Neurology Flashcards
What are the criteria needed for a low risk BRUE?
- No concerns from history or exam
- Age >60 days
- Born 32+ weeks + corrected 45+ weeks
- No CPR by trained provider
- Event <1min in duration
- First event
What is the recommended management for a low risk BRUE?
- Educate family, offer CPR training
- May obtain ECG, pertussis swab & observe with pulse oximetry & serial observations
- Need NOT do a viral swab, blood glucose, serum bicarb, neuro-imaging or admission solely for cardio-monitoring
- Do NOT do an infectious work-up, initiate home cardiac monitoring, prescribe a PPI
What is your differential diagnosis for acute onset ataxia?
- Post infection —> cerebellitis (typically truncal), GBS (especially campylobacter), ADEM
- Tumor (e.g. medulloblastoma, ependymoma, astrocytoma)
- Stroke/bleed
- Intoxication
- OMAS (opsoclonus myoclonus ataxia syndrome)
What age is acute cerebellar ataxia seen? How long after a viral illness does it typically occur?
- 1-3yo
- 2-3wk after the viral illness
What are 8 red flags for headaches in children?
- Acute onset, terrible headache —> SAH or intraparenchymal bleed
- Progressively worsening headache —> tumor
- Early morning awakening with headache and vomiting —> increased ICP
- Neck stiffness, fever —> meningitis
- Younger than 3yo
- Presence of seizures
- Associated mood, mental status or school performance change
- Neurocutaneous stigmata (cafe-au-lait macules, hypopigmented macules)
What is the criteria for a typical migraine without aura?
- At least 5 attacks fulfilling 2-4
- HA lasting 2 to 72h
- HA with 2+:
- Unilateral or bilateral in location (often frontal)
- Pulsating quality
- Moderate or severe pain intensity
- Aggravated by or causing avoidance of routine physical activity (e.g. walking)
- 1+ of:
- N/V
- Photo/phonophobia
What is the criteria for Tourette syndrome?
- 2+ motor tics (e.g. blinking, shrugging shoulders) + 1+ vocal tic (humming, clearing throat, yelling out a phrase)
- Tics for at least 1 year (can occur many times per day, nearly every day or intermittently)
- Onset <18y
- Not due to another etiology (i.e. medications, medical conditions such as Huntington’s or post-viral encephalitis)
What are the typical CSF findings for Guillain Barre syndrome?
- Low-normal WBC
- Normal glucose
- Elevated protein
What is the main treatment of GBS?
IVIG
What is the classic EEG finding in infantile spasms?
Hypsarrhythmia
What are the treatment options in infantile spasms?
- Vigabatrin (retinal toxicity) *effective in TS
- Prednisolone / ACTH (wt gain, HTN, irritability, adrenal suppression)
How can you differentiate benign myoclonus of infancy & infantile spasms?
- No arm movement in BMI
- BMIs do NOT occur in clusters
- Normal EEG in BMI
What are the anti-epileptics that are most effective in childhood absence syndrome?
Ethosuxamide
Valproic acid
(lamotrigine)
What are the clinical features of benign rolandic epilepsy?
- Peak onset: 7-10yo
- Duration of seizures: 2-3min
- Nocturnal focal seizures with movements of face / mouth
- Can present with inability to speak (“sleep walking”)
- May spread to be GTC
- Most outgrow during puberty
What anti-epileptics should NOT be used for primary generalized epilepsy?
Carbamazepine
Phenytoin
What are the idiosyncratic reactions of the following AEDs: keppra, carbamazepine, topiramate, lamotrigine, VPA, vigabatrin
- Keppra: aggression / rage, suicidality
- Carbamazepine: rash, hepatitis, anemia
- Topiramate: weight loss, kidney stones
- Lamotrigine: rash
- VPA: weight gain, hepatitis, pancreatitis, decreased platelets, rash, hair loss
- Vigamatrin: retinal toxicity
What diagnostic testing should be done for SMA and DMD?
- SMA - SMN1 gene deletion testing
- DMD duplication deletion analysis
During which weeks GA does PVL occur?
24-32 weeks GA
What is the criteria for conversion disorder?
- 1+ symptoms affecting voluntary motor and sensory function
- Clinical finds are incompatible with a recognized neurologic or medical conditions
- Symptom or deficit is not explained by a medical condition
- Symptom or deficit causes clinically significant distress or impairment in functioning (can also be La Belle Indifference)
What is the treatment for Tics?
- Educational
- Psychotherapeutic (behaviour therapy)
- Meds - 1st line clonidine or guanficine (alpha-2 agonist), 2nd line is risperidone
What are six red flags for syncope?
- Occurs during exercise or after prolonged exertion
- Severe chest pain or palpitations
- No warning/prodrome (no presyncope)
- Required CPR
- Neurological deficit
- Occurred while supine
- Seizure activity
- Family history of unexplained death
What are the typical bacteria that cause GBS?
- Typical: Campylobacter jejuni, mycoplasma, H flu
- Others: EBV, CMV, Lyme disease, West nile (mimic)
When do breath holding spells usually resolve?
5-years old
What are the different underlying etiologies of infantile spasms?
- ⅔ cases have a secondary cause
- Includes: prior HIE, prior stroke, brain malformation, chromosomal abnormality (T21), genetics (TS)
- ⅓ have no underlying cause
What anti-epileptics are used in children aged <2yo?
Phenobarbital
Levetiracetam / Keppra
Topiramate
What are the diagnostic teata for X-linked adrenoleukodystrophy and metachromatic leukodystrophy?
-X-linked adrenoleukodystrophy: VLCFA in serum, RBCs and skin fibroblasts. MRI head shows symmetric periventricular white matter lesions -ML: ARSA-A enzyme level, MRI is helpful but not adequate for diagnosis
What is the most common cause of seizures in a neonate?
HIE (50-60%)
What are red flags for a spinal dimple?
- Cutaneous lesion (hyperteochosis, hemangioma, atretic meningocele, lipoma, caudal appendage) 2. Deviated or “split” gluteal cleft 3. Multiple dimples 4. Dimple diameter > 5mm 5. Location > 2.5cm above the anal verge or above the gluteal cleft
When would you consider doing an LP for a child with a febrile seizure?
-Infants < 6mo or if the child is ill-appearing at any age -Infants < 1yo with an unknown or inconplete immunization history -Children om antibiotics (can mask meningitis) -Febrile status epilepticus
Whay are risk factors for subsequent epilepsy in a child with a febrile seizure?
Simple febrile seizure (1%), recurrent febrile seizures (4%), complex due to >15min duration or recurrence w/in 24h (6%), fever <1h before febrile seizure (11%), FHX epilepsy (18%), complex (focal) (29%), neurodevelopmental abnormalities (33%)
What is the main diagnosis to rule out when a child presents with acute onset esotropia?
Increased ICP
What is the CATCH rule?
High risk: -GCS < 15 2h after injury -Suspected open or depressed skull fractures -History of worsening headache -Irritability on exam Medium risk: -Any signs of basal skull fracture -Large boggy hematoma of scalp -Dangerous mechanism (MVC, fall from > 3ft, down 5 stairs, fall from bike without helmet)
