Neuro Flashcards
Migraine headache dx
> 5 fulfilling features: 2-72h, at least 2 of (usually frontal/temporal, pulsating, moderate-severe), at least one of (n/v, photo or phonophobia)
Tension headache dx
10 episodes total. <1day/month is infrequent, >15d/month is chronic. lasts 30min-7days. 2 of (bilateral, pressing/tightening, mild-moderate, not aggravated by routine activity) + no n/v or phono/photophobia.
Headache triggers
menstruation, exercise, food/odors, stress, chocolate, processed meats, aged cheeses, nuts, altered caffeine, dairy, shellfish, dried fruits. predisposition to migraines: cyclic vomiting, abdominal migraine, benign paroxysmal vertigo.
migraine s/s
nauseate abdominal pain, vomiting, pulsating pain, can be unilateral, relief with sleep, aura, visual changes, family member history
Pathologic headache flags
sudden onset of hyperacute or increasing pain, accompanying neurological signs, first/worst headache; awakens from sleep; vomiting without nausea, visual disturbances, increased pain with straining/sneezing/coughing/ etc, occipital region/neck pain, cognitive issues, seizures or numbness, gait issues, fever, family history of neuro diagnoses, hx of VP shunt/meningitis etc
headache dx/tx
if concerns for pathology, MRI first line within 2-4 weeks. tx: NSAIDs first line for acute treatment. if abortive meds for migraines, sumatriptan/zolmitriptan taken at onset. don’t use >3x/week. prophylactic when severe 2-4x/month or tension or migraine with functional disability. meds: B-blockers, antidepressants, anticonvulsants, CCBs. can do magnesium, coenzyme Q10, riboflavin, butterbur, omega3, migraleif. refer suspected pathological headaches
Epilepsy
recurrent unprovoked seizures (event with abnormal electrical signal from cerebral cortex). can generalized or focal. single unprovoked with risk for future ones or 2 unprovoked more than 24hr apart or diagnosis of syndrome. staring spell can be triggered by 2-3 min hyperventilation.
epilepsy dx
CBC, LFTs, glucose, LP if <6mo or with persistent neuro s/s; EEG, MRI after focal seizure or EEG abnormal or s/s ICP or >15min or <6mo, or new onset of focal neuro deficit. Diff: breath holding, inattentive staring, benign movements, self-stimulation, tantrums, syncope, migraine headaches, GERD, conversion disorder, metabolic problems, tumors, etc.
epilepsy tx
refer if suspected. monitor for AED, labs, case management. goal no seizures and no side effects. if needing 3+ meds, intractable and consider non-pharm.
Common epilepsy meds
Keppra (mood changes, headache, significant aggression or depression) lamotrigine (SJS, somnolence, headache, dizziness); oxcarbazepine for focal (hyponatremia, dizziness, ataxia, drowsy, SJS, blood cell count changes); topiramate (glaucoma, met. acidosis, paresthesia, weight loss, cognitive change); lacosamide (suicide, syncope, arrhythmia, dizzy, headache, ataxia); valproic acid (bone marrow suppression, weight gain, hair loss, liver toxicity, pancreatitis); ethosuximide for absence sz (blood cell changes, SJS, upset stomach, headache, weight gain); carbamazepine for focal (SJS, hypersensitivity, photosensitivity, tiredness); phenobarbital for neonatal or status (blood cell count changes, SJS, irreversible cognitive change, sedation, GI s/s)
seizure med pointers
if GI effects, decrease dosage/increase frequency; first s/s of toxicity is sedation, changes in behavior, and changes in cognition and balance. some herbal products interfere with seizure control. taper if child can go 2 years without a seizure. leg prior to taper. most tapered over 6-8w. if return of sz, return to initial med dose. epilepsy resolved when 10 years seizure free and 5 without meds.
keto diet
first line for GLUT1 transporter deficiency, or for intractable. high ratio of fats to protein plus carbohydrates. typical 4:1 ratio. prior to starting, r/o certain metabolic conditions. screen for growth and nutritional status. side effects: vitamin and mineral deficiency, abdominal pain, constipation or diarrhea, fatigue, slowed growth, renal stones.
epilepsy other treatments
surgery; VNS (In left anterior chest wall inferior to clavicle). counsel on contraception since teratogenic AEDs. teach first aid; never swim alone, dangerous sports ok if well controlled or constant supervision. wear a helmet. don’t drive until seizure free 6 mo. caution with DTaP vaccine.
status epilepticus/ febrile seizures
> 30 min or no recovery between events. rescue med. febrile most common in kids; 38 C fever before or after seizure and in ages 6-60mo. simple is generalized and <15min, complex general or focal, >15 min, clustering. 2/3 don’t recur. risk for recurrence: first sz <18 mo, low degree of temp at seizure time, fever not present until after, family history.
CP
chronic non progressive motor disorder d/t damage to areas in brain that control motor function. disturbances in sensation, perception, cognition, communication, and behavior. 3 types: spastic, athetoid/dyskinetic, and ataxic. current dx criteria is motor dysfunction and either abnormal neuroimaging or risk factors.
CP s/s
hypotonic < 6mo, then hypertonic. decreased head circumference, early head injury, persistent primitive reflexes, hand preference before 1 year of age, feeding issues, irritable or depressed, difficulty with movement, speech issues, asymmetric or abnormal deep tendon reflexes, ankle clonus,
CP risk factors
maternal vaginal bleeding 6-9th months pregnancy; severe proteinuria or preeclampsia, antepartal hemorrhage/stroke/seizures, maternal hyperthyroid, maternal infection exposure; labor/delivery, fetal distress, SGA, low birth weight, preemie, multiple births, intracranial hemorrhage, meningitis, encephalitis, head trauma
cp dx/tx
hammersmith neuro exam, GMFCS. MRI, chromosomal/metabolic studies, LP if sepsis suspected. CP is a central disorder. refer, educate, support, help with finances. manage nutrition, BM, dentistry, drooling, swallow study, respiratory infections, skin breakdown, antispasmodic med, botox, may need help for osteopenia, vision issues, may need surgeries
neurofibromatosis
dominantly inherited, error in NF1 tumor suppressor gene. has 2 + of following: 6+ cafe au last macule >5mm in prepuberty or >15mm post puberty; 2+ neurofibromas, freckling in axillary/inguinal region, optic glioma, 2+ litchi nodules, osseous lesion, relative with NF1. can have skeletal deformities, CV issues, neurocognitive issues. tx of optic gliomas is usually unnecessary. high risk learning disabilities.
Genetics
+ history for inherited disorder, at risk, physical findings/dysmorphic features, DD, structural anomalies.
common genetic things
Down: short, brachycephaly, mid face hypoplasia, brush field spots, epicentral folds, protruding tongue, cataracts, small ears, lax joints, broad hands, single palmar crease, clinodactyly, congenital heart disease, at risk for hypothyroid/alzheimer/leukemia, DD, hearing loss, hypotonia. Turner: short, short neck with webbing, posteriorly rotated ears, ptosis, short metacarpals, cardiac issues, hip dysplasia/scoliosis/kyphosis, horseshoe kidney, OM, delayed puberty/infertility, hearing loss, strabismus, learning disabilities. Klinefelter: tall/long arm span, dental decay, delayed puberty, small penis, gynecomastia, autoimmune issues, skin striae, scoliosis, shy withdrawn, immature, ADHD. Fragile X: prominent forehead, long narrow face, prominent jaw, feeding problems, strabismus, OM, seizures, short, connective tissue issues, OSA, DD, behavior issues, autism. Prader-Willi: FTT, short, obesity, hypothalamic insufficiency, strabismus, myopia, sleep apnea, enamel hypoplasia, scoliosis, delays.
genetics: emergency plan
make a plan with diagnosis, clinical findings/status, meds, allergies, immunizations, highlight common presenting problems and management strategies, medical contact information.
