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Pediatrics > Neuro > Flashcards

Neuro Flashcards

1
Q

What trimester does the brain and spinal cord develop

A

First. Susceptible to infection, substance abuse and maternal dietary deficiencies

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2
Q

When does the nervous system develop until

A

Age 4

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3
Q

Vertebrae in children

A

Not completely ossified, greater risk for cervical spine injury and compression fractures

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4
Q

Neuro – history

A

Most important part of the neuro exam. Fam history of seizures, degen neuro diseases, sensory defects, Neural tube defect (NTD). History of pregnancy: maternal illness, placental dysfunction, fetal distress, prematurity, meconium staining, apgar score. Child health history: delayed motor or speech development, hypotonia, seizures, childhood illnesses. Parental concerns: vision, hearing, development.

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5
Q

Infant/Child assessment

A

Height, weight, blood pressure, head circumference. 3 and 9 rule for head circumference. Newborn 35, 3 month 40, 9 month 45. 3 year 50. 9 year 55.

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6
Q

Hydrocephalus

A

Excess CSF in intracranial space, and specifically in the intraventricular spaces within the brain causing dilation of the ventricles and a wide range of symptoms.

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7
Q

Two primary causes of hydrocephalus

A

Congenital .5-1% or Aquired from lesions, tumors, infection, intracrainial bleed, myelomeningocele. Need shunt to drain CSF

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8
Q

Infancy s/s hydrocephalus

A

Protruding forehead or bossing – sunset eyes, Depressed eyes or setting sun where the eyes rotate down making the sclera visible above the pupil. Sluggish pupils. Irritable, lethargy, feeding poorly, changes in LOC, arching of back (opisthotonus), lower extremity spasticity., May cry when picked up or rocked but quiet when still.

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9
Q

Childhood hydrocephalus

A

Headache on awakening that improves with vomiting or sitting up. Papilledema, strabismus, ataxia. Irritable, lethargy, apathy, confusion, incoherent

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10
Q

Hypotonia epidemiology

A

Neuromuscular – muscular dystrophy or spinal muscular atrophy v Nonneuromuscular which is not common. Hypoxic due to ischemic ecephalopathy or premature birth with intraventricular hemorrhage

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11
Q

Muscular Dystrophy

A

Group of progressively degernative inherited diseases that affect muscle cells of specific muscle groups – leads to weakness and atrophy. Most identified in early childhood characterized by progressive muscle weakness

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12
Q

Pseudohypertrophic (Duchenne) MD

A

Most severe and common type seen in childhood. X linked, inherited recessive disorder seen only in boys

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13
Q

Clinical manifestations of MD

A

Children have a hx of meeting motor dev by earlier years, s/s get more obvious by age 3. Difficult running, riding a bike, climbing stairs. Later abnormal gait is apparent – waddling and lordosis (exacc curv of lumbar spine).

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14
Q

Gowlers Sign

A

when they fall they rise from the floor by rolling on stomach, pushing up on their knees and walking hands up their legs to stand up. Seen in MD.

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15
Q

Pseudohypertrophy

A

Muscles in thighs and arms become enlarged from fatty infiltration and feel firm or “woody” upon palpation

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16
Q

Progression of MD

A

Contractures and deformities involving the large and small joints are common. Fine motor skills are kept though. By age 12 ambulation is impossible and they need a wheelchair. Facial and resp muscles affected later in the terminal stages of the disease – cardiomegaly, resp tract infections, cardiac failure. Moderate obesity, decreased IQ, shortened lifespan

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17
Q

Therapeutic Mgmt MD

A

Maintain ambulation and independence for as long as possible. Mobile as possible with braces, surgery, PT. Maximize self sitting, resp function, self care, prevent obesity, prevent resp tract infections

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18
Q

Types of Partial seizures

A

Simple, comlpex, partial evolving into generalized

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19
Q

Generalized seizure types

A

Absense, myoclonic, tonic, atonic, clonic, tonic-clonic

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20
Q

Neonatal Seizures

A

brief and subtle – eye blinking, mouth and tongue movement, bicycling movements of limbs. Cannot be provoked or consoled. Autonomic changes – body temperature changes, pulse irregularities. EEG less predictable.rhythmic twitching - rigid posture - jerking extremities. Subtle chewing, salivation, blinking, changes in skin color

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21
Q

Neonatal seizure pathophys

A

Myelinization of CNS is incomplete during the first months of life

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22
Q

Major causes of seizures in children

A

Birth injuries (atoxia) or congenital defects of CNS. Acute infections in late infancy or early childhood. Idiopathic if older than 3.

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23
Q

Epilepsy

A

A chronic disorder characterized by recurrent, unprovoked seizure activity and may be inherited. Result of brain or CNS irritation. Seizures are abnormal sudden excessive discharge of electrical activity within the brain.

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24
Q

Tonic Clonic

A

Grand mal. 2-5 minutes with a tonic phase of stiffened and rigid muscles of arms and legs with immediate loss of consciousness. Followed by a clonic or rhythmic jerking of all extremities. Bites tongue, incontinent. Fatigue confusion and lethargy may last up to an hour

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25
Q

Seizure observations

A

Tongue biting, clenching jaw, incontinence, dyspnea, apnea, cyanosis. One to three minutes, Postictal confusion, amnesia and difficulty speaking. May have headache, muscle soreness, drowsy. Can sleep immediately after.

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26
Q

Absence seizure

A

Petit mal. More common in children. Brief period of loss of consciousness and blank staring. Return to baseline immediately after.

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27
Q

Myoclonic

A

Brief jerking or stiffening of extremities. Singly or in groups. Few seconds, can be symmetric or asymmetric.

28
Q

Atonic

A

aka Akinetic, drop attacks. Sudden loss of muscle tone. Lasts for seconds, post ictal confusion. Causes the client to just drop.

29
Q

Complex partial seizure

A

`Lose consciousness for 1-3 minutes. Automatisms. Not aware of the behavior – lip smacking, patting, picking at clothes. Afterwards has amnesia. Usually temporal lobe affected.

30
Q

Simple partial seizure

A

Conscious through out episode. Usually an aura before the seizure - deja vu, smell, sudden onset of pain. Unilateral movement of the extremitiy. May have unusal sensations like change in heart rate, flushing, epigastric discomfort.

31
Q

Unclassified seizures

A

Half of all seizures, Occurs for no reason and do not fit into category

32
Q

Febrile seizures

A

2-5% children. 6 months to 6 years. The younger the child the more likely they are to re occur. Familial tendency. Phenobarbital or diazepam during emergency, Teach fever reducing measures. Temp is usually > 101.8, occurs while the temp is increased not after. Seizure usually over before getting to the ER.

33
Q

Febrile seizures caused by

A

nervous system is immature. Will not create any brain damage.

34
Q

Mgmt Febrile Seizures

A

Tempid baths are ineffective. Vigorous use of antipyretics. Protect from injury during seizure. Call 911 if > 5 minutes

35
Q

Tx Febrile seizures

A

Fever reduction, eval history (episodic and family), seizure control if ongoing – can give Diazepam rectally

36
Q

Prophylaxis w medications for febrile seizures

A

If focal or prolonged, if neurologic anomalies, if first degree relative has seizure history, if the child is less than one year old, if multiple series in 24 hour period

37
Q

Need a CT in first time seizure patients if

A

structural lesions, partial onset, age > 4, no identified cause

38
Q

CT in recurrent seizure patients if

A

change in pattern, prolonged post ictal, worsening mental status

39
Q

Seizure treatment

A

Correct underlying pathology, if any antipyretics ineffective in febrile seizures the anti-epileptic decision is trial and error. Antiepileptics are not 100 percent effective.

40
Q

Seizure tx if febrile

A

Supportive, reassurance, antipyretic, oral valium, Do not need to refer to peds neuro unless they are frequent or one occurs w out fever

41
Q

Neonatal seizure tx

A

phenobarbital

42
Q

Generalized tonic clonic tx

A

phenytoin, phenobarb, carbamazepine, valproic acid, primidone

43
Q

Absense seizure tx

A

Ethosuximide, valproic acid

44
Q

New anti epileptics

A

Felbamate, gabapentin, lamotrigine, topamax, vigabatrin

45
Q

If giving seizure meds consult with

A

neurologist

46
Q

Concussion definition

A

process involving traumatic biomechanical forces either a direct blow to the head, face or neck. Rapid onset, short lived impairment of neurological function and it resolves spontaneously. Functional disturbance not a structural injury, may or may no involve loss of consciousness, resolution is sequential, post concussive symptoms may be prolonged. No abnormality seen on standard structural neuroimaging studies

47
Q

Energy Crisis

A

Release of amino acid neurotransmitters - changes in permeability of cell wall - influx of sodium and or efflux of potassium - pH of the cell changes leading to influx of calcium

48
Q

Clinical concussion features - symptoms

A

somatic (headache), cognitive (feel like in a fog), and or emotional symptoms (lability)

49
Q

Physical signs concussion

A

loss of consciousness, amnesia

50
Q

Behavioral changes concussion

A

Irritability

51
Q

Cognitive impairment

A

slowed reaction times

52
Q

Sleep disturbances

A

drowsiness

53
Q

Concussion mgmt

A

Refer to concussion specialists or peds neuro. R/o more serious intracranial pathology: side line eval/neuro exam, CT MRI, Educate about natural course of concussion. Post injury mgmt. Prevent second impact syndrome. Prevent behavioral effects of injury. Prevent emergence of post concussion syndrome.

54
Q

Concussion headache

A

Can be delayed up to 3 weeks after MTBI. Acute post traumatic headaches are self limited. Can give nsaid, acetaminophen. Can treat acute/post traumatic migraine with amitriptyline or topamax or beta block, SSRI

55
Q

Post concussive syndrome

A

Symptoms include at least three of the following after traumatic brain injury: headache, fatigue, dizziness/vertigo, impaired memory, difficulty concentrating, insomnia, irritable, lowered stress tolerance/emotional/alcohol. Other associated symptoms include noise sensitivity, neck pain, non-dermal paresthesias, interference with social role functioning

56
Q

Predictors for the development of post concussive syndrome include

A

Female sex, ongoing litigation?, low socioeconomic status, prior headaches, prior TBI, prior psych illness

57
Q

NJ Bill A2743

A

Parents must sign concussion information form. Coaches, school physicians, and athletic trainers need to undergo a concussion training program. Requires student athletes to be removed from play if suspected concussion. Need medical clearance before returning.

58
Q

Most peds headaches are benign but these are those that need urgent diagnosis and treatment

A

SAH, intracranial bleed, neoplastic lesion, encephalitis, meningitis, intracranial venous thrombosis, vasculitis, metabolic disorders

59
Q

Red Flags

A
60
Q

Triptans

A

Axert and Nasal Imitrex approved for 12 and up. Contraindications are cerebrovascular, cardiac or peripheral vascular disease, uncontrolled HTN, hemiplegic, basilar migraine

61
Q

Alt treatments for peds headache

A

Vitamin cocktail for 3 months: Mg 250 and b2 200 BID CoQ10 100 TID

62
Q

Neonates most common cause of meningitis

A

group B strep and gram negative enteric bacilli

63
Q

Infants and young children meningitis causes

A

strep pneumonia, n. meningitis, h influenza B. HIB is the most common cause

64
Q

Children older than 5 most common causes of meningitis

A

strep pneumonia and n meningitis.

65
Q

Clinical manifestations of Meningitis

A

acute symptoms rapidly appear within 24 hours. URI or GI symptoms days before. May suddenly have shock and DIC.

66
Q

Nonbacterial meningitis – Aseptic Meningitis

A

Viruses. A/w other diseases like measles, mumps, herpes, leukemia. Abrupt or gradual. Headache, fever, malaise. 2 months: strep, hib, n gonn.

Pediatrics (17 decks)

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