Neurological Issues and Disorders Flashcards
Tic Disorders
brief, abrupt, non-purposeful movements or utterances
most common is tourette syndrome–refer to neurology
What is the normal onset of tics?
between 6 and 12 years of age
What are causes of tics?
unknown–possibly familial predisposition
associated with medications such as methylphenidate and amphetamines
Copropaxia
obscene gestures
- seen with complex motor tics
coprographia
obscene writing
- seen with complex motor tics
Vocal tics
oropharyngeal, nasopharyngeal or laryngeal sounds
consonants or syllables
meaningful or nonsense words or phrases
coprolalia (obscene speech)
palilalia (repeating one’s own words) and echolalia (repeating anothers words)
Complex motor tics
involves vocal tics and simple motor tics
Neurofibromotisis
von Recklinghausen disease
a neurocutaneous syndrome characterized by numerous cafe-au-lait spots on the body and nerve tumors on the skin and in body
progressive disorder that does not affect intelligence
autosomal dominant, present in a first degree relative
What are signs and symptoms of neurofibromatosis?
multiple cafe-au-alit spots
seizures
What are the diagnostic criteria for neurofibromatosis?
must have at least 2 of the following:
- six more more CLS spots >5 mm in prepubertal child OR >15 mm in post pubertal child
- 2 or more cutaneous neurofibromas (flat, varying in size)
- axillary or inguinal freckling
- 2 or more lisch nodules in eyes (looks like black dots)
- distinctive osseous lesions
- autosomal dominant, present in 1st degree relative
Febrile seizures
seizures occurring during the course of and as a result of fever with peak incidence of 1-3 years old
If a seizure occurs greater than 24 hours after a fever then it most likely means?
infection
Risk factors for febrile seizures
family history of a seizure disorder, tobacco use by mother during pregnancy, neonatal hospitalization >28 days, frequent infections in 1st year of life
Majority of febrile seizures are_____
tonic clonic
What is the recurrence rate for febrile seizures?
after 1: 30% for a 2nd
after 2: 50% for a 3rd
Partial seizures
involves one hemisphere
Simple partial: no LOC, a variety of other symptoms (motor, autonomic, and sensory)
Complex partial: impaired consciousness–staring >20 seconds before, during, or after symptoms
Generalized seizures
bilateral, involving both hemispheres
types: absence (petit mal), tonic, tonic-clonic (grand mal), atonic
Absence seizure
petit mal
brief staring episodes (10-20 seconds)–may smack lips, blink eyes, stare ahead
onset and termination are very brief
usually benign in childhood
Tonic seizure
sudden increase in muscle tone producing postures
consciousness is usually partially or completely lost
postictal alternation of consciousness is usually brief, may last several minutes
Tonic clonic seizure
grand mal
sudden LOC with arrested respirations
clonic phase involves increased muscle tone followed by bilateral rhythmic jerks lasting 2-3 minutes, followed by flaccid coma
urinary or fecal incontinence may occur
postictal state is characterized by deep sleep for up to an hour, headache, disorientation, muscle discomfort, nausea–can last for a minute to hours
Atonic seizure
sudden loss of muscle tone
may result in head drop or falling to the ground
Signs and symptoms of a brain tumor in an infant
increased head circumference, tense, bulging fontanel without fever
irritability
head tilt
loss of developmental milestones
Signs and symptoms of a brain tumor in a child
headache–worst in the morning followed by vomiting, usually increase in frequency
Abnormal neurological or ocular findings: ataxia, hemiparesis, cranial nerve palsies somnolence seizures head tilt, FTT, diabetes insipidus papilledema loss of fine motor control positive babinski sign behavior changes
Infratentorial, brainstem tumors predominate what age group?
4-11 year olds
When ordering diagnostic tests on someone with a brain tumor, what test should you approach with caution?
LP
Migraines are due to _______
dilation and excessive pulsation of the beaches of the external carotid artery
Classic migraine
with aura
>10 years old
Common migraine
without aura
Confusional migraine
more common in younger children
period of confusion and disorientation followed by vomiting and deep sleep, waking feeling well
headache may not be described
Abdominal migraine
episodic abdominal pain with nausea, vomiting followed or accompanied by headache
Prophylactic pharmacologic therapy for migraines
**prophylactic therapy if attacks occur more than 3-4 times per month, or if migraines interfere with daily functioning or school
NSAIDS propranolol (inderal) amitriptyline (elavil) topiramate (topamax) imipramine (tofranil) verapamil (calan)
Pharmacologic management for acute migraine attack
Tylenol or ibuprofen taken right away (7.5-10 mg/kg dose in younger children, may use up to 800 mg/dose in older teens)
- *–triptans for adolescents
- *maxalt or imitrex nasal for children ages 6-11
avoid in children at risk for heart disease
What are the 4 mechanisms of headache pain?
- vascular dilation: cranial artery distention (migraine, fever)
- muscular contraction: head and neck muscle contraction (tension)
- traction: space occupying lesion (tumor, mass, abscess, hematoma, increased ICP)
- inflammation: infection (meningitis, sinuses, teeth, encephalitis)
Afebrile headache differentials
subarachnoid hemorrhage intraparenchymal hemorrhage postictal headache cerebral ischemia severe hypertension space-occupying condition (brain tumor, hydrocephalus) acute dental disease acute glaucoma, inflammatory disease of the eye/orbit
Febrile headache differentials
meningitis
brain abscess or other intracranial infection
encephalitis
sinusitis
associated infection: strep throat, mono, influenza, rubeola
Meningitis
viral is more common in infants
bacterial only occurs in up to 2% –infants between 6-12 months old are at highest risk and 90% of cases occur in children between 1 month-5 years
Signs and symptoms of meningitis
Newborns/infants: mimics septicemia, temp instability, irritability, poor feeds, lethargy, vomiting, bulging fontanel, no stiff neck
Older infants and children: N/V, irritability and confusion, headaches, back pain, nuchal rigidity, hyperesthesia, cranial nerve palsy, ataxia, photophobia
Kerning’s sign
if lift Knee up, head lifts up
flexion of hip at 90 degrees, pain on extension of leg
Brudzinski’s sign
if lift head up, knee comes up
involuntary flexion of legs when neck is flexed
CSF analysis of meningitis
cloudy
WBCs present
increased protein
decreased glucose
Name the cranial nerves, what their major functions are, and what type they are (sensory, motor, or both)
- Olfactory–smell, S
- Optic–vision, S
- Oculomotor–most EOMS, opening eyelids, papillary constriction, M
- Trochlear–down and inward eye movement, M
- Trigeminal–muscles of mastication, sensation of face, scalp, cornea, mucus membranes, and nose, B
- Abducens–lateral eye movement, M
- Facial–move face, close mouth and eyes, taste anterior, saliva, tear secretion, B
- Acoustic–hearing and equilibrium, S
- Glossopharyngeal–phonation, gag reflex, carotid reflex, swallowing, taste posterior, B
- Vagus–talking, swallowing, general sensation from carotid body, carotid reflex, B
- Spinal accessory–movement of trapezius and sternomastoid muscles (shrug shoulders), M
- hypoglassal–moves the tongue, M
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