Neuro problems Flashcards
Most common primary brain tumor in kids? 2nd?
- Astrocytoma
- Medulloblastoma
- PNET - primitive neuroectodermal tumor
- Ependymoma
- Craniopharyngeoma
Posterior vermis syndrome
unbalanced gait,
trunk dystaxia
horizontal nystagmus
papilledema
Hemispheric syndrome (cerebeller)
arm, led and gait dystaxia
w/ ipsilateral cerebellar signs
commonly: astrocyoma/abscess
Strabismus abnormal findings (6)
constant strabismus at any age eye deviation after 4 months of age asymmetric corneal light reflex asymmetric intensity of red reflex deviation on cover test torticolis or head tilt
Rx of strabismus
Penalization therapy: cycloplegic drops to blur normal eye
Occlusion therapy: patch normal eye
prescription eyeglasses
surgery
Complication of strabismus
amblyopia
diplopia
Klumpke palsy in shoulder dystocia damage to…
C8 and T1 nerves
C/f of C8/T1 shoulder dystocia
Claw hang: extended wrist hyperextended MCP joints flexed IP joints Absent grasp reflex Horner syndrome Intact Moro and Biceps reflex
Erb duchenne palsy damage to
injury to 5th and 6th cervical nerves
Erb duchenne pasly c/f
Decreased moro and biceps reflexes Wiaters tip: extended elbow pronated forearm flexed wrist and fingers Intact grasp reflex
IVH assoc w/
Prematurity
low birth weight infants
What causes Posterior Vermis syndrome?
Medulloblastoma, which effects the cerebellar vermis
Seizures in early morning (moaning, grunting, pooling of saliva, then spreads to generalized tonic-clonic) 3-13 years old. What are they are what is the prognosis? What does EEG show?
Benign rolandic epilepsy
Excellent prognosis, most resolve by themselves during adolescence. Sometimes they are treated with valproic acid or carbamazepine
EEG shows biphasic spike and wave disturbances in the mid-temporal and central regions
Seizures throughout the day beginning at 5-9 years old. Seizure often accompanied by automatisms. What does EEG show?
Absence epilepsy (no post-ictal state)
3-Hz/second spike, treated with ethosuximide.
Resolves by adolescence with cognitive impairment
Seizures beginning at 3-8 months of age and characterized by brief, myoclonic jerks. What is it, what causes it, how do you treat it? What does EEG show?
Infantile spasms
Tuberous sclerosis, PKU, HIE, IVH, meningitis, and encephalitis
Most patients will develop moderate to severe mental retardation, and treatment is ACTH, valproic acid, and vigabatrin
EEG shows hypsarrhythmia
12-16 years of age, seizures involve myoclonic jerks that cause the adolescent to throw objects during their morning routine. What is it, what’s the EEG finding, what’s the treatment and the prognosis?
Juvenile myoclonic epilepsy (also associated with generalized tonic-clonic seizures, which are of greater concern)
EEG shows 4-6 second generalized spike or polyspike and wave activity.
Treated FOR LIFE with valproic acid
What is cerebral palsy and what are the risk factors for getting it?
Injury to a developing brain (static encephalopathy) that primary effects motor function. The injury that primarily effects motor often leads to other neurologic defects, like seizures, learning disabilities, retardation, visual/auditory deficits, etc.
Risk factors are: prematurity, TORCH, traumatic delivery, low Apgar at 15 minutes, HIE, IVH, and kernicterus
Name of the 4 types of CP
- Spastic diplegia - spasticity of lower extremities; typically arising from ischemia to zone around ventricles (which results in periventricular leukomalacia)
- Spastic hemiplegia - unilateral spasticity (upper limb usually effected more than lower limb); often caused by perinatal vascular insults, postnatal trauma, and CNS malformations
- Spastic quadriplegia - motor weakness of head, neck, and all 4 limbs. Often associated with seizures, scoliosis, GERD, and speech problems
- Extrapyramidal - problems controling face, neck, trunk, and limbs, but no spasticity (very hypotonic). This usually occurs in full-term infants that experience HIE or kernicterus
What should you expect if a patient has a viral illness followed by the abrupt onset of weakness and sensory disturbances in the lower extremities.
Transverse myelitis (notice that it follows a viral illness and has sensory disturbances, the two things that differentiate it from Guillain-Barre)
Spontaneous recovery (although not always full recovery) in weeks or months
What is pseudotumor cerebri? What causes it?
Increased ICP with a normal CSF cell count, anatomy, position, and absence of brain tumor.
Usually idiopathic, but can be caused by drugs, endocrine disorders, and thrombosis of venous sinsuses
Usually occurs in obese, adolescent females
What condition is often mistaken as “fetal hiccups?”
Pyridoxine dependency - leads to generalized tonic clonic seizures soon after birth, and treatment is immediate Vit. B6
10-20 seizures per day, starting around postnatal day 3 and usually self-resolving
Benign familial neonatal seizures
What is adrenoleukodystrophy? How does it present?
It is a progressive demyelination of the CNS combined with adrenal cortical failure (sad)
- 5-10 years old, child has altered behavior
- Poor school performance
- Gait/coordination disturbances, loss of vision/hearing
- Seizures and a vegetative state
Physical exam will show hyperpigmentation and hyperreflexia
If a 1-3 year old patient presents with episodes of ataxia/vertigo associated with rapid eye movements and horizontal nystagmus, what do they most likely have?
Benign paroxysmal vertigo
Differentiate between partial, generalized, simple, and complex seizures
Partial - focal area of the brain
Generalized - whole brain
Simple - no loss of consciousness
Complex - loss of consciousness, aura, automatisms
What type of seizure most likely occurred if it was unobserved, but the patient wet themselves or bit their tongue?
Partial with secondary generalization
