Neurologic Disorders Flashcards
1
Q
Autonomic Nervous System
A
- controls visceral activities
- comprised of sympathetic/parasympathetic systems, with opposite effects on same organs
2
Q
Sympathetic Nervous System
A
- “fight or flight”
- epinephrine and norepinephrine
3
Q
Parasympathetic Nervous System
A
- slows activity, decreases metabolic rate
- acetylcholine
4
Q
Pathophysiology and Defense Mechanisms
A
- nervous system is related to all parts of the body
- neurotransmitters include dopamine, serotonin, glutamate
5
Q
Assessment of the Nervous System - History
A
- onset
- pain and/or headache
- sensory deficits
- injury
- reflexive responses
- behavioral changes
- motor/balance changes
6
Q
Assessment of the Nervous System - Medical History
A
- prenatal
- birth history/neonatal course
- injuries/infections
- cardiovascular/respiratory disorders
- environmental exposure to toxins
- metabolic disorders
- past neurologic diseases/tests
- drug ingestion
- urinary tract disease
- physical growth
7
Q
Assessment of the Nervous System - Family Disease History
A
- similar symptoms/pedigree
- consanguinity
- migraine history
- intellectual functioning of family members
8
Q
Specifics of the Neurological Examination
A
- Behavior and mental status
- Cranial nerve function
- Motor examination
- Sensory examination
- Reflexes
- Cranium examination
- Autonomic nervous system
- Meningeal signs
9
Q
Diagnostic Studies for Neurologic Disorders
A
- CT/MRI
- Laboratory studies for systemic disease, infection, inflammation
- lumbar puncture
- electroencephalogram
- US in infants
- polysomnography, electromyography, nerve conduction, evoked responses, cerebral arteriography
10
Q
Multiple Sclerosis
A
- chronic, relapsing disorder of the CNS
- demyelination of brain, spinal cord, optic nerves
- rare before the age of 10
11
Q
Multiple Sclerosis Symptoms
A
- unilateral weakness, ataxia, other cerebellar symptoms
- symptoms last more than 24 hours
- HA
- motor symtoms: vague parasthesias
- visual disturbances
- vertigo, dysarthria, sphincter disturbances
12
Q
Multiple Sclerosis - Diagnostic Studies
A
- Neuroimaging
- Lumbar puncture
13
Q
Multiple Sclerosis - Management
A
- Corticosteroids
- IVIG
- Plasmapheresis
- Monoclonal antibodies
14
Q
Cerebral Palsy
A
- nonreversible disorder
- chronic, nonprogressive; impairs control of movement
- may have disturbances in sensation, perception, cognition, communication, behavior
- epilepsy, musculoskeletal problems may be present
- degree of brain injury individual
15
Q
Three Types of Cerebral Palsy
A
- Spastic - muscle stiffening and tightness
- Athetoid - involuntary, purposeless muscle movement
- Ataxic - affects balance and coordination
16
Q
Cerebral Palsy - Clinical Findings
A
- Prenatal/natal history
- Seizures
- Hearing, vision problems
- Change in growth parameters, head circumference
- Early head injury or meningitis
- Developmental milestones
- Functional health problems - feeding, irritability, movement difficulties, persistent primitive reflexes, communication
- Orthopedic exams - scoliosis, fractures, dislocations
- Neurologic exam - DTR, tone, atrophy, fasciculations, asymmetric movements, head size
17
Q
Cerebral Palsy - Diagnostic Studies
A
- imaging studies
- chromosomal and metabolic studies
- lumbar puncture if sepsis is suspected
18
Q
Cerebral Palsy Prevention
A
- good prenatal care and screening
19
Q
Management of Cerebral Palsy
A
- referral of suspected cases
- family education/support/financial resources
- nutrition/elimination
- dentistry/drooling
- respiratory, skin, mobility, vision, communication, pain, osteopenia
20
Q
Bell Palsy
A
- sudden, acute unilateral paralysis/weakening of facial nerve without sensory loss
- viral etiology suspected
- onset rapid; may last 1-9 weeks; spontaneous remission
21
Q
Bell Palsy - History
A
- localized pain
- swelling in one ear
- sagging of face
- URI within previous 2 weeks/exposure to cold temperatures
22
Q
Clinical Findings of Bell Palsy
A
- unilateral motor changes - forehead, cheek, perioral
- normal BP
- dribbling liquids from weak side/eating difficult
- hypersensitivity to noise
- eyelid fails to close on affected side
- lacrimation, taste, salivation impaired
- no limb weakness
- herpes lesions on affected side
23
Q
Bell Palsy Diagnostic Studies
A
Not indicated
24
Q
Management of Bell Palsy
A
- methylcellulose eye drops
- steroids in newly diagnosed patients
25
Q
Epilepsy and Seizure Disorders
A
- misfiring of cortical neurons of brain
- convulsive: episodes of involuntary contraction of voluntary muscles
- recurrent, unprovoked = “epilepsy”
- multiple etiologies: genetic, symptomatic, idiopathic conditions
26
Q
Epilepsy and Seizure Disorders - History
A
- description of seizure
- underlying medical diagnoses
- pervious CNS infection or birth trauma
- intrauterine infection, trauma, bleeding
- toxic exposure, drug use
- anticonvulsant medication stopped abruptly, doses missed, change in brands
- recent head injury
- family history
- milestones
27
Q
Epilepsy and Seizure Disorders - Clinical Findings
A
- focal abnormalities/weakness
- seizure activity during exam
- hypertension
- systemic disease
- cardiovascular disease
- neurocutaneous disease
- signs of head trauma
- transillumination of skull in infants
28
Q
Epilepsy and Seizure Disorders - Diagnostic Studies
A
- CBC, LFTs
- Metabolic screen later in workup
- Blood glucose
- Urine/serum toxicology
- LP if younger than 6 months
- EG
- MRI
- CT
- Polysomnography
29
Q
Nonepileptic Seizures
A
- most common manifestation of conversion disorder
- unilaterally/bilaterally coordinated motor activity like thrashing, jerking
- occur only when observed; do not interrupt play
- pupils normally reactive to light
- situation specific
- no associated injury
- abrupt recovery – no postictal state
- no incontinence
- no EEG changes, even during episodes
30
Q
Management of Epileptic Seizures
A
- referral
- PCP can monitor stable children
- drug monitoring
- ketogenic diet
- surgery
- antiepileptic medication withdrawal (gradual withdrawal after 2 years of no seizures)
- safety (swimming, driving, sports)
- immunizations (pertussis vaccine on individualized basis)
31
Q
Febrile Seizures
A
- most common type in children
- brief, generalized, simple or complex
- concurrent illness with rapid fever rise
32
Q
Febrile Seizures - History
A
- duration, type, frequency in 24 hours
- fever, level of temperature
- abnormal neural findings (not consistent with febrile seizure)
- family history of seizures
- maternal smoking in perinatal period
- prematurity
- development of child
33
Q
Febrile Seizures - Diagnostic Studies
A
- LP
- Blood glucose
- CBC, calcium, electrolytes, urinalysis optional
- EEG if neurological signs present
- MRI for complex febrile seizures
34
Q
Febrile Seizures - Management
A
- protect airway, breathing, circulation
- time duration of seizure
- reduce fever with tylenol or ibuprofen
- anticonvulsants only if complex; if neurological signs present
- prophylaxis not recommended
- education about febrile seizures
35
Q
Secondary Headache
A
- worse in the morning on awakening
- wakens child from sleep
- vomiting without nausea
- increased pain with straining, sneezing, coughing
- occipital/neck pain
- mental, personality, behavioral alterations
36
Q
Headaches - Physical Examination
A
- blood pressure: supine and standing
- growth parameters
- eyes, ears, neck, sinuses, teeth, TMJ
- thyroid gland
- bones and muscles of skull
- nerves, reflexes
37
Q
Management of Headaches
A
- pain and stress management
- migraines: abortive therapy, reducing frequency, severity, length of treatment
38
Q
Head Injury
A
- mild to severe tissue damage
- acceleration-decelerration or rotational forces
- long term sequelae more common in children
39
Q
Open Head Trauma
A
more focal injuries
40
Q
Closed Head Trauma
A
multifocal/diffuse injury
41
Q
Secondary Effects of Head Injury
A
- hypoxia
- ischemia
- hypotension
- hemorrhage
42
Q
Head Injury - History
A
- Acute Concussion Evaluation (ACE) tool
- History of injury
- Loss/alteration of consciousness, confusion, irritability, behavior
- Vomiting
- HA, blurred vision, diplopia
- Numbness/loss of sensation
43
Q
Head Injury - Physical Examination
A
- vital signs
- thorough physical examination
- care neurologic examination
- signs of CNS involvement
- Glasgow coma scale
- periorbital hemorrhage (raccoon eyes) - ED emergency
- “battle sign” (ecchymosis behind the ear) - ED emergency
44
Q
Head Injury Diagnostic Studies
A
- severity dictates need for studies
1. penetrating trauma
2. altered LOC
3. amnesia about injury
4. focal neurological signs/deficit
5. depressed skull fracture/basilar injury (raccoon eyes and battle sign)
6. Seizures
7. Persistent vomiting
8. History of coagulopathy
45
Q
Management of Minor Closed Head Injury with no loss of consciousness
A
- observation in clinic, ED, home
- understanding of signs to watch
46
Q
Management of Minor Closed Head Injury with brief loss of consciousness
A
- observation in clinic, ED, home
- understanding of signs to watch
- CT scanning accepted
- Hospitalization if reliable home monitoring not possible
47
Q
Management of Moderate Head Injury with worrisome symptoms
A
- admission, prolonged observation in ED
- Hospitalize for the following:
- changing vital signs
- seizures
- AMS, slurred speech
- prolonged unconsciousness/persistent memory deficit
- depressed or basilar skull fractures
- persistent HA
- recurrent vomiting/unexplained fever
- unexpected injury (child abuse)
- worrisome CT/MRI findings
48
Q
Post-Trauma sequelae and post-concussion syndrome
A
- cognitive deficits may persist for months
- speech/motor difficulties for years
- HA, dizziness, irritability, impaired concentration in adolescents, aggression, disobedience, regression, inattention, anxiety in younger children
49
Q
A
