Neuro problems

Question 1

Most common primary brain tumor in kids? 2nd?

Answer 1

1. Astrocytoma
2. Medulloblastoma
3. PNET - primitive neuroectodermal tumor
4. Ependymoma
5. Craniopharyngeoma

Question 2

Posterior vermis syndrome

Answer 2

unbalanced gait,
trunk dystaxia
horizontal nystagmus
papilledema

Question 3

Hemispheric syndrome (cerebeller)

Answer 3

arm, led and gait dystaxia
w/ ipsilateral cerebellar signs
commonly: astrocyoma/abscess

Question 4

Strabismus abnormal findings (6)

Answer 4

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

Question 5

Rx of strabismus

Answer 5

Penalization therapy: cycloplegic drops to blur normal eye
Occlusion therapy: patch normal eye
prescription eyeglasses
surgery

Question 6

Complication of strabismus

Answer 6

amblyopia

diplopia

Question 7

Klumpke palsy in shoulder dystocia damage to…

Answer 7

C8 and T1 nerves

Question 8

C/f of C8/T1 shoulder dystocia

Answer 8

Claw hang:
extended wrist
hyperextended MCP joints
flexed IP joints
Absent grasp reflex
Horner syndrome
Intact Moro and Biceps reflex

Question 9

Erb duchenne palsy damage to

Answer 9

injury to 5th and 6th cervical nerves

Question 10

Erb duchenne pasly c/f

Answer 10

Decreased moro and biceps reflexes
Wiaters tip:
extended elbow
pronated forearm
flexed wrist and fingers
Intact grasp reflex

Question 11

IVH assoc w/

Answer 11

Prematurity

low birth weight infants

Question 12

What causes Posterior Vermis syndrome?

Answer 12

Medulloblastoma, which effects the cerebellar vermis

Question 13

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?

Answer 13

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

Question 14

Seizures throughout the day beginning at 5-9 years old. Seizure often accompanied by automatisms. What does EEG show?

Answer 14

Absence epilepsy (no post-ictal state)

3-Hz/second spike, treated with ethosuximide.

Resolves by adolescence with cognitive impairment

Question 15

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?

Answer 15

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

Question 16

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?

Answer 16

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

Question 17

What is cerebral palsy and what are the risk factors for getting it?

Answer 17

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

Question 18

Name of the 4 types of CP

Answer 18

1. Spastic diplegia - spasticity of lower extremities; typically arising from ischemia to zone around ventricles (which results in periventricular leukomalacia)
2. Spastic hemiplegia - unilateral spasticity (upper limb usually effected more than lower limb); often caused by perinatal vascular insults, postnatal trauma, and CNS malformations
3. Spastic quadriplegia - motor weakness of head, neck, and all 4 limbs. Often associated with seizures, scoliosis, GERD, and speech problems
4. 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

Question 19

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.

Answer 19

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

Question 20

What is pseudotumor cerebri? What causes it?

Answer 20

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

Question 21

What condition is often mistaken as “fetal hiccups?”

Answer 21

Pyridoxine dependency - leads to generalized tonic clonic seizures soon after birth, and treatment is immediate Vit. B6

Question 22

10-20 seizures per day, starting around postnatal day 3 and usually self-resolving

Answer 22

Benign familial neonatal seizures

Question 23

What is adrenoleukodystrophy? How does it present?

Answer 23

It is a progressive demyelination of the CNS combined with adrenal cortical failure (sad)

1. 5-10 years old, child has altered behavior
2. Poor school performance
3. Gait/coordination disturbances, loss of vision/hearing
4. Seizures and a vegetative state

Physical exam will show hyperpigmentation and hyperreflexia

Question 24

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?

Answer 24

Benign paroxysmal vertigo

Question 25

Differentiate between partial, generalized, simple, and complex seizures

Answer 25

Partial - focal area of the brain
Generalized - whole brain
Simple - no loss of consciousness
Complex - loss of consciousness, aura, automatisms

Question 26

What type of seizure most likely occurred if it was unobserved, but the patient wet themselves or bit their tongue?

Answer 26

Partial with secondary generalization