Neuro

Question 1

Seizures

Answer 1

Etiology
Differentials
Defining characteristics
Diagnostic criteria
Management

Question 2

Epilepsy

Answer 2

Etiology
Differentials
Defining characteristics
Diagnostic criteria
Management

Question 3

Headaches

Answer 3

Etiology: Environ, food, emotions, trauma (migr)
Behavioral, muscular, vascular (tension)
Differentials: HTN, TMJ, chronic sinusitis, head injury
Defining characteristics: worse or not with physc. activity, light/sound sens., n/v, dizziness, FH
Diagnostic criteria
Management: stress management, sleep, routine, avoid caffeine, hydration
Meds: M: elavil, prozac, cymbalta, periactin
T: NSAIDs, Tylen., Elavil

Question 4

Neurofibromatosis

Answer 4

Etiology
Differentials
Defining characteristics: Cafe au lait macules, neurofibromas, Lisch nodules of the iris, axillary freckling, optic nerve gliomas, bone lesions. Associated with renal artery stenosis, coarctation of the aorta, middle aortic syndrome, and PCC (adrenal tumors)
Diagnostic criteria
Management

Question 5

Tuberous sclerosis

Answer 5

Etiology
Differentials
Defining characteristics
Diagnostic criteria
Management

Question 6

Tics

Answer 6

Etiology
Differentials
Defining characteristics
Diagnostic criteria
Management

Question 7

Meningitis

Answer 7

Etiology
Differentials
Defining characteristics
Diagnostic criteria
Management

Question 8

Head injuries

Answer 8

Etiology
Differentials
Defining characteristics
Diagnostic criteria
Management

Question 9

Syncope

Answer 9

Sudden LOC and “melting” collapse. Most common in F 15-19yo and usually d/t vasovagal (dizzyness, nausea, irr HR, orthost. hypoten, tachyc)
Cardiac cause- cardiomyop., aortic or pulm. stenosis, arrhythmia, myocarditis, IF exercise induced- very concerning).
Neuro cause- seizures
Envrin.- vaccines, blood, etc
CLASSIC: slow onset of nausea, lightheadedness, diaphoresis
Diagnostics- EKG, H&P, tilt table, EEG if seiz. suspected, labs (toxic., HCG, glucose)
POC: inc water + Na. Limit caffeine, lie down, refer if seiz. or card. susp. Reg. exercise increase
If no change, can add fludrocortisone then Midrodrine if still no improv.
PMH, FH, event hx (usually recall triggers or s/sx- position changes (prolonged standing, quick change to upright), current illness, emotion/painful stimulus, hot envrion.)
RED FLAGS: chest pain or palpitations or during exercise
Neuro flags: position with head lower than waist, bending forward. Fecal or urinary incont., lateral tongue biting may be seizures. Confusion in post-ictal is not normal to syncope.
May be psych if no triggers; multi in a day; or happen while seated/prone
San Fran rules:
CHESS (CHF, Hct <30, EKG abn., SOB, Systolic <90) any positive: refer/admit
Boston rule:
BADHEART
(Brain event, Abn VS, Depl. of volume, Heart attack/ACS, Electrical abn (EKG), A/P/T/M valve dz, Relative with sudden death, Terrible ticker) Any pos: refer/admit

Question 10

Tension HA

Answer 10

Behavioral, vascular, or muscular. Up to 25% of kids. Squeezing/tightening, no aggrav. by phys. activity. No n/v
Routine for day and sleep, hydration, no caffeine, stress reduc.
NSAIDs, Tylenol, SSI, Elavil

Question 11

Migraine

Answer 11

FH, trauma/illness/envrion/food/emotions
Risk: puberty, >10yo
Charact: pounding/throbbing, worse with activity, sound/light sensitive, n/v, dizzy
Reduce anxiety/disability, stress reduction, rest, routine, hydration, sleep, avoid caffeine
Meds: Elavil, prozac, cymbalta, periactin

Question 12

CSF pressure increase

Answer 12

nausea, protracted vomiting, lethargy, irritability, eye movement abnormalities developing over hours or days
Prompt referral