Neurology Flashcards
Causes of seizures may include f___, ing___, tu___, and el___ di____
fever
ingestion
tumors
electrolyte disturbances
Seizure s/s include
Bo__/bl___ in____
ap___
cy___
au___
bowel/bladder incontinence
apnea
cyanosis
aura
Children with seizures should be referred to the ED when the seizure lasts > __ minutes,
if child had a
h___ i___, h___ f___, or is presenting with compromised r___/c___ function
5 minutes
head injury
high fever
Respiratory/cardiac function
What type of seizure affects bilateral brain hemispheres?
generalized
What type of seizure causes tone loss?
a____
atonic
What type of seizure affects one hemisphere?
F_____
focal
What type of seizure causes rhythmic repetitive movements?
c_____
clonic
What type of seizure causes extension/flexion of the head/trunk/extremities?
tonic
A febrile seizure occurs on fever ____
*affects children __-___ M.O.A
*are often less than ___ minutes
*They do not reoccur within ___ hours
Rise
6-60
15
24
Febrile seizures usually do not require diagnostic workup unless m____ s/s are present
meningeal
Status epilepticus is a seizure lasting > ____ minutes
— or __ or more seizures occur without return to?
30 minutes
2 or more, baseline neuro status
1st line status epilepticus management
a____
b_____
ABC’s
benzodiazepine administration
2nd line status epilepticus management
*administering a_____ such as
—di___, k_____, or p____ load
antiepileptics
–Dilantin, keppra, phenobarbital load
Children with refractory status epilepticus require a drug i___ c___ and e___
drug-induced coma
EEG
Children with refractory status eplepticus may need s___ r____ or the placement of a v___ n____ s_____
surgical resection
vagal nerve stimulator
Acute seizure control
*stabilize within __-___ minutes (ABC’s + IV)
*Administer initial benzos within __-___ minutes
*Administer 2nd line antiepileptics witthin __-___ minutes
0-5 minutes
5-20 minutes
20-40 minutes
In children, the last choice in seizure treatment includes ph_____ due to the risk of lowering ___
phenobarbital
IQ
Third-line seizure control management should be treated within __-___ minutes
—third line therapy includes re___ do___, an____ Dr___, and co___ e___ monitoring
40-60
–repeat dosing, anesthetic drips, continuous EEG
How long does it take for a seizure to cause brain damage?
30 minutes
The 1st line seizure diagnostic test is with an ___
EEG
In an acute seizure event, what diagnostic test is quick and is able to see blood/bone/lesions/fluid?
CT
MRI’s
*have no r____
*assesses br__ ma___, sk___, and or____
*able to see is____, in___, a__m____, sp___ co___ lesions, and de___ disease
radiation
brain matter, skull, orbits
ischemia, infarcts, AV malformation, spinal cord lesions, degenerative disease
MRI’s take l___ and may require s____
longer and may require sedation
When obtaining an MRI, keep in mind that Bivona traches have m___ r____
metal rings
When obtaining an MRI, keep in mind that shunt valve settings will c___
change
A lumbar puncture is obtained to r/o
me___ or
in___/in___/au___ processes
meningitis
inflammatory/infectious/autoimmune
Obtain an LP in infant who are ___-___ M.O.A with an unknown vaccine status
6-12
An LP in females with pseudotumor cerebri is done to r___ c___
remove CSF
LP’s are contraindicated in children with a h__ i___, obtain a C__ first
high ICP
CT
LP procedure
*place child in the l___ d___ position
*insert needle between __-__ along the i__ c__ l___
lateral decubitus
L3-L5, iliac crest line
Children who are difficult for LP should get them done in?
IR
To prevent air leak, before removal of LP needle replace the s___
stylus
Spinal cord injury occurs most often s/p t____ such as a f___ from a tall h___ or h__/n___ t____
trauma
fall from a tall height
head/neck trauma
s/p trauma, younger children are prone to S____
SCIWORA
spinal cord injury without radiologic abnormalities
Down syndrome children are prone to a____-a___ s___ s/p acute f___ i____
atlanto-axial subluxation
flexion injury
Spinal cord Injury Impairment scale
A=
B,C, D =
E=
complete
incomplete
normal
Spinal cord injury diagnostic tests include an
x___
c__
m___
x-ray
CT
MRI
Spinal cord management
1) A___
2) c____ i____
3) IV s___ ( __ mg/kg)
ABC’s
c-spine immobilization
steroids 30 mg/kg
Neurogenic shock management
* f____, a__-a___ agents
fluids
alpha-adrenergic
Neurogenic shock may lead to pa___ or loss of to___
paralysis
loss of tone
In neurogenic shock, what criteria is used to assess the need for a CT?
chalice or
pecarn criteria
Children with neurogenic shock require and art line for i___ monitoring and c___ p____ monitoring
ICP
cerebral perfusion
A primary brain injury is an ___ event, for example a h____
acute
hemorrhage
A secondary brain injury are the resulting s/s s/p a___ i___, for example i___
acute injury
ischemia
Epidural hematoma
*Dont c____ s___ l___
*stay on the s____ of i___
cross suture lines
side of impact
Subdural hematoma
*c___ shaped
*c___ s___ but are not m___
crescent-shaped
cross sutures
midline
Intraparenchymal brain injuries b___ into t___
bleed into tissues
Intraventricular brain injuries b___ into v___
bleed into ventricles
hypoxic-ischemic brain injuries
*develop l___
*occur if brain is hypoxic for > __-__ hours
*CT will show a h___ brain
later
24-48
hyperdense
TBI management includes
* minimizing se_____ brain injuries
*In____, reduce ___, and minimize se____
*continuously monitor for wo____ in s/s
secondary
Intubate, ICP, seizures
worsening
A concussion is defined by a GCS score of __-____
13-15
A concussion is a
*m____ h___ i_____
*No L____
*no routine i_____
mild head injury
LOC
imaging
What standardized tool is used to evaluate for concussions?
SCATS assessment
S/P concussion, kids can return to activities when they are at pre-m____ s____ and s___ f____
pre-morbid state
s/s free
Cerebral palsy is a neuro in____ leading to mo____ im_____. Classified by the type of movement
insult
motor impairment
In what CP are muscles unable to relax?
s____
spastic
What CP is characterized by the child having movement but is unable to control muscle movement?
ath_____
athetoid
In what CP is their motor impairment of the arms and legs on one side?
hemiplegic
In what CP is their motor impairment of both legs?
diplegia
In what CP is their motor impairment of all 4 extremities?
quadriplegia
Encephalitis is a condition where their is brain p____ i_____
–can be viral, bacterial, fungal, or autoimmune
parenchyma inflammation
In neonates, encephalitis is most often caused by?
HSV
In immunocompromised children, encephalitis is most often caused by?
varicella
Encephalitis s/s
v___ problems, h____, n__-p____ s/s, f___, and at_____
vision
headache
neuropsych
fever
ataxia
Encephalitis management
*Treat the primary cause
*initiate a_____
*in 90% of cases, e___ will be abnormal
acyclovir
EEG
In hydrocephalus, there is e____ CSF
excess CSF
Hydrocephalus is characterized by
*r___ head g____
*e____ ventricles
*trouble e____
*dy____
*h___ or w___ c___
*if severe, a_____
rapid head growth
enlarged
trouble eating
dysphagia
hoarse or weak cry
apnea
Congenital hydrocephalus is often caused by a m_____
myelomeningocele
In a shunted hydrocephalus, fluid will drain into the a____ p____ s_____
abdominal pleural space
What is the most common immediate shunt placement post-op complication?
*will present with s___ neck or f____
infection
stiff neck or fever
Shunt malfunction is often caused by a b____ or b____ shunt.
—obtain a shunt s____
—may also obtain a ___
blocked or broken shunt
—shunt series
—CT
Shunt over/underdraining may occur, these children require c___ f____ due to the risk for h_____
close follow up
hemorrhage
If a shunt infection is suspected, you may need to t___ the s____ to obtain a c___ sample
tap the shunt
CSF sample
If a shunt infection is suspected, begin a____ and then r___ the shunt once i___ has c____
antibiotics
replace
infection has cleared
craniosynostosis is p____ skull f____
premature skull fusion
40% of craniosynostosis children have g___ s_____
genetic syndromes
craniosynostosis will lead to brain g____ r_____
growth restriction
craniosynostosis is associated with aper_____, crou_____, p___-r____, tu____, va____ and da___ wa_____
aperts
crouzanes
Pierre-Robinson
turner
VATER
dandy walker
to diagnose craniosynostosis obtain a __-skull f____, c___, and m____
—-management is with s____
3D skull film, CT, MRI
surgery
craniosynostosis complications include
*postop p___ and b____
*assess for S____
*Surgery is better when children are ______
pain and bleeding
SIADH
younger
Botulism is p_____ d_____ s_____ neuromuscular w______
progressive descending symmetrical neuromuscular weakness
Botulism is caused by __-b____ s____
—found in contaminated s____, h____, or w_____
C. botulinum spores
soil, honey, water
C.botulinim spores can be detected in s_____
—-occurs more frequently in infants < ____ M.O.A
stool
12
botulism s/s includes
c_____, w____, d_____, decrease g___ response, w___ e___ m_____
constipation
weakness
dysphagia
gag
weak eye muscles
botulism txt is with botulism ____
IVIG
Guillan-barre is a p____ a____ s____ p_____
progressive ascending symmetrical paralysis
Guillan-barre most often occurs __-___ weeks s/p v____ illness or prior i____
4-6 weeks
viral
infection
Guillan-barre s/s include p____, n____, extremity t____, s___ loss, and g___ disturbance
pain
numbness
extremity tingling
sensory loss
gait disturbance
Guillan-barre is diagnosed through c__ p____
CSF protein
Guillan-barre treatment is with ____ or p_____
IVIG
plasmapheresis
Muscular dystrophy is often diagnosed by ___ YOA
2
Muscular dystrophy presents with pr____ s____ pr____ w_____
— Usually, there will be a g____ link
progressive symmetrical proximal weakness
genetic
Muscular dystrophy will eventually affect the r___ center
–consult with p____
–provide v___ support
respiratory
pulmonology
ventilation
Type 1 spinal muscular atrophy occurs in i___ by ___ M.O.A.
—-babies will have f____/b___ difficulty, will often have a____ p_____ infections
infants, 6
feeding/breathing difficulty
aspiration pneumonia
Type 3 spinal muscular atrophy occurs at ___ M.O.A and up
—-initially these children will be able to w____ and then end up c___ b____
18 M.O.A.
walk
chair bound
pediatric stroke will present with se____, ap_____, fo___ and vi___ deficits
seizures
aphasia
focal/visual
ADEM is characterized by a
br___ and ra____ e____ onset
Brief and rapid encephalitis
In ADEM their will be widespread brain i____ s/p i_____
inflammation s/p illness
ADEM s/s include w_____, p_____, and s___ like activity
weakness
paralysis
seizure
ADEM treatment
-s____, i____, and p_____
*Children with ADEM have a high risk for r_____
steroids, IVIG, plasmapheresis
-relapse
posterior reversible encephalopathy syndrome is where there is a b___ b____ b___ disruption with r____ abnormalities
blood-brain barrier
radiologic
What is the most common s/s of posterior reversible encephalopathy syndrome?
seizures
brain death is i____ l___ of all brain f____
irreversible loss of all brain functions
In order to diagnose brain death, the following must be present.
co___, ap____, and ab___ of br___ re____
coma
apnea
absence of all brainstem reflexes
brain death diagnosis is made by __ separate n___ e____ by different m____
two separate neurological exams by two different MD’s
In neonates, the brain death examination is separated by?
24 hours
In infants and children, the brain death examination is separated by?
12 hours
pseudotumor cerebri is the rapid production of ____, most often in a___ f____
CSF
adolescent females
pseudotumor cerebri complications include v___ l____
vision loss
pseudotumor cerebri treatment goal is to preserve the patients v_____
*assess for p_____ and cranial nerve __ p____
papilledema
cranial nerve 6 palsy–problems with eye movement
Females with pseudotumor cerebri will have a normal ___ and ____
CT
CSF
The diagnostic test for pseudotumor cerebri is with an ____
**The openening pressure will be > ___ mm hg
LP
280
Arteriovenous malformation is when their is an abnormal i___-c__ connection between a___ and v____
intracranial
arteries and veins
children with Arteriovenous malformation are at an increased risk for?
bleeds
children with Arteriovenous malformation will present with neurologic d____, ensure to closely monitor i___
deficits
ICP
The gold standard diagnostic test for AV malformation is with a?
cerebral angiography
Hypoxic ischemic encephalopathy is a consequence of prolonged b___ h____ which results in irreversible neuro sequela
brain hypoxia
Hypoxic ischemic encephalopathy management is with ___ and s___ control
ICP
seizure
Hypoxic ischemic encephalopathy diagnostic studies include e___, c___, m____
EEG
CT
MRI
Neurofibromatosis is an ____ condition
—presents with t___ in the b___, s___, s___, and e____
inherited
—tumors
brain, spine, skin, eyes
90% of children with NF will have the presence of?
cafe au lait spots
Due to tumor presence, children with NF are at risk for n____ d____
neurocognitive deficits
NF management includes close follow up of n___, h___, and o____
neuro
hearing
ophthalmic
Tuberous sclerosis is inherited via a___ d_____
autosomal dominance
Tuberous sclerosis includes the presence of b___ t____
Bening tumors
Tuberous sclerosis is diagnosed
with
___ major criteria or
__ major and __ minor criteria
2
1 and 2
Tuberous sclerosis management is with ____ control
seizure
