn
SMA
POLI
muscles affected more in neuropathy
distal
dx of GBS
POLIO
transverse myelitis
POLIO VS GBS
POLIO: asymetericl , csf is more inflammatory , autonomic dysfunction not that common like gbs, just supportive treatment , more acute , more likley to cause permanent parylis, can spread via feces , dmaages anterior horn
gbs: csf just protein,has a specific tx , more insisuious,fever is uncommon , immune mediated, cant spread from person to person , damages the myelin , more likley to have sensory abnormalities
Sign of botulism
diagnosis
treatment
PATHOPHYS
constipation + descending hypotonia , drooling
toxin in stool
immunoglobulin 50mg/kg (human ) not horse
in babies its the ingetsion of sportes and go tht gut and perfom toxins and not the preformed toixn, it affectec the cranial neres (weak cry, weak suck, decreased gag reflex)
dx myositis from myopathy
myositis : pain upon movement and acute and cause is enterovirus mostly CK only temporary affected for less than a month
myopathy: won’t hurt when you palpate or move
dermatomyositis key features
PROXIMAL muscle weakenss
heliotrope rash
grottoes papules
elevated creatink kinase
anti JO
antibodies in dermatomyositis
features of hsv encephalitis and hwich one is more commone
features of encephalits in older kids
EEG
csf
tx
anti jo
but also antinuclear
hemorragic necrotic lesions
hs1 more common but for neonatal period hs2 is common but can also be hs1
anomia (dont know the name of)
aphasia - cant speak
hemiparesis
TEMPORAL LOBE FOCAL seizure which can become genralised
unilateral or bilateral temporal periodic high waves
lymphoctoisis, pleocytosis, erythroctyrachia, proteinrachia
aciclovir IV for 2-3 weeks 30-60mg/kg-
are reflexes affected in Dermatomysotis
no changes
reflexes in collagen laxity
normal
symptoms of collagen laxity + complications
hypotonia
may have transitory motor delay
may have no weakness or slight weakness
tendon reflexes are normal
mitral valve proplapse!
lunation of lens
aneurysms
pneumothorax
duchess CK LEVAL
VERY HIGH! >1000
IS cp congenital or acquired
both such as torch infection cmv or acquired during birth delivery
most common cause of cp
whoch reflexes persist
a complication of chicken pox
ANTENATAL
morro, palmar, fencing
acute cerebelltis - the most common type of cerebellitis
what example is hIE in the category of cp
perinatal
hie more common for
TERM BABIES
CAUSES OF POST NATAL CP
lennoz gastraut triad (lecture)
HSV ENCEPHALITIS
atypical abscences, DROP attacks
slow spik and waves (awake) drop attacks when asleep 10hz
psychomotor retardation
meningitis
which CP has has primitive reflexes leading
in hemiplegic what is more affeted
in diplegic what is more affected
dyskinetic
upper more affcted
all 4 but the lower limbs more affcted
which cp affects arms more than legs
what is paraplagia
quads + hemiplegic
legs
which cp is associated with epilepsy
deffo quadriplegic
but 50% of hemiplegic have focal epilepsy
types of dyskinetic cp
ADEM
dystonic and choreoathhetoid
acute desiminated encepholitis
after infection oR VACCINATION due to cross reaction
tx methylpredinososle
(multile defcits over the brain)
unlikely to be cp if
other family members have the same “CP” ® no certain etiology ® normal MRI ® regress - motor, cognitive or other ° multisystem disease
signs of hydrocephalus in babies
subactute pan scelrosing
- bulging fontanelle
- prominant scalp veins
- sunset eyes
- increase HC
after latent measles, memory loss, chnage in behavior then later comes myoconic jerks !!!!lastly persistant vegetative state - die- no cure
NMDAR encephalitis
antibodies against the receptor in brain
key word is dyseknias and autonomic instablitiys (hypersalvation, hyperthermia)
can come as a result of HSE after recovery so dx from reactivation but you would see NEW SIGNS like the dsykinesia
tx- methylpredisonlone, IVIG, plamapheresis,rituximab
how to we treat hydrocephluas
- shunt- connect from the ventricle of the brain to another area of the body to drain, like peritoneal cavity . risk is that shunt is infected and may have to be changed many time, always suspected meningitis in these kids if they have a fever
- Endoscopic third ventriculostomy (ETV) - creating a small hole in the third ventricle of the brain (one of four fluid-filled cavities in the brain) so that the excess fluid can make its way out and relieve pressure.
if you had to specifically decribe GBS what woul you say
its a lower motor neruon disease and polyneuropathy and demyelinating
usual first symptom for gbs
acute necrotiizng encephalopathy
tingling sensation in extremities
very fatal, go into coma real fast
tx with methylprednisolone
similar to reyes in that it affects liver enzymes
nb! thalmaus symmetrical lesions on ct
compliation os sma
willl need feeing help as weak eating and get tired easily from just chewing
resp fialure as muscles fail
freuqnet infectins as weak cough cant clear secrtions
aspirarion pneumonia
scoliois- as the muslces supporting the spine
e
examples of prenatal cp
TORCH
genetics syndromes
placental insufficnecy
clasification of CP accourding to lesion site
reyes syndrome and triggers dx
pyrimidal tract
extrapyrimiadal
cerebellar
aspirin + valproate >5-10
hypoglycmeia, fatty liver, elevated transaminase , hyperammonia
ryes like syndrome but no hypoglycmeia you need to check for inborn errors of metabolbilsm s happens <5
