Neuro Flashcards
List bacterial causes of meningitis in neonates.
- Group B strep (3/4) o Early GBS infection reduced with pre-partum prophylaxis o Late (>7 days not prevented by intrapartum antibiotics) - E coli - Neisseria menigitidis - Staph epidermidis - Staph aureus - Group D strep - Ureaplasm urealyticum - Heamophilus type b - Non typeable Haemophilus - Listeria monocytogenes – common in certain immigrant groups, assoc with unpasteruised milk
Beyond the neonatal period, what are the main causes of ABM?
- Strep pneumo 45%
- N. meningititis 45%
- H. flu
- Less common (
List host factors that increase the risk of meningitis.
- Age
What are the basic four steps in the usual development of meningitis and encephalitis?
- Infection of respiratory tract
- Development of bacteremia
- Invasion of the meninges
- Inflammation of the brain
List additional means by which bacteria gain access to the meninges and CSF.
- Mechanical disruption o VP shunt o Basal skull fracture o LP - Direct extension o Sinusitis o Mastoiditis o Otitis media
List indications for LP in meningitis (Box 175-1)
- Signs and Sx of meningitis or toxic appearance
- Febrile infants
What is the normal CSF serum glucose ratio, what is hypoglucorrhachia?
What is a normal CSF protein?
- Normal: ~0.6 to 1.0
- Hypoglucorrachia:
Who is at a very low risk of bacterial meningitis in patients with CSF pleocytosis?
- Patients with CSF pleiocytosis have a very low likelihood of ABM if they have none of the following: o +ve Gram stain o CSF ANC > 1000 o Peripheral ANC > 10,000 o Protein >.8 g/L o Hx seizure before or at presentation
Who should get a CT head before LP?
Focal neuro signs
- Signs elevated ICP – ie papilledema
- Seizure
- Known intracranial mass
- Hx head trauma
- Immunocomprimised
List risks of dexamethasone in bacterial meningitis.
- GI bleeding
- False sense of clinical improvement
- Reduced blood brain barrier penetration of vancomycin (although this has not been shown to reduce the time to sterilization of the CSF)
List indications for empiric acyclovir in menigoencephalitis.
- Ill or febrile infant with a history of maternal HSV infection
- Vesicle on the skin
- Seizure
- Focal neuralgic findings
- Atypical presentation of sepsis or meningitis
Describe infantile spasms.
- Onset in the first year of life, rapid, jackknife flexor or extensor spasms that appear in clusters
- 2/3 associated with a congenital brain malformation or tuberous sclerosis
- Majority will progress and become significantly developmentally delayed.
What is the triad of West syndrome?
- Infantile spasms
- Arrested psychomotor development
- Hypsarrythmia (characteristic EEG pattern)
Describe Benign Rolandic Epilepsy of Childhood.
- Partial epilepsy between ages 3 and 13 years
Seizures occur while sleeping involving the face and twisting of the face mouth and anarthria
What is the defininition of a febrile seizure, and what age group does it affect?
- Def:
o Seizure accompanied by a fever without CNS infection
o 6mo – 5 years old
o Developmentally normal child - At risk during rapid rise in fever, typically early in the course of an illness
- Slight increase in risk of epilepsy from 1% (baseline population) to 2% with febrile Sz.
What are the risk factors for febrile seizure:
- Previous febrile seizure
- Young
- Family history of febrile seizures
- High temperature
- Parental report of developmental delay
- Neonatal discharge at an age greater than 28 days (suggesting perinatal illness requiring hospitalization)
- Daycare attendance
- Maternal alcohol intake and smoking during pregnancy has a 2-fold increased risk.
- Interestingly, no data support the theory that a rapid rise in temperature is a cause of febrile seizures.
How are febrile seizures classified?
- Simple: 15min, recurrent (>1 within 24 hrs), or focal
- Febrile Status: 15-30min, seizures without recovery, +/- focal.
What are the most common causes of neonatal seizures (Box 175-1)?
- Seizures are more common in neonatal period than any other childhood period
- Most common are:
o Hypoxic ischemic encephalopathy (HIE)
o CNS infection
o Congenital brain malformation
o CVA
o Drug WD or intoxication
o Metabolic disturbances
§ MC = Hypoglycemia, hypocalcaemia,
§ Hypomagnesemia, Pyridoxine deficiency - Inborn errors of metabolism rare, but early treatment can be lifesaving
What disorders in neonates and children are seizure mimics
Neonates:
- jitteriness
- opishotonos
- myoclonic jerks
- hypoglycemia
- periodic breathing
- normal neonatal movement
Non-neonate
- breath holding spell
- rigors/chills
- Sandifer’s syndrome (GERD)
- migraine
- syncope
- CVA
- sleep d/o
- -night terror
- -narcolepsy
- -sleep myoclonus
- -sleep walking
movement d/o
- tics
- shudder attacks
- paroxysmal choreoathetosis
psychological
- psychogenic seizure
- panic attacks
List drugs that may cause seizure (Box 175-8).
Analgesics / Anesthetics: - Etomidate - Ketamine - Lidocaine - Salicylate Antibiotics: - PCN - B-lactams - Isoniazid - Flagyl Anticholinergics Anticholinesterases: - Organophosphates - Physostigmine Sympathomimietics: - Cocaine - Amphetamine - Methylphenidate Anticonvulsants: - Carbamazapine - Phenytoin Antidepressants: - TCA - SSRI - Buproprion - MOAI-s Antipsychotics: - Chlorpromazine - Haldol Antidysrhythmics: - Procainamide - Tocanide - Some BBs Antihistamines: - Diphenhydramine Antitumor drugs: - Cyclosporine - Methotrexate - Busulfan - Chlorambucil Bronchial agents: - Theophylline - Aminophylline Other: - Baclofen - CO - CN - EtOH - Flumazenil - Hypoglycemics - Pb - Lithium - Nicotine
What are red flags for headache in children?
- Associated neuro symptoms
- Occurrence with straining or athletic activities
- Change in pattern
- Nocturnal awakening
Bilateral occipital headache
List a differential diagnosis for headache in children (Box 175-13).
- AVM, aneurysm
- Congenital malformation
- Hydrocephalus
- ICH (SAH, SDH, EDH, intraparenchymal)
- HTN
- Infectious (Meningitis, encephalitis, abscess)
- Metabolic
- Neoplasm
- Pseudotumor cerebri
- Toxins (Meds, cocaine, analgesia rebound)
- Trauma (eg leptomeningeal cyst)
- Opthalmologic: astigmatism, refraction errors, eye strain
- Migraine
What are the 1998 Revised Criteria for diagnosis of pediatric migraine without aura (Box 175-14)
>5 attacks fulfilling the following: HA lasting 1-48 hours HA has >2 of the following: - Either bilateral or unilateral - Pulsating quality - Moderate to severe intensity - Aggravated by routine physical activities > 1 accompany HA: - Nausea and/or vomiting - Photophobia and/or phonophobia
List causes of childhood ataxia.
Post infectious
- Acute cerebellar ataxia
- Acute post infectious demyelinating encephalomyelitis
- Guillain-Barre
- Brainstem encephalitis
Metabolic
- Aminoacidopathies
- Mitochondrial d/o
- Organic acidopathies
- Urea cycle d/o
Autoimmune
- MS
- Opsoclonus-myoclonus
Vascular
- Migraine (basilar)
- Stroke
- Vertebral artery dissection
Neoplastic
- Tumor
- Neuroblastoma
- ganglioblastoma
Genetic
- Friedreich’s ataxia
- Ataxia-telangectasia
