neuro Flashcards
night terror vs nightmare
night terror in early part of night and child has no recollection
normal age for breath holding spells?
What is the pathophys
Possible tx?
about 1 yr: 6 mos-2yr
Always triggered
Would have tachycardia then brain hypoxia, then rare GTC
May treat with iron, but controversial
recurrence of febrile sz
Risk of epilepsy
30% after 1st
50% after 2 or more
Epilepsy: about 1-2% (doubled risk)
Avoid what meds in Dravet?
Na channelopathy, avoid Na channel blockers
Na channel blockers
Phenytoin, Lamotrigine, Carbamaz, Oxcarbamaz
What is Dravet?
SMEI
Tx of JME?
Prognosis
VPA or topamax
Need to stop living the teenage life, but otherwise good prognosis on meds
Topiramate side effects
cognitive
nephrolithiasis
Bad AED combo…
VPA and what?
Lamotrigine (NO DEPAKOTE/LAMICTAL)
commonest cause of CMT
demyelinating, duplication PMP 22 gene
mechanism in Friedreich ataxia
when does it show up
GAA trinucleotide repeat expansion
shows up in latter half of 1st decade
loss of ankle jerk and a babinski? What is it?
Friedreich ataxia (others don’t happen in kids: spinocerebellar degen and tabes dorsalis
prevalence of migraine in adolescents
15%
asymmetric crying faces
which side abnormal
other issues?
drooping side is normal, absent DAOM in 80%
check for heart prob (assoc anomaly)
3 mutations in RETT
MECP2, CDKL5, FOX
abnormal CBC< ataxic gait, oculocutaneous lesions?
High risk of what?
Ataxia telangiectasia
Risk for Hodgkins and leukemia
immunologic issues in ataxia telangiectasia
T cell dysfunction, low Ig levels
Lots of respiratory tract infx
which occurs in younger kids: Ataxia telangiectasia or Friedreich ataxia?
Younger: TA
Older FA: late childhood / early adol
ataxia, high arch foot, no LE reflexes, DM, cardiomyopathy/CHF
Friedreich Ataxia
Fried Arch: cardiac / arch issues
relationship between when sydenham chorea and strep occur?
chorea months after strep infx, after antistreptococcal ab titers have normalized
chorea, hypotonia / rigidity, emotional lability
Huntington’s chorea
how long must tics be present for Tourette’s dx
1 yr
possible treatments for GBS ascending paralysis
IVIG or plasmapharesis. NOT steroids
antibodies often present in myasthenia gravis?
anti smith Abs, anti-Acetylcholine receptor Abs
congenital myasthenia gravis cause/prognosis?
lifelong from genetic defect of NMJ
how to clinically distinguish between congenital MG and transient (6wk) MG?
transient does NOT involve eyes.
how does botulinum toxin work?
blocks release of Ach from NMJ
gene for DMD/Beckers?
xp21
proportion of time in DMD that mom is a carrier?
2/3
Steinart disease, also known as what?
What does it involve?
Myotonic Muscular Dystrophy
Involves smooth and striated muscle
steroid treatment for spinal cord compression vs spinal trauma?
compression: dexamethasone
Trauma: Methylprednisolone 30mg/kg x 1 hour
why fosphenytoin compared to phenytoin?
phenytoin can produced purple glove syndrome (skin necrosis)
% of kids who get febrile szs?
3% by 5th bday
pedi boards use what drug to treat benign rolandic seizures?
carbamazepine
tx for JME?
vpA
most common risk factor for premies developing CP
perinatal infx
New drug for Wilson’s? What else for Tx?
Tridentine and give zinc
Criteria for Lennox Gastaut and Rx
- Many seizure types: Atonic, Tonic, GTC, absence atypical
- DD / ID
- Spike and slow wave on EEG
Tx: Felbamate (Aplastic anemia), Banzel
3-5 Hz spike and wave?
Tx?
JME
Tx: VPA, Lamictal
HC rule?
35 at birth, then 3 mos/ 9 mos rule + 5cm each
No more than what head growth per week in first three mos?
0.5cm / week
retinal lacunes, agenesis of corpus callosum, vertebral anomaly
Aicardi syndrome
SMA gene and chromosome
SMN 2 on chromosome 5
anchoring of cord of conus medullaris due to thickened filum terminale
Dx and what level
tethered cord, L2 or below
defect in botulism
EMG finding
- no release of ACh
2. EMG incremental response to repetitive rapid stim
neonatal vs congenital myasthenia
Neonatal is transient and does NOT involve opthalmoplegia
EMG with decrement with repetitive stim
myasthenia
CTG repeat on chr 19 with anticipation
myotonic dystrophy
features of what:
Frontal baldness, endocrine issues, cataracts, cognitive
Myotonic dystrophy
Rx for myotonic dystrophy
mexilitine, phenytoin, carbamazepine
weakness pattern in nemaline myopathy
neck, face, proximal muscles
marker for ataxia telangiectasia
high AFP
NF1 chromosome
TS chromosomes
NF: 17
TS: 9., 16
tram track calcifications on XR/CT?
Sturge Weber under angioma