Neuro Flashcards
In what trimester is the neuro system formed in utero?
1st trimester
Until what age are the number of glial cells and dendrites developing?
4yo
Until what age is the brain growing?
Puberty
In what direction does myelination occur?
Head to toe (cephalocaudal)
What are the primititve reflexes?
Rooting, Babinski, Moro, Palmar grasp, Fencing
What is the rooting reflex?
Babies turn face towards a stimulus and start rooting/sucking.
What is the Babinski reflex?
When foot is firmly stroked, toes flex outwards.
What is the Moro reflex?
When baby feels as if it is falling, extremities fan out.
What is the palmar grasp reflex?
When something is placed in newborn’s hand, baby will grasp that object.
What is the fencing reflex?
When a baby’s head is turned to one side, the arms and leg of that side are extended and the arms and legs of the opposite side are flexed.
When does the posterior fontanel close?
3mo
When does the anterior fontanel close?
18-24mo
What are possible causes of altered LOC?
Hypoxia, trauma, infection, poison, shunt malfunction, seizure, balance disturbances (endocrine, metabolic, electrolyte, acid/base), CNS disorders, structural defects
What is decorticate posturing?
A position that may indicated altered LOC d/t injury ABOVE brainstem, extremities brought to the “core” (brought in tight)
What is decerebrate posturing?
A position that indicates altered LOC d/t injury BELOW the brainstem, extremities splayed outwards.
What are the early s/s of increased ICP?
HA, visual changes, N/V, dizziness, pupils, sunsetting eyes, seizures, bulging fontanel
What are the three categories of the GCS?
Eyes, verbal, motor.
What is the most common neuro dysfunction in kids?
Seizures
What are idiopathic seizures?
Seizures with unknown cause (not epileptic)
What is the major cause of seizures in newborns?
Birth injury (anoxia) or congenital CNS defects
What is the major cause of seizures in infants?
Infection
What are absence seizures?
- AKA petit mal
- Brief loss of consciousness
- No change in muscle tone
- Onset @ 4-12yrs
- No aura
- Lasts 5-10sec
- S/s = lip smacking or twitching of eyes
- Minimal risk of falling
What are atonic seizures?
- Sudden loss of muscle tone
- Onset @ 2-5yrs
- Possible loss of consciousness
- Risk of falling (helmet worn often)
What are myoclonic seizures?
- Contractions of muscles
- No loss of consciousness
- Often occurs when falling asleep
- May be mistaken for exaggerated startle reflex (test if head can flex, if cannot, may be a myoclonic sz)
A child is wearing a helmet for seizures, what seizures are they most likely experiencing?
Atonic
What type of seizures occur most frequently when falling asleep?
Myoclonic
What are the 3 types of epilepsy?
Partial (focal) seizures, generalized, and ideopathic
At what age does epilepsy typically manifest?
5-6yrs
What is partial epilepsy?
- No loss of consciousness
- Sz lasts 30sec
- Sz occur at any time of day
- Motor responses involve =1 extremity
- Can progress to general
What is status epilepticus?
Acute sz that lasts >30min (despite medical intervention)
What steps are taken during status epilepticus?
- Maintain airway
- Check electrolytes, glucose, blood gases, temp, BP
- Administer meds
When can a bite block be used during a seizure?
If placed before seizure begins (during aura)
If IV access isn’t available, how can meds be given during status epilepticus?
Rectal valium
What is the ceiling dose for anti-epileptic meds?
None. AEs = RR depression, can maintain respiratory but key is stopping seizure
What meds may be used during status epilepticus?
Benzos = Valium (rectal or IM) + Ativan + Versed (intranasal); Anticonvulsant = phenytoin (IV)
What labs need to be considered for seizure disorders?
Glucose, BUN, Ca+2, Na+
What diagnostic tests are performed to assess a seizure disorder?
EEG, MRI (brain lesions), LP (meningitis)
What are common pediatric seizure triggers?
Changes in dark-light patterns, loud noises, extreme temp changes, dehydration, fatigue.
What age most commonly experiences febrile seizures?
6mo-5yr
What gender is more likely to experience febrile seizures?
Male
Are febrile seizures related to the extremity of the temperature or the rate of temp change?
Rate of change
What is done to tx febrile szs?
- Tx ongoing seizure (Diazepam, rectal)
- Protect head from injury
- Call 911 if lasts >5min
- Reduce fever
- Evaluate hx for prior sz
How do you prevent febrile szs?
- Vigorous tx of fever w/ antipyretics (tylenol, NOT aspirin)
What is the “5th day fit”?
When dosing long-term phenobarbital for sz control, 5th day fit = random seizure on 5th day of tx after period w/o seizures
What is the first line drug for febrile and neonatal seizures?
Phenobarbitol (GABAA and Ca+2 channel antagonist)
Which anti-sz drug can not be mixed with glucose (D5W, etc.)?
Phenytoin (blocks Na+ channels)
What is an AE to phenytoin to be aware of?
Gingival hyperplasia (gum overgrowth); tx w/ soft toothbrush and regular oral care
What is fosphenytoin?
A version of phenytoin that can be given with glucose
What is a dangerous side effect of valproic acid?
Hepatotoxicity (secondary to long-term use); monitor serial LFTs
What is the med of choice for status epilepticus?
Diazepam (rectally)
Which anti-sz meds can be given via IV?
Phenobarbital, phenytoin, fosphenytoin, valproic acid, diazepam.
What are the side effects of phenytoin?
Gingival hyperplasia *, rashes, acne, hirsutism, osteoporosis
Which anti-sz meds can be given PO?
Phenytoin, valproic acid.
Which anti-sz meds can be given IM?
Fosphenytoin, diazepam.
Which anti-sz med can be given intranasally?
Midazolam (Versed)
When are anti-sz meds discontinued?
- Seizure free for 2yrs
- Normal EEG
Why should anti-sz meds be weaned?
Abrupt cessation can trigger bad seizures
When should anti-sz meds not be stopped?
During puberty
What are the components of a seizure assessment?
- WATCH THE CLOCK
- Airway
- Maintain safety
- VS
- Neuro assessment (pupils, etc.)
What education should be given for a child with a seizure disorder?
- Get enough sleep
- Do not swim alone
- Limit activity during start of new long-term med
- Wear ID bracelet
What are the s/s of bacterial meningitis in an infant?
- Fever
- Bulging fontanel
- Changes in feeding
- Vomitting
- Diarrhea
- Irritable
- Lethargic
What are the s/s of bacterial meningitis in a child?
- Fever
- Altered LOC
- Muscle/joint pain
- URI or GI
- Irritability
- Vomit
What do you assess for with bacterial meningitis?
- Petechiae (purpura of BLE)
- HA
- Photophobia
- Nuchal rigidity
- Sz
- DIC (excess coagulation)
- Shock
How do you assess nuchal rigidity?
- Kernig’s sign (flexing of leg)
- Brudzinski sign neck flexing causes legs to flex)
How is bacterial meningitis transmitted?
Droplet
How is bacterial meningitis definitively diagnosed?
LP
How is bacterial meningitis of treated?
Antibiotics
What are the s/s of viral meningitis?
Same as bacterial but less severe:
- Petechiae (purpura of BLE)
- HA
- Photophobia
- Nuchal rigidity
- Sz
- DIC (excess coagulation)
- Shock
What is the role of antibiotics with viral meningitis?
Antibiotics are dosed until bacterial meningitis can be definitively be ruled out.
What is encephalitis?
Inflammation of CNS leading to altered brain and spinal cord function.
What are the vectors of encephalitis in the US?
Ticks and mosquitoes
What are the s/s of encephalitis?
Bacterial meningitis + speech difficulties
What are the s/s of severe encephalitis?
- High fever
- Occular palsies (1 sided paralysis)
- Disorientation
- Coma
- Seizures
- Paralysis
What tests are diagnostic of encephalitis?
- LP
- EEG
How is encephalitis tx?
Symptom management (fluids, fever reduction, pain control, seizure control and prevention)
How do you differentiate between encephalitis or meningitis?
Assess for meningeal irritation- Kernig’s or Brudzinski’s signs
What are examples of structural neuro defects?
- Microcephaly
- Hydrocephalus
- Carniosynostosis
- AV malformations
What is craniosyntosis?
Skull plates misalign and fuse
What is AV malformation?
Atrial and ventricle miscommunication
What are the s/s of AV malformation?
Initially asymptomatic, then HA, sz, stroke
