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Peds > Neuro > Flashcards

Neuro Flashcards

1
Q

tension HA

A

emotional distress, fatigue, lack of sleep, stressors.

eipsodic, worsen throughtout day, band around head, tenderness of posterior M of neck

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2
Q

migraine

A

can be atypical: cyclical vomiting, abd migraine, paroxysmal vertigo.
throbbing, photophobia, phonophobia, N/V
precipitate by stress, light, odor, food
relieved by sleep
RF: fx
classic- has aura - visual sx, speech changes, sensory abn like paresthesias
common- w/o aura. most common type in children. unilateral, usually frontal or temporal.
basilar artery migran or hemiplegic migrane cause acute ataxia

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3
Q

concerning sx of HA

A
  1. relieved by vomiting after lying down- incr ICP
  2. sudden onset- intracranial hemorrhage
  3. awaken from sleep- incr ICP
  4. fever + photophobia- infection
  5. worsen with cough or valsava- incr ICP
  6. progressively worsen- serious
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4
Q

ataxia DD

A

post infectious cerebellitis, infectious cerebellitis, medication or toxin, IC mass, opsoclonus- myoclonus syndrom, migraine HA, hydrocephalus, metabolic disease, neurodegen disease, psych illness

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5
Q

post infectious cerebellitis aka acute cerebellar ataxia

A

most common cause of ataxia in kids. only in 1-3yo. AI - cerebellar demyelination
occur wks after viral infection
onset- sudden + ataxia, vomit, nystagmus in 50%, dyarthria in some
CSf normal or pleocytosis, protein elevated
most recover in few mo
usually no fever or systemic sx

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6
Q

infectious cerebellitis

A

viral or bacterial. often febrile, AMS, maps, enterovirus EBV or bacteria that cause meningitis

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7
Q

ataxia localizing tumor

A

most likely in cerebellum or frontal lobe

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8
Q

opsoclonus-myoclonus syndrome

A

paraneoplastic syndrome- neuroblastoma. 6mo-3yo. ataxia + myoclonus + opsoclonus( jerky conjugate mvt of eyes)

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9
Q

hydrocephalus ataxia

A

insidious onset, chronic decr in coordination. HA/V

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10
Q

cerebellar mass

A

coordination, precision and balance impacted. no impact on initiation of mvt. bc close to 4th ventricle, cause obstructive hydrocephalus.
1) vermis- dysarthria, truncal ataxia, gait abn
2) cerebellar hemispheric lesion-IL lim abn, nystagmus, tremor/ dysmetria, spares speech
fall/look toward side of lesion
3) deep cerebellar nuclei- tremor, myoclonus, opsoclonus

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11
Q

LP + incr ICP

A

LP is CI bc cause brain herniation

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12
Q

infratentorial lesion

A

cerebellar signs, incr ICP

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13
Q

brain tumor

A

most common solid tumor in children and 2nd most common form of childhood ca behind leukemia. highest ca childhood death.
most common 10 is supratentorial.
RF: radioation exposure, genetic syndrome (tuberous sclerosis, NF)
most common medulloblastoma and juvenile pilocytic astrocytoma are each 20%.

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14
Q

brain stem glioma

A

resection for low grade. prog variable

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15
Q

ependymomas

A

from 4th ventricle. cause hydrocephlus. resection + rad. 50% 5y survival

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16
Q

astrocytoma of cerebellum

A

best prog of infratentorial tumor in kids. often cystic. resection. rad if high grad, 90% 5y survival with complete resection

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17
Q

medulloblastoma

A

most common pediatric tumor. malig that spread through CNS - metastasize to extra cranial site. resection + rad+ chemo.
prog dep on size and spread

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18
Q

hypotonic infant types and PE

A

1) central hypotonia- dysfunc of UMN
2) peripheral hypotonia- dysfunc of LMN
PE: weak cry, decr spontaneous mvt, frog leg posture, M contractures

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19
Q

peripheral hypotonia

A

associated with decr fetal mV and breech presentation.
consciousness unaffected. M bulk and DTR decr
etio
1) serum CK
2) DNA test for SMA
3) EMG - myathenic D
4) M bx

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20
Q

central hypotonia

A

associate with sz in neonatal period, altered lvl of consciousness, incr DTR, ankle clonus

etio:
1) CT to r/o CNS injury or congenital malformation
2) electrolyte: Ca, Mg, MH3, lactate, pruvate to r/o metabolic D
3) high resolution chromosome studies- FISH for genetic D(prader willi)

21
Q

acute life threatening causes of hypotonia etio

A

sepsis, meningitis, acute metabolic D

22
Q

spinal muscular atrophy (SMA)

A

anterior horn cell degeneration
P: hypotonia, weakness, weak cry, tongue fasiculations, bell shaped chest, frog leg posture, nomral extraocular mvt and sensory
type I-infantile 3yo
etio: AR -C5-survivial MN gene SMN1 mut –> degeneration and loss of anterior horn MN
dx: DNA test -90%, M bx show atrophy
tx: supportive. no cure. gastrotomy tube feeding. physical therapy
prog: survive till type I- 1yo. II-adolescent III-adult.

23
Q

infantile botulism

A

bulbar weakness and paralysis. 2/2 ingest C. botulinum spore and absorption of botulinum toxin-in contaminated honey
toxin prevent presynaptic release of ach.
time line
1) onset 12-48 post ingestion.
2) consitmation = 1st sx
3) neuro sx follow- weak cry suck, loss of previous motor milestones, ophthalmoplegia, hyporeflexia
4) paralysis symmetric and descending. diaphragmatic paralysis sometimes
dx: hv, neuro exam, EMG-ancremental response during high freq stimulation
tx: supportive NG feed, ventilation. botulism ig improve course. ab CI = worsen course
prog- excellent

24
Q

congenital myotonic dystrophy

A

can’t relax contracted M
AD- C19-trinucleotide repeat, transmit though affected mother in 90% cases
P: antenatal hx- poyhydramnios+ poor swallowing, neonatal-weakness, hypotonia, poor feeding and respiratory problem
PE: facila diplegia (bl weakness), hypotonia, areflexia, arthrogyrposis
myotonia dev after 5yo.
adult-myotonic facies, can’t release rip after handshaking, ptosis

25
Q

CMD dx, tx, prog

A

suspect in all infants with hypotonia. examine mom. DNA test
Tx: supportive
prog-MR 50-65. feeding problem improve

26
Q

hydrocephalus ex vacuo

A

not true hydrocephalus. ventricular enlargement due to brain atrophy

27
Q

acquired hydrocephalus

A

IV hemorrhage- most common in premie, bacterial meningitis, brain tumor

28
Q

hydrocephalus signs , tx

A

incr head circumference

1) infants: large anterior and posterior fontanelle split sutures. sunset sing- tonic downward deviation of both eyes caused by P from enlarged 3rd V on upward gaze center in midbrain
2) older kids: sign of ICP: 6CN palsy, brisk DTR, downward plantar
tx: ventriculoperitoneal shunt

29
Q

Spina bifida

A

any failure of bone fusion in posterior midline of vertebral column.
decr by prenatal folic acid. cause by valproate, phenytoin, methotrexate
dx: prenatal- AFP elevated in 80%, fetal sonography. after birth- PE, confirm by MRI

30
Q

myelomingocele

A

herniation of SC and meninges though bony cleft. usually through lumbosacral area. 20x more common than meningocele
P: fluctuant midline mass, defect dep on lvl of lesion. associated with hydrocephalus /chiari type II in 90%, cervical hydrosyringomyelia, defect in neuronal migration, orthopedic problem, genitourinary defects
tx: urgent survical repair in 24hr to decr morbidity from infection and trauma

31
Q

meningocele

A

herniation of only meninges. usually no neural deficits
P: fluctuatnt midline massfillled with CSF
surgical repair

32
Q

SB occulta

A

no herniation through cleft.
-hairy pathch or dimple on back. no neural deficit
no tx needed

33
Q

coma

A

in

34
Q

breathing v coma

A

1) hypovent- opiate or sedative
2) hypervent- ketoacidosis (kussmael), neurogenic pul edema, midbrain injury
3) Cheyne stokes- alternating apnea and hyperpneas- bilateral cortical injruy
4) apneuristic breathing- pause at full inspiration- pons damage
5) ataxic or atonal breathing- irreg respiration no matter. medullary injury, impending death

35
Q

pupil v coma

A

1) unilateral dilated, unreactive pupil-uncal herniation
2) b/l diated, UR- irreversible brainstem injury or post ictal
3) bl constricted, R, opiate or pontine

36
Q

caloric irrigation

A

deviate toward cold water. if not- pontine injury

37
Q

febrile sz

A

non CNS cause. pt 6mo-6yo
simple febrile sz- 15min focal features, or recur w/in 24hr
Dx: hx, nl neuro exam, r/o CNS infection clinically or CSF. LP if suspect meningitis. no imaging or EEG
tx: 1st = none. few- antipyretics. many= daily anticonvulsant or abortive rectal diazepam

38
Q

infantile spasm

A

west syndrome. onset 3-8mo. rare in >2yo. tubers sckerisus. brief mycologic jerks, , jackknifing sz or salaam sx.
dx: EEG- hyperarrhythmia pattern.
tx: adrenocortcotropic hormone (ACTH) IM, valproic acid, vigabatrin
prog-poor. severe MR

39
Q

benign rolandic epilepsy

A

nocturnal partial sx with secondary generalization. most common partial epilepsy in kids. 3-13yo
AD
early morning- oral buccal manifestation- moaning, fronton, pooling saliva then spread to face and arm then tonic clonic
dx- eeg- spike and sharp wave in mid temporal and central regions
tx- valproic acid
prog- excellent

40
Q

migraine

A

unilateral, pounding, start periorbital (kids can be bifrontal). AD. 5HT. w/o aura is most common type in kids
migraine equivalent- no HA but prolong, transient change in behavior, cyclic vomit,/ abd pain and paroxysmal vertigo
opththalmoplegic migraine- unilateral ptosis, CN III palsy
basilar artery migraine- vertigo tinnitus, ataxia, dysarthria
no obvious precipitating cause
improve by sleep. nl neuro exam
propranolol- prophylactic

41
Q

tension HA

A

bifrontal, dull, diffuse, aching, M contracture. rare in

42
Q

acute cerebellar ataxia of childhood

A

2/2 AI or postinfectious cause (varicella, influenze, EBV, myoplasma)
most common cause of ataxia in kids
onset 18mmo-7y. rare in >10yo
P: truncal ataxia, refuse to walk bc fear of falling, slurred speech and nystagmus, no fever
CT: normal. do to r/o tumor hemorrhage
tx: supportive. take 2-3mo

43
Q

Guillain barre

A

ataxia, areflexia, ascending weakness, nl sensation. campylobacter jejuni. prodromal gastroenteritis. cell mediated immune response cross react with schwann cell mem. facial weakness in 50%
dx: LP- albuminocytologic dissociation- incr CSF protein wo incr cell count. EMG- decr N conduction veocity. spinal MRI in

44
Q

miller fisher syndrome

A

ophthalmoplegia, ataxia, areflexia

45
Q

sydenham chorea

A

st. vitus’ dance
AI + rheumatic fever. self limiting. present with chorea and emotional lability.
onset 5-13yo
cross react with ab to basal ganglia cells
follow 2-7mo after strep pharyngitis. restless, speech jerky, profusion of tongue- chameleon tongue, choleric hand- flexed. milkmaid’s grip- can’t maintain. no effect on gait and cog
DD: SLE, huntington, wilson
dx: elevated antistreptolysin O (ASO) anti DNase (ADB) , MRI - incr signal in caudate and putamen, single photon emission SPECT incr perfusion
tx: haloperidol, valproic acid,
prog- all recover, mo-2yo

46
Q

gower’s sign

A

extend each leg then climb up thigh until upright. bc weak pelvic M. in DMD and BMD.

47
Q

muscular dystrophy dx

A

CK high. EMG show polyphasic potential. normal conduction.
cardiac involvement in 50%. mild cog impairment in DMD not BMD>
M bx- M dystrophic pattern
DNA testing - deletion in 90% pt
tx: no cure. oral steroid transiently improve strength

48
Q

myasthenia gravis

A

AI D progressiv weakness or diplopia
anti ACHR ab at NMJ
neonatal myathenia- transient weakness 2/2 placental transfer of maternal AChR ab in mo with myasthenia graves. see hypotonia, weakness, feeding problem
junile myathenia- 2/2 AChR ab formation. bilateral ptosis - most common presenting sign. incr weakness in day with repetitive activity, diplopia, DTR preserved. may have other AI D.
Dx: tensilon test - IV edrophonium chloride - cholinesterase inhibitor= transient improvement of ptosis. decremental response to N stimulation, AChR ab titers
tx: neonatal- tx sx bc self limiting. juvenile- cholinesterase inhibitor like pyridostigmine bromide. immunotherapy- corticosteroids, plasmapheresis, IVIG, thymectomy
prog: neonatal -resolv in 1-3wk
juvenile- 60% remission after thymectomy

Peds (21 decks)

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