Neurology Flashcards
Seizures
Abnormal electrical discharge and change in patient’s usual function can include ALOC, incontinence of bowel and bladder, apnea, cyanosis followed by post-ictal state.
Common causes include fever, toxins, infections, solid mass or tumor.
Simple Partial Seizures
Motor signs, somatosensory or special sensory, autonomic symptoms and signs, psychic signs.
Dx: Most important aspect of diagnosis is history of event and resulting disability.
- i.e., hypoxia, family history of seizures and type is also important.
- Labs: (none needed for simple febrile seizure), CBC, electrolytes, toxicology screen, glucose, calcium, magnesium.
- Imaging: CT or MRI depending on type and focal deficit.
Tx: Based on situation, consult neurology. Seizure therapies have some significant side effects.
Complex Partial Seizures
Simple partial onset followed by impairment of consciousness or with impairment of consciousness at onset.
Febrile Seizures
Occur on onset and rise of fever, usually between ages 6 months and five years.
- Short, resolve spontaneously.
Tx: Treat in regards to use of antipyretics.
Status Epilepticus
A single seizure lasting longer than 30 minutes or two or more consecutive seizures without returning to baseline LOC.
Tx: (First Line Therapy) ABC, benzodiazepines PR, IM, IV.
- (Second Line Therapy) Dilantin or phenobarbital load.
Lumbar Puncture
Should be performed when a child with a seizure and fever also has symptoms that suggest meningitis.
- Neck stiffness, + kernig and/or + Brudzinski signs.
Is an option if an infant aged 6 to 12 months has a seizure and fever but has not received recommended immunizations for Hib or Strep pneumoniae or if immunization status cannot be determined.
When a child with a seizure and fever has been pretreated with antibiotics, because antibiotics can mask the signs and symptoms of meningitis but may not be sufficient to eradicate it.
Blood culture and serum glucose testing should be conducted concurrently to determine whether the hypoglycorrhachia characteristic of bacterial meningitis is present.
Spinal Cord Injury
Age Specific Considerations:
- Infants have poorly developed cervical musculature, head is disproportionately large.
- Children < 9 years have wedge shaped vertebral bodies, angled horizontally.
- Young children have cartilaginous endplates with lax interspinous ligaments, so they are more prone to SCIWORA (spinal cord injury without radiological abnormality).
- Children with Down’s syndrome are prone to atlanto-axial subluxation as a result of acute flexion injuries (sports activities).
SCIWORA
Spinal cord injury without radiological abnormality
Mechanism of Spinal Cord Injury
Divided into complete and incomplete lesions.
- Incomplete leaves residual motor or sensory function more than three segments below the level of the injury.
- Complete lesion is defined as having no preserved motor or sensory function more than three levels below the injury.
Teraplegia
(Formerly quadriplegia) Is an injury of the eight cervical segments. Paraplegia is an injury in the thoracic, lumbar, or sacral segments.
Spinal Cord Injury: Evaluation
Description of injury, mechanism of injury, medical problems, timing of onset of symptoms, motor and sensory assessment, muscle strength and motor weakness evaluation.
- Typical trauma incident includes fall from height, head, neck, or spinal trauma, MVC, diving, contact sports, abusive head trauma.
Spinal Cord Impairment Scale
A: (Complete) No sensory or motor function preserved below S4-S5
B: (Incomplete) Sensory function present; no motor function preserved below the neurologic level extending through S4-S5.
C: (Incomplete) Motor function preserved below the neurologic level with muscle grade < 3.
D: (Incomplete) Motor function preserved below the neurologic level with muscle grade of 3 or greater.
E: (Normal) Sensory and motor function preserved.
Spinal Cord Injury: Diagnostics
Radiographs - head and neck films with lateral views and odontoid views.
CT and MRI
Spinal Cord Injury: Management
Initial management is to manage airway, immobilize C-spine, high dose IV steroids (30mg/kg), manage neurogenic shock with fluids, alpha-adrenergic agents, continuous monitoring. Spinal shock follows some spinal cord injuries and can last several days, causing paralysis and loss of tone with hypovolemia.
Traumatic Brain Injury
Trauma to the head and brain occurring in two distinct phases.
- Primary occurs with the moment of impact with disruption of the brain parenchyma.
- Secondary occurs from systemic (hypotension, hypoxia, anemia) or intracranial problems (tumor, cerebral edema, seizures, infection.
S/S: Classified as mild, moderate, or severe based on neurologic assessment. Headache, irritability, changes in neuro status, vomiting, transient neuro symptoms such as cortical blindness.
- LOC, AMS, vomiting, increased head circumference in young infant.
Dx: To scan or not to scan?? Use PECARN or CHALICE.
Tx: Acute monitoring - ICP monitor, cerebral perfusion pressure monitoring (CPP).
- Goal of TBI management is to lower ICP, optimize CPP, oxygenation and ventilation with appropriate cardiac output, surgical evacuation of of mass or blood.
- Rapid sequence intubation, minimize increased ICP.
- Continued evaluation of symptoms is extremely important in children with moderate to severe brain injuries, but children with mild injury should also be monitored for changes in status.