Neuro Flashcards
Which neuro abnormalities are seen in pts w/ static sxs?
congenital abnormalities or brain injury (think cerebral palsy)
Which neuro abnormalities are seen in pts w/ progressive sxs?
degenerative disease or neoplasn
Which neuro abnormalities are seen in pts with intermittent sxs?
epileptic or migraine syndromes
Which neuro abnormalities are seen in pts with saltatory sxs?
bursts of sxs followed by partial recovery
-vascular, demyelinating d/o
What PE findings may indicate spine bifida?
Midline defects:
tufts of hair, lipomas, dimpling
Accelerating pattern of head circumference may indicate? decelerating pattern?
hydrocephalus
degenerative neurologic disorder
How can you assess CN II?
pupillary light reflex, visual acuity
How can you assess CN III, IV, VI?
following objects, fixating, oculocephalic reflex, EOMs
How can you assess CN V?
sucking/swallowing, light touch
How can you assess CN VII?
observe fast at rest, crying/blinking
How can you assess CN VIII?
hearing
How can you assess CN IX, X?
gag reflex, sucking, salivation
How can you assess CN XI?
posture, spontaneous movement
How can you asses CN XII?
tongue movement
What are some primitive reflexes? When do most of them disappear?
Moro, grasp, rooting, foot placing, tonic neck
4-6 months
asymmetry indicates focal brain or PNS lesions
s/s seen w/ upper motor neurons
Spastic paralysis, Increased tone
Increased DTRs/+Babinski (in older children, normal in infants); usually with clonus
Minimal muscle atrophy/strength loss
Fasciculations absent
May have sensory disturbances
STIFFNESS, INCREASED PASSIVE TONE
s/s seen w/ lower motor neurons?
Flaccid paralysis
Decreased tone
Absent DTRs
Profound muscle Atrophy
Fasciculations present
May have sensory
disturbances
WEAKNESS, DECREASED PASSIVE TONE
What are some red flags for children w/ headaches?
headache in child <5y/o
new (“explosive onset”) & worsening HA in a previously healthy child
worst HA of life
unexplained fever
night time or early morning awakening HA
HA w/ vomiting
HA worse w/ straining
postural HA
neurocutaneous stigmata
What is the most concerning headache pattern in children?
chronic progressive
>4 months or >15x/month
usually increased ICP
possible psych factors
When should you order imaging in child presenting w/ HA?
Abnormal neurologic exam
Concern for space occupying lesion
Typical pediatric sxs for migraines?
Frontal, bitemporal or unilateral throbbing for 2-72 hrs (Unilateral sxs usually after puberty)
sxs relived by sleep
+/- visual aura
N/V, abdominal pain, phono/photophobia
Tx for migraines?
eliminate triggers: HA diary
acute: NSAIDs, APAP, triptans, antiemetics
Prophylaxis:
<6: Cyproheptadine
>6: Propranolol, Amitriptyline, Topiramate
Non pharm: B12
What is Pseudotumor Cerebri - Idiopathic intracranial hypertension (IIH)
elevated ICP w/ norm cerebrospinal fluid composition, and no other cause of intracranial hypertension
s/s: HA, papilledema, vision loss, intracranial noises, photopsia
Epidemiology of pseudotumor cerebri?
MC in females of childbearing age; does occur in peds- usually adolescents (11 years +)