Neurology Flashcards by Erica Unknown

Recovery time for facial nerve palsy

2-3 weeks

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Tearing, photophobia, enlarged globe

Glaucoma

Also have corneal edema and clouding causing dull red reflex and dampened pupillary reflex

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Sturge Weber eye association

Congenital glaucoma in 30-70%

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Syndromes associated with glaucoma

NF, Retinoblastoma, homocystinuria, trisomy 21, congenital rubella (also cataracts), Stickler syndrome, Sturge Weber syndrome, corticosteroids

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CMV eye association

Chorioretinitis

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Toxoplasmosis eye association

Chorioretinitis

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MC outcome in infant with Cystic PVL

Spastic diplegia
(Damages deeper, more medial fibers that control lower extremity function)

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Lack of babbling by which age is concern

11 months

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Echolalia begins

Between 15-18 months

Repetition of sounds

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First line treatment for moderate or severe hearing loss

Amplification combined with intensive speech and language

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Normal EEG of extremely preterm infant

Discontinuous

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When does EEG become continuous?

31-33 weeks

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Hypotonia, severe mental deficiency, ataxia

Angelman syndrome

Maternal deletion

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Hypotonia, weakness, contractors, absent DTRs, tongue fasiculations

Spinal muscular atrophy or Werdnig Hoffman disease (degeneration of anterior horn cell)

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First manifestation of NF-1

Cafe au lait macules (smooth borders)

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When are pupils reactive to light

30-32 weeks

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What age is optic nerve myelination complete?

24 months

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MC etiology of congenital hearing loss

Genetic (MC genetic cause is connexin 26 gene mutation)

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Abnormal hearing screen threshold

35 db

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Palmar grasp reflex appears and disappears. Persistence signifies:

Appears 28 weeks
Established by 32 weeks
Disappears by 2-4 months
Persistence - athetoid CP

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Moro reflex appears and disappears

Appears 28-32 weeks
Established by 37 weeks
Disappears by 6 months

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Crossed extensor reflex appears and disappears

Leg extended and sole rubbed → opposite leg will first have flexion and then extension with fanning of toes
Appears 26 weeks
Established by 34 weeks
Disappears by 2 months

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Rooting reflex appears and disappears

Appears 30 weeks
Established by 34 weeks
Disappears by 4 months

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Tonic reflex appears and disappears. Persistence means?

Appears 35 weeks
Established by 1-2 months
Disappears by 6 months
Persistence: Focal cerebral abnormalities

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Only medication to decrease IVH

ACS (24-48h before delivery) | Also maternal transfer before imminent preterm birth

Prader Willi genetic cause

Paternal deletion in chromosome 15q11-13 | Both copies come from mother (maternal uniparental disomy)

Angelman genetic cause

Maternal deletion in chromosome 15q11-13 | Both copies come from father (MANs copies) (paternal uniparental disomy)

Myotonic dystrophy cause

Trinucleotide repeat

Effects of Kernicterus

``` TEAM Teeth - dental enamel dysplasia Eye abnormalities (paralysis of upward gaze) Auditory dysfunction Movement dysfunction - Athetoid CP ```

Leading cause of vision impairment in preterm infants

ROP

Threshold disease

ROP in Zones I or II in at least 5 contiguous or 8 total clock hours + plus disease 50% progress to stage 5

Treatment for threshold disease

Laser within 2-3 days

Most common area involved in ROP

Zone III

Where is Zone I of eye

Most posterior part of retina Vessels closest to optic disc Most immature zone

ROP Stage "Distinct demarcation Line"

Stage 1

ROP Stage "demarcation line is thickened and elevated, ridge"

Stage 2

ROP Stage "ridge with extra retinal neovascularization

Stage 3

ROP Stage with partial retinal detachment

Stage 4

ROP Stage with complete retinal detachment

Stage 5

What refractive errors do premature infants get?

Hyperopia and myopia | Myopia strongly associated with hx of significant ROP

Up vs down slanting palpebral fissures

Line away from nose | Up in Downs

Enlargement of the 4th ventricle, complete or partial absence of the cerebellar vermis, cysts

Dandy Walker syndrome

Can clonus be a normal finding in newborns?

Yes, up to 3 months of age

Area of brain injury in HIE

White matter

EEG pattern in HIE

depression or burst suppression

Acquired maternal antibodies that block Ach receptors at the NMJ

Transient neonatal MG

Measures brainwaves generated in response to an auditory stimulus

ABR

Measures the acoustic feedback from the cochlea in response to an auditory stimulus

OAE

Which test takes longer? ABR or OAE?

ABR

Which test may be unable to detect some forms of sensorineural hearing loss?

OAE

ELBW population has disproportionate risk of which disability?

Non-verbal, math related

MC cranial nerve to be injured at birth

Facial nerve

Weakness of upper and lower facial muscles

Facial nerve palsy (L more likely)

Ocular dysplasia, hydrocephalus, cerebral malformations

Walker Warburg syndrome

Nerves for Erb Duchenne vs Klumpke's palsy

C5-7 vs C8-T1

Conductive hearing loss on bone and air conduction

Good bone conduction, poor air conduction

Sensorineural hearing loss on bone and air conduction

poor air and bone conduction

Are NTD preventable by folic acid?

Most but 1/3 are not preventable d/t other factors such as diabetes, inc BMI, antiepileptics (Valproic acid), Trisomy 13 and 18

Hypomyeliniation with PVL is associated with which stage of oligodendrocyte?

Pre-oligodendrocyte (90% of oligodendrocyte population at 28 weeks)

Space that subgaleal occurs

Subaponeurotic space | Bleeding of emissary veins between scalp and dural sinuses

Space that cephalohematoma occurs

Subperiosteum

Benefit of therapeutic hypothermia

25% reduction in combined death or major NDI in moderate or severe HIE

Adverse effects of cooling

bradycardia, thrombocytopenia, subcutaneous fat necrosis

MC condition misdiagnosed as neonatal seizures

Benign sleep myoclonus

Why is aEEG less sensitive at picking up focal seizures?

Reduced number of channels | Use of a two channel aEEG with simultaneous raw EEG is more sensitive

MCC neonatal seizures

Global cerebral hypoxic ischemia ie HIE

Disability and mortality with newborn seizures

54% surviving children with disability | 10% mortality (higher in HIE, cerebral dysgenesis and infection)

What causes inflammation in HIE?

Microglia (macrophages of the brain) release cytokines, chemokine and proteases Monocytes and neutrophils infiltrate the injured brain

Initial treatment for spina bifida

Prone, sterile saline soaked dressing, plastic wrap (not bag)

Normal resting posture at 28 weeks

Limbs extended

Normal resting posture at 32 weeks

Slight flexion of the knee then hips

Normal resting posture at 36 weeks

Flexion of all 4 extremities

Structural or functional abnormality at an organ level

Impairment ie. damage to vision

Restriction at the personal level that results from an impairment

Disability ie. worsening eye sight

Disadvantage at the societal level that prevents fulfillment of the individual's role

Handicap ie. inability to drive

Testing to get with ear tags or skin pits

Audiologic evaluation + Renal ultrasound (especially if family history, can be Goldenhar syndrome)

Sniffling in infant due to

Mucosal edema 2/2 estrogen exposure

Negatives of Phenobarbital for seizures

Only 1/3 patients respond to initial bolus | Increased neuronal apoptosis and impaired ND outcomes

How is hereditary retinoblastoma treated?

Chemotherapy

Hereditary vs nonhereditary retinoblastoma

Hereditary in 40% RB, AD; inactivation both alleles of RB1 gene; usually bilateral Nonhered usually unilateral

When can fetus respond to sound?

20-25 weeks

MC lesion in neonates - supratentorial vs infratentorial

Supratentorial

MC presentation of congenital intracranial tumor:

Increasing head circumference with bulging fontanelle (50%)