Neuro Flashcards
most important diagnostic tool in neuro
history
what test can see the posterior fossa bets?
MRI
what is a good eval for hydro, hemorrhage, gross structures, calcification
US
when do HAs typically begin normally?
middle school aged
when do you do a CT/ MRI for HA in a kid
Concern about sub-arachnoid, subdural hematoma
Concern about increased IC pressure or hemorrhage
Red flags for HA
fails to respond to tx focal neurological findings (first 2-6 months) progressive frequency/ severity awake from sleep, worse in morning AM vomiting at risk hx or condition
What are some focal neurologic findings
CN VI palsy diplopia new onset strabismus papilledema hemiparesis ataxia
can you have photophobia or phonophobia w/ a tension type HA?
Yes, but usually only have 1
Constant, aching, tight
Occipital, frontal or constricting band around head
Tension type HA
chronic tension HA is often a sign of what
depression and/or anxiety
Severe, pulsatile (pounding)
unilateral, can be bilateral
Frontal or temporal regions, retro orbital or cheek
Migraine hA
what may be the only symptoms of migraine in a kid
vomiting
tx for migraine
Ibuprofen APAP early caffiene + ergot triptans and DHE rest and quiet avoid opioids
Migraine prevention
TCA beta blockers (propranolol) Calcium channel blockers (verapamil)
A sudden, transient disturbance of brain function manifested by involuntary motor, sensory, autonomic, or psychic phenomena
Seizure
2 or more seizures not provoked by particular event or cause.
Epilepsy
a benign condition of childhood with unilateral focal seizures and speech abnormalities, often hereditary.
Rolandic epilepsy
when should you do studies w/ a migraine
worse on awakening
awakens pt
worse with cough or bending over
Seizure > 30 min
Sequential seizures without regain LOC > 30min
Status epilepticus
Onset of seizure begins in one area of one cerebral hemisphere (apparent clinically or via the EEG) with no LOC
simple focal seizure
Onset of seizure begins in one area of one cerebral hemisphere (apparent clinically or via the EEG) with altered LOC (staring)
complex focal seizure
a simple or complex partial seizure that ends in a generalized convulsion
secondary generalized seizure
Seizures arise from both hemispheres, simultaneously
generalized seizure
unique to kids 6 month- 6 years. happens with changing temp. doesn’t tend to cause damage or increase risk of epilepsy
febrile seizure
if a second seizure is going to occur, when is it likely?
within 6 months after 1st seizure
if a second seizure is going to occur, when is it likely?
within 6 months after 1st seizure
what type seizures are frequently associated w/ underlying structural brain dz?
generalized seizures
what type of partial seizure may have an aura/ automatisms?
Complex partial
what type seizure will a patient be confused for generalized?
generalized tonic-clonic
symptoms in infants that occur in clusters when drowsy. Have severely abnormal EEG pattern. Due to brian injury at birth and are hard to control.
Infantile spasm (west syndrome)
if a patient has infantile spasms with no hx of birth problems or MRI or meatbolic origin is there a better or worse outcome.
Better
usually 3-13 years old. Normal IQ and MRI. will have twitching and tingling when awake and grand mal when asleep. often runs in families
Benign rolandic epilepsy (benign focal epilepsy of childhood)
when do you Tx for benign rolandic epilepsy
only if seizures are frequent, problem in school or anxiety
effective txs for benign rolandic epilspey
avoidance of sleep deprivatoin
carbamazepine, oxcarbamazepine
will usually outgrow
when is status epilepticus common
children under 5, especially <12 months
can status epilepticus be the first seizures?
yes, often happens
most common cause of status epilepticus in children
Infection and metabolic disorders
too much potassium can lead to what?
arrhythmia
do you tx febrile szs?
no
what is a complex febrile seizure?
one side of body shaking, staring
prolonged (>15-20 minutes)
multiple in 24 hours
more likely to lead to epilepsy
If you do have to tx a febrile seizure what do you give?
rectal diazepam
can syncope have rhythmic jerking?
Yes, can have some
can syncope have rhythmic jerking?
Yes, can have some
Transient LOC and postural tone due to cerebral ischemia or anoxia.
syncope
can syncope have a prodrome?
Yes Dizziness, lightheadedness, nausea, sweating, pallor
Neurally mediated
Transient hypotension from vasodilation and/or decreased heart rate
Arousal 1-2 min up to 1h
Vaso-vagal or neurocardiogenic syncope
tx for syncope
Direct management of any cardiac cause
Reassurance and avoidance of triggers for vaso-vagal stimulation
causes of increased ICP
Cerebral edema
Mass lesion
children will have HA, diplopia/ strabismus, papilledema, herniation syndromes
increased ICP
management for hydrocephalus caused by obstruction that will get better as kid ages
shunt that drains into peritoneal cavity
where is pain with supratentorial elevated ICP
eye
forehead
temple
where pain with infratentorial increased ICP
occiput
neck
when are HA from elevated ICp worse
morning
awakening
standing up
at night
Increased intracranial pressure without identifiable mass or hydrocephalus. Obese teenage girl with HA tinnitus, papilledema, visual loss. normal MRI>
pseudotumor cerebri
most common causes or childhood stroke
cyanotic heart dz
sickle cell anemia
meningitis
hypercoaguable state
symptoms of childhood stroke
hemiplegia, unilateral weakness, seizures.
most common cause of concussion in children
fall
Brief loss of consciousness or stunned for minutes to hours. Amnesia is common and transient
Head Injury -Concussion
what kids with a concussion should be evaluated
All children with amnesia or who were unconscious should be evaluated in ER.
what will a meningomyelocele often have on prenatal screen?
elevated alpha fetoprotein
displaced cerebellum through foramen magnum into spinal canal – posterior laminectomy. Sx will hve progressive ataxia or vertigo. low lying tonsils alone
Arnold Chiari I
displaced cerebellum plus meningomyelocele – surgical repair and shunt. low lying tonsils + hydrocephalus
Arnold Chiari II
occipital encephalocele – surgical repair
Hydrocephalus common
Arnold Chiari III (anencephaly)
smooth brain
Severe delay, seizures. Associated with syndromes
Most common disorder of neuronal migration
Lissencephaly
Premature closure of sutures
Sporadic and idiopathic
Craniosynostosis
what type Craniosynostosis will have a short wide head (brachycephalic)
coronal sutures
Tx for craniosynostosis
Treatment is surgical excision of fused suture line – best done prior to 6 months of age
Autosomal Dominant
Café au lait spots - >6 of 5mm prepubertal pt
Neurofibromatosis
AD, rare , characterized by benign tumors in vital organs such as the brain, eyes, kidneys, heart and skin. will have ash leaf spots, Adenoma Sebaceum
Shagreen Patch
Tuberous sclerosis
Diagnostics for tuberous sclerosis
CT for calcified nodules
MRI for demyelination
Unilateral port wine stain over upper face
Follows cranial nerve V. Can have leptomeningeal vascular anomaly and calcifications can lead to seizures.
Sturge Weber
Impairment of coordination and balance of voluntary movement
Cerebellar problem
ataxia
most common cause of ataxia in children
post-infectious or drug intoxication
Sudden onset of ataxia,staggering, frequent falls
Nystagmus, vomiting, irritaility, lethargy possible
Sensory and reflexes preserved
No evidence increased ICP
will recover in 1-4 weeks
post infectious acute cerebellar ataxia
do you need to tx post infectious acute cerebellar ataxai
No, most get between in 1-4 weeks by themselves
kids uses hands to walk up legs to standing position
Gower sign
what are 2 disorders of the anterior horn cells?
Spinal muscular atrophy (SMA)
poliomyelitis
If you have a lower motor neuron lesions will be it be high tone or low tone?
low tone
Neuromucular junction problem
Myasthenia gravis
muscle weakness, which may manifest with floppiness, delayed motor milestones, unsteady gait or muscle fatiguability. Progressive with normal mental development but body fails.
SMA (spinal muscular atrophy)
> 10 years old, ophthalmoplegia and ptosis, loss of facial expression and difficulty chewing
Juvenile myasthenia gravis
Similar to Duchenne except later, less severe
Death usually in adulthood
Becker muscular dystrophy
X-Linked recessive Onset at 2-6 yrs Proximal muscles affected before distal Waddling gait, difficulty with stairs pseudohypertrophic calf Gower Sign – pelvic weakness Elevated CPK 75% mortality by age 20
Duchenne muscular dystrophy
what is used to tx spastic cerebral palsy?
botox
