Neurological Disorders Flashcards
most important tool diagnostically in neuro
history
most common HA in kids
migraine and tension-type
CT or MRI scan is very necessary and appropriate for eval of a headache
FALSE. Unless concern about sub-arachnoid, subdural hematoma or concern about increased IC pressure or hemorrhage
HA red flags
fails to respond to therapy focal neurologic findings progressive frequency/severity worsens with valsalva awakens from sleep worse in am/morning vomiting at risk hx
HA brought on by fatigue or stress. Constant, aching, constricting band around the head
tension type HA
Pain is bilateral and diffuse, dull and aching,
often present upon awakening, not associated with nausea, vomiting, neurologic problems
chronic tension HA
treat tension type HA
difficult, sometimes antidepressants
Pain is severe, pulsatile (pounding), unilateral, can be bilateral, frontal or temporal regions, retro orbital or cheek
migraine
may be the only symptom of migraine in younger children
vomiting
HA associated with N/V photophobia, phonophobia, vertigo, fatigue, mood alteration
migraine
when should you do studies on a child’s migraine
if they have focal neurologic signs, HA worse on awakening , or awakens pt , or with a cough or bending over
diagnosis of migraine
history
HA that is recurrent with acute onset that often resolves only after sleep
migraine
treat a migraine
Ibuprofen or acetaminophen early in the attack
Caffiene, caffiene+ergot
Triptans (sumatriptan, rizatriptan, etc.) and DHE (dihydroergotamine)
Rest and quiet
Avoid narcotics
prevent a migraine
Tricyclic antidepressants
Beta Blockers ie propranolol
Calcium channel blockers, such as verapamil
Predominantly male
Unusual in children under 10
Unilateral, severe pain
cluster HA
A sudden, transient disturbance of brain function manifested by involuntary motor, sensory, autonomic, or psychic phenomena
seizure
2 or more seizures not provoked by particular event or cause
epilepsy
a benign condition of childhood with unilateral focal seizures and speech abnormalities, often hereditary
Rolandic epilepsy
Pain is severe, pulsatile (pounding), unilateral, can be bilateral, frontal or temporal regions, retro orbital or cheek
migraine
generalized seizures
Absence (petit mal) Generalized tonic clonic (grand mal) Tonic Clonic Atonic
partial seizures
Simple partial (focal) Complex partial (psycho-motor) Benign rolandic epilepsy
Onset of seizure begins in one area of one cerebral hemisphere (apparent clinically or via the EEG)
partial/focal epilepsy
complex focal means
LOC (starting)
this type of seizure makes up 40-60% of childhood seizures
partial/focal
Seizures arise from both hemispheres, simultaneously
generalized seizures
these seizures are frequently associated with underlying structural brain disease and are difficult to treat and classify
myotonic, tonic, atonic, atypical absence
infantile spasms aka
west syndrome
these are clinical spasms that occur in clusters when drowsy. Severely abnormal EEG. Related to a brain insult at birth, malformation, tuberous sclerosis, or metabolic origin
infantile spasms
Strange posturing, back arching, writhing
Alternating L and R limb shaking during same seizure
Psychosocial stressor
pseudoseizures
Seizures can happen when awake (twitching and tingling on one side of the body) or when asleep (grand mal)
Benign Rolandic epilepsy
benign focal epilepsy of childhood
treat benign rolandic epilepsy
avoid sleep deprivation
carbamazapine
oxcarbazepine
time (outgrown)
30 minutes or more of continuous seizures or recurrent seizures without regaining consciousness
status epilepticus
treat status epilepticus
ABCs, IV lorazepam (valium)
You think a kid has BRE, so you order a CT or MRI. Good or bad?
Bad, dont need one for BRE
this type of febrile seizure: one side of body shakes, stares, prolonged (over 15 min), multiple in 24 hours
complex seizures
Cannot make diagnosis of epilepsy
Most useful for classifying types and guiding therapy
EEG
treat febrile seizures
usually none
rectal diazepam if prolonged
PB or VA can prevent (consider SEs)
fever management prop doesnt work
this type of febrile seizure is most common
simple- whole body shakes, brief (less than 20 min), only 1 in the course of illness
this type of febrile seizure is more likely to progress to epilepsy
complex
spells that mimic seizures
migraine variants breathholding spells (tantrums- breath holding on exhalation) syncope pseudoseizures
Strange posturing, back arching, writhing
Alternating L and R limb shaking during same seizure
Psychosocial stressor
pseudoseizures
Transient LOC and postural tone due to cerebral ischemia or anoxia
syncope
most common cause of childhood stroke
cyanotic heart disease
sickle cell anemia
meningitis
hypercoagulable states
Neurally mediated
Transient hypotension from vasodilation and/or decreased heart rate
Arousal 1-2 min up to 1h
vasovagal or neurocardiogenic syncope
most common type of syncope
vasovagal or neurocardiogenic syncope
syncope that may have cardiac symptoms (angina, palpitations)
Often occurs during exercise
cardiac
causes of increased ICP
cerebral edema
mass lesion
infant comes in with bulging fontanelle
Increasing head circumference, separating sutures
Lethary, vomiting, FTT, “setting-sun sign”
increased ICP
kid comes in with headaches, diplopia/Strabismus, papilledema, herniation syndromes
increased ICP
supretentorial HA location
eye, forehead, temple
intratentorial HA location
occiput, neck
smooth brain
lissencephaly (a migrational disorder)
Increased intracranial pressure without identifiable mass or hydrocephalus
Obese teenage girl is typical phenotype
pseudotumor cerebri
what is essential to diagnosis of pseudotumor cerebri
LP- elevated opening pressure
most common cause of childhood stroke
cyanotic heart disease
sickle cell anemia
meningitis
hypercoagulable states
kid comes in with hemiplegia, unilateral weakness, seizures. what do you think
stroke
Brief loss of consciousness or stunned for minutes to hours
No localizing neurologic signs
Amnesia is common and transient
head injury-concussion
diagnosis of concussion
head CT
child complains of headache, dizziness, forgetfulness, inability to concentrate, slowing of response time, mood swings, irritability
post concussive syndrome
Often identified on US, likely have elevated alpha fetoprotein on prenatal screen
MMC
displaced cerebellum through foramen magnum into spinal canal – posterior laminectomy. Progressive ataxia or vertigo
Arnold Chiari I
displaced cerebellum plus meningomyelocele – surgical repair and shunt
Arnold Chiari II
occipital encephalocele – surgical repair
Hydrocephalus common
Arnold Chiari III
smooth brain
lissencephaly (a migrational disorder)
most common migrational disorder
lissencephaly
disorder of anterior horn cells
SMA
poliomyelitis
disorder of the nerve itself
Guillian Bare
bell palsy
Autosomal Dominant
Café au lait spots - >6 of 5mm prepubertal pt
neurofibromatosis
disorder of the muscle itself
muscular dystrophy
myotonic dystrophy
how can you eval tuberous sclerosis
woods lamp
Unilateral port wine stain over upper face (follows CN V). Associated with seizures
Sturge Weber
Impairment of coordination and balance of voluntary movement
Cerebellar problem
ataxia
most common cause of ataxia in children
post-infectious (2nd drug intoxication)
hereditary ataxia
Friedreich
Sudden onset of ataxia,staggering, frequent falls
Nystagmus, vomiting, irritaility, lethargy possible
Sensory and reflexes preserved (motor abnormal)
No evidence increased ICP. Recently had a viral prodromal illness
post infectious acute cerebellar ataxia
prognosis post infectious acute cerebellar ataxia
90% recover in 1-4 weeks
while kid tries to get up… uses hands to walk up legs
Gower sign
disorder of anterior horn cells
SMA
disorder of the nerve itself
Guillian Bare
disorder of the NMJ
Myasthenia gravis
disorder of the muscle itself
muscular dystrophy
myotonic dystrophy
Present with muscle weakness, which may manifest with floppiness, delayed motor milestones, unsteady gait or muscle fatiguability
NM disorders
spinal muscular atrophy: (AR)
progressive weakness and wasting of skeletal muscles;
Normal mental, language and social skills (SAD)
Eventual respiratory failure and death
Anterior horn cell disorders
progression associated with bulbar palsy and respiratory depression
peripheral nerve disorders
kid >10 years old, ophthalmoplegia and ptosis, loss of facial expression and difficulty chewing
juvenile myasthenia
X-Linked recessive Onset at 2-6 yrs Proximal muscles affected before distal Waddling gait, difficulty with stairs pseudohypertrophic calf Gower Sign – pelvic weakness
Duchenne MD
this MD has 75% mortality by age 20
DMD
this MD comes about later and is less severe. Death occurs usually in adulthood
Becker MD
specific lab for MD
elevated CPK (prescribe steroids)
most common type of cerebral palsy
spastic
MOTOR problem. Non-progressive and originated before or at or near birth. Ataxia, choreoathetosis, and can have seizures
cerebral palsy
