Neurological Issues and Disorders

Question 1

Tic Disorders

Answer 1

brief, abrupt, non-purposeful movements or utterances

most common is tourette syndrome–refer to neurology

Question 2

What is the normal onset of tics?

Answer 2

between 6 and 12 years of age

Question 3

What are causes of tics?

Answer 3

unknown–possibly familial predisposition

associated with medications such as methylphenidate and amphetamines

Question 4

Copropaxia

Answer 4

obscene gestures

- seen with complex motor tics

Question 5

coprographia

Answer 5

obscene writing

- seen with complex motor tics

Question 6

Vocal tics

Answer 6

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)

Question 7

Complex motor tics

Answer 7

involves vocal tics and simple motor tics

Question 8

Neurofibromotisis

Answer 8

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

Question 9

What are signs and symptoms of neurofibromatosis?

Answer 9

multiple cafe-au-alit spots

seizures

Question 10

What are the diagnostic criteria for neurofibromatosis?

Answer 10

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

Question 11

Febrile seizures

Answer 11

seizures occurring during the course of and as a result of fever with peak incidence of 1-3 years old

Question 12

If a seizure occurs greater than 24 hours after a fever then it most likely means?

Answer 12

infection

Question 13

Risk factors for febrile seizures

Answer 13

family history of a seizure disorder, tobacco use by mother during pregnancy, neonatal hospitalization >28 days, frequent infections in 1st year of life

Question 14

Majority of febrile seizures are_____

Answer 14

tonic clonic

Question 15

What is the recurrence rate for febrile seizures?

Answer 15

after 1: 30% for a 2nd

after 2: 50% for a 3rd

Question 16

Partial seizures

Answer 16

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

Question 17

Generalized seizures

Answer 17

bilateral, involving both hemispheres

types: absence (petit mal), tonic, tonic-clonic (grand mal), atonic

Question 18

Absence seizure

Answer 18

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

Question 19

Tonic seizure

Answer 19

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

Question 20

Tonic clonic seizure

Answer 20

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

Question 21

Atonic seizure

Answer 21

sudden loss of muscle tone

may result in head drop or falling to the ground

Question 22

Signs and symptoms of a brain tumor in an infant

Answer 22

increased head circumference, tense, bulging fontanel without fever
irritability
head tilt
loss of developmental milestones

Question 23

Signs and symptoms of a brain tumor in a child

Answer 23

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

Question 24

Infratentorial, brainstem tumors predominate what age group?

Answer 24

4-11 year olds

Question 25

When ordering diagnostic tests on someone with a brain tumor, what test should you approach with caution?

Answer 25

LP

Question 26

Migraines are due to _______

Answer 26

dilation and excessive pulsation of the beaches of the external carotid artery

Question 27

Classic migraine

Answer 27

with aura

>10 years old

Question 28

Common migraine

Answer 28

without aura

Question 29

Confusional migraine

Answer 29

more common in younger children
period of confusion and disorientation followed by vomiting and deep sleep, waking feeling well
headache may not be described

Question 30

Abdominal migraine

Answer 30

episodic abdominal pain with nausea, vomiting followed or accompanied by headache

Question 31

Prophylactic pharmacologic therapy for migraines

Answer 31

**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)

Question 32

Pharmacologic management for acute migraine attack

Answer 32

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

Question 33

What are the 4 mechanisms of headache pain?

Answer 33

1. vascular dilation: cranial artery distention (migraine, fever)
2. muscular contraction: head and neck muscle contraction (tension)
3. traction: space occupying lesion (tumor, mass, abscess, hematoma, increased ICP)
4. inflammation: infection (meningitis, sinuses, teeth, encephalitis)

Question 34

Afebrile headache differentials

Answer 34

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

Question 35

Febrile headache differentials

Answer 35

meningitis
brain abscess or other intracranial infection
encephalitis
sinusitis
associated infection: strep throat, mono, influenza, rubeola

Question 36

Meningitis

Answer 36

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

Question 37

Signs and symptoms of meningitis

Answer 37

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

Question 38

Kerning’s sign

Answer 38

if lift Knee up, head lifts up

flexion of hip at 90 degrees, pain on extension of leg

Question 39

Brudzinski’s sign

Answer 39

if lift head up, knee comes up

involuntary flexion of legs when neck is flexed

Question 40

CSF analysis of meningitis

Answer 40

cloudy
WBCs present
increased protein
decreased glucose

Question 41

Name the cranial nerves, what their major functions are, and what type they are (sensory, motor, or both)

Answer 41

1. Olfactory–smell, S
2. Optic–vision, S
3. Oculomotor–most EOMS, opening eyelids, papillary constriction, M
4. Trochlear–down and inward eye movement, M
5. Trigeminal–muscles of mastication, sensation of face, scalp, cornea, mucus membranes, and nose, B
6. Abducens–lateral eye movement, M
7. Facial–move face, close mouth and eyes, taste anterior, saliva, tear secretion, B
8. Acoustic–hearing and equilibrium, S
9. Glossopharyngeal–phonation, gag reflex, carotid reflex, swallowing, taste posterior, B
10. Vagus–talking, swallowing, general sensation from carotid body, carotid reflex, B
11. Spinal accessory–movement of trapezius and sternomastoid muscles (shrug shoulders), M
12. hypoglassal–moves the tongue, M

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