Neuro Lecture Flashcards

Question

Acute recurrent temporal headache?

Answer 1

Pattern of attacks of pain separated by symptom-free intervals. Primary headache syndromes, such as migraine or tension-type headache, usually cause this pattern. Recurrent headaches are occasionally due to specific epilepsy syndromes (benign occipital epilepsy), substance abuse, or recurrent trauma.

Answer 2

Implies a gradually increasing frequency and severity of headache. The pathologic correlate is increasing ICP. Causes of this pattern include pseudotumor cerebri, brain tumor, hydrocephalus, chronic meningitis, brain abscess, and subdural collections.

Answer 3

Pattern of frequent or constant headache. Chronic daily headache generally is defined as >3-mo history of ≥15 headaches/mo. Affected patients have normal neurologic examinations; psychologic factors and anxiety about possible underlying organic causes are common

Answer 4

Tension Type Headaches Migraines Secondary Headaches

Answer 5

-Fever -Stress -Foods / additives -Head injury -Environmental factors -Inherited disorders

Answer 6

History Physical Neuroimaging

Answer 7

Intermittent symptomatic analgesics Dark, quiet room Tylenol/NSAIDS Lifestyle modifications Preventative approaches Non pharmacologic treatments Abortive treatment - migraines Ondansetron Triptans

Answer 8

Tier 1 (analgesics): Acetaminophen 15 mg/kg per dose, or Ibuprofen 10 mg/kg per dose, or Naproxen 5 mg/kg per dose

Answer 9

Tier 2 (triptans) for children who weigh > 50 kg (generally >10 yrs): Sumatriptan 50 mg, or Almotriptan 6.25 mg, or Rizatriptan 5 mg (decrease dose with concomitant propranolol) Tier 2 (triptans) for children 30 to 50 kg (generally 5 to 10 yrs of age):Rizatriptan one-half (2.5 mg) or one (5 mg) tablet (decrease dose with concomitant propranolol), or Sumatriptan 5 mg nasal spray, or Sumatriptan 25 mg tablet

Answer 10

Combine a triptan with a tier 1 med., take at the same time, and/or Promethazine 0.25 to 0.5 mg/kg per dose

Answer 11

One of the most frightening events a parent can witness 5-10% of all children experience one or more seizures About 1% of all children have epilepsy (seizure disorder) Most common cause: Unknown etiology Febrile illness Brain damage Genetic factors Seizures are an abnormal electrical impulse in the brain

Answer 12

Simple Complex Benign Rolandic Secondarily generalized

Answer 13

No loss of awareness Involuntary movements Various sensations/feelings/emotion Can become secondarily generalized

Answer 14

Temporal Lobe Epilepsy Psychomotor Altered consciousness Automatisms Lip smacking Rubbing hands together Uncharacteristic behavior Fearfulness Agitation Can become secondarily generalized

Answer 15

Types Tonic-Clonic Absence JME Atonic

Answer 16

May begin with cry Involves loss of consciousness Tonic Clonic Postictal

Answer 17

ABC’s Lay on side Nothing in mouth Clear area Administer Diastat®

Answer 18

Short lapses of awareness; impaired consciousness only (no LOC) Most common ages 3-12 Diagnosis frequently months to years after signs and symptoms. Frequently first noticed by teachers May cause significant school problems

Answer 19

Peak onset between 12-18 years Myoclonic jerks Arms, shoulders or neck involvement No loss of consciousness Mostly occur upon waking Resemble startle response Objects are dropped or thrown Myoclonic - tonic clonic - absence seizures Usually lifelong Often inherited

Answer 20

12-18 years old

Answer 21

Drop attacks Head drops Sudden collapse May need protective head gear Resistant to AEDs

Answer 22

Manifestations Recurrent apnea Eye deviation Jerking movements of one limb or both limbs on the same side Swimming or bicycling movements Abnormal EEG Frequently overlooked due to subtleness of manifestations

Answer 23

Etiologies Hypoxic/ischemic encephalopathy Intracranial hemorrhage Central nervous system infection Cerebral infarction/malformations Developmental/genetic defects Drug withdrawal Trauma Inborn errors of metabolism Hypocalcemia Hypoglycemia Benign neonatal seizures (familial / non-familial)

Answer 24

West syndrome - encephalopathy in infancy characterized by infantile spasms, arrest of psychomotor development, and hypsarrhythmia. Age-dependent 2-7 months peak onset Flexor and/or extension movement Cluster series Hypsarrhythmia - a disorganized, chaotic pattern of brain waves that occurs in children with infantile spasms Resulting mental retardation Treatment ACTH and other antiepileptic drugs (AED’s)

Answer 25

- encephalopathy in infancy characterized by infantile spasms, arrest of psychomotor development, and hypsarrhythmia

Answer 26

Etiology Prenatal-microcephaly, polymicrogyria, schizencephaly, encephalopathies, congenital infections Perinatal -hypoxic-ischemic, meningitis, trauma, intracranial hemorrhages Postnatal-phenylketonuria, degenerative disease, encephalitis

Answer 27

3-4% of all children Fever >38o C Related to the rapid rate of temperature rise; not just the degree of fever Typically generalized Peak at 6-18 months 30-40% recurrence rate Frequently + family history 3 months to 6 years

Answer 28

Risk factors Younger than 12 months of age Lasting >5 minutes Partial seizure Delayed development

Answer 29

Fever management Diastat: 2-5 y/o - 0.5 mg/kg PR x1; Max: 1 tx/5 days up to 5 tx/mo 6-11 y/o - 0.3 mg/kg PR x1; Max: 1 tx/5 days up to 5 tx/mo IV AED’s Future fever control

Answer 30

Begins around ages 5-16 years, often disappears around puberty Seizures usually occur during sleep or upon wakening Twitching, numbness, or tingling of the face or tongue; may interfere with speech and cause drooling AED use optional EEG may show centro-temporal spikes Can become secondarily generalized

Answer 31

Distinguishing characteristics Occur in adolescence Females > males (3:1) Associated with anxiety disorders Can occur with a seizure disorder Usually stop after diagnosis

Answer 32

Distinguishing characteristics (cont’d) Unresponsive to effective AED’s Appear as atypical generalized clonic or tonic seizure Jerking from side to side Wild thrashing Tonic posturing Intermittent stopping and starting Resist eye opening and arm flopping to face Normal video EEG

Answer 33

1. Convulsive Tonic-Clonic Tonic 2. Nonconvulsive Absence Complex partial

Answer 34

Description: ? Seizure > 5 minutes or clusters of seizures without full recovery to base line 10% of first time seizures Risk Hypoxia  brain injury  developmental delay  learning difficulties Death Sudden Unexplained Death in EPilepsy - SUDEP

Answer 35

ABC Rectal Diastat IV access Draw for glucose, electrolytes, AED levels, LFT’s Toxic screens as indicated Urine drug screen Start infusion LP MRI/CT EEG

Answer 36

Benzodiazepines Diazepam Lorazepam Midazolam Fosphenytoin Valproic acid Phenobarbital Pentobarbital Levetiracetam

Answer 37

Pharmacological therapy When to stop medication Ketogenic diet 3-5:1 fat: carbs & PRO (high-fat, adequate-protein, low-carbohydrate diet) Brain surgery Focal resection Hemispherectomy Corpus callosotomy Vagus Nerve Stimulation

Answer 38

3-5:1 fat: carbs & PRO (high-fat, adequate-protein, low-carbohydrate diet) manages seizures

Answer 39

VNS is sometimes called a “pacemaker for the brain.” The use of VNS is limited to a select group of individuals who have treatment-resistant epilepsy or treatment-resistant depression. VNS is approved as add-on therapy for focal (partial) seizures in adults and children four years of age and older when medications haven’t controlled their seizures.

Answer 40

Learning problems Medication effects Frequent seizures Parent/teacher/medical provider communication – vital

Answer 41

Safety issues Climbing / heights Traffic hazards Bathing Swimming Driving Sleep deprivation Alcohol Compliance with treatmen