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Pediatrics > Neurology > Flashcards

Neurology Flashcards

1
Q

what is the best dx tool for neuro?

A

History

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2
Q

where is LP done?

A

22 gauge needle at L3-L4 intervertebral space

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3
Q

what is LP used for measuring?

A

Opening pressure, cell count (red and white), glucose, protein, culture, gram stain, PCR for viruses

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4
Q

what does CT find?

A

bleeding and masses

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5
Q

what does MRI show?

A

Myelination and demyelenation

Can see posterior fossa best

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6
Q

what can US show?

A

Eval for hydro, hemorrhage, gross structures, calcification

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7
Q

Routine neuroimaging is or is not indicated for children presenting with recurrent headaches unless

A

is there is an abnl neuro exam, coexistence of seizures or other red flags.

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8
Q

when do you do CT or MRI for HA?

A

rarely necessary/appropriate
Concern about sub-arachnoid, subdural hematoma
Concern about increased IC pressure or hemorrhage

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9
Q

when should you do labs for HA

A

if suspect infectious origin

CBC, blood cultures, lumbar puncture etc for meningitis

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10
Q

what are 5 red flags of HA

A
  • Headache fails to respond to therapy
  • focal neurologic findings appear (in first 2-6 months)
  • progressively increasing frequency / severity of headache, headache worse with valsalva
  • headache awakens from sleep, worse in the morning, AM vomiting
  • at-risk hx or condition: neurocutaneous disorder
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11
Q

(brain tumor, hemorrhage, hydrocephalus, pseudotumor, meningitis,) may cause

A

increased ICP

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12
Q

(intracerebral hemorrhage, vasculitis, or AVM) may cause

A

vascular HA

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13
Q

(postictal or ictal) may cause what 2ndary HA?

A

epilepsy

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14
Q

(sinusitis, dental abscess, trigeminal neuralgia, TMJ pain, carotid dissection) may cause what 2ndary HA

A

h and neck patho

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15
Q

(HTN, DM, cardiac disease-source of emboli/stroke) may cause

A

2ndary HA

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16
Q

what drugs may cause 2ndary HA

A

(analgesic overuse/rebound, drug abuse-cocaine, psychostimulants, OCPs, steroids)

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17
Q

what psych do may cause 2ndary HA?

A

depression

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18
Q

HA that is Severe, pulsatile (pounding)
unilateral, can be bilateral
Frontal or temporal regions, retro orbital or cheek

A

Migraine

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19
Q

May be only symptom in younger children (cyclic vomiting)

Vomiting may herald the end of the headache

A

Migraine

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20
Q

Assoc symptoms
N/V photophobia, phonophobia, vertigo, fatigue, mood alteration
Vomiting

A

Migraine

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21
Q

children have what kind of aura for HA

A

visual

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22
Q

when are studies warranted for migraines?

A

focal neurologic signs

HA worse on awakening , or awakens pt , or with a cough or bending over.

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23
Q

how do you treat migraines

A

Ibuprofen or acetaminophen early in the attack
Caffiene, caffiene+ergot
Triptans (sumatriptan, rizatriptan, etc.) and DHE (dihydroergotamine)
Rest and quiet
Avoid narcotics

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24
Q

how do prevent migraines?

A

Tricyclic antidepressants
Beta Blockers ie propranolol
Calcium channel blockers, such as verapamil

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25
Q

how do you dx a migraine?

A

Hx

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26
Q

what are TTH brought on by?

A

Brought on by fatigue, exertion, stress

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27
Q

which of the following is not for migraines?

A

narcotic - morphine

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28
Q

what is Pain described as
Constant, aching, tight
Occipital, frontal or constricting band around head
May occur simultaneously with vascular headache

A

TTH

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29
Q

how do you treat TTH?

A

Relieved by rest, analgesics

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30
Q

who gets cluster HA

A

Predominantly male

Unusual in children under 10

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31
Q

what is HA that is Unilateral, severe pain
Periorbital or retro-orbital
May have ipsilateral autonomic dysfunction (flushing, tearing, sweating, nasal congestion)
Patient can’t sit still due to the pain

A

Cluster HA

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32
Q

how long does cluster HA last

A

Lasts minutes to hours – typical 30 min to 2 hrs

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33
Q

t or f cluster ha Occur in clusters, often seasonal

A

T

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34
Q

how do you treat cluster HA?

A

O2 - 100%

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35
Q

A sudden, transient disturbance of brain function manifested by involuntary motor, sensory, autonomic, or psychic phenomena.

A

seizure

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36
Q

2 or more seizures not provoked by particular event or cause.

A

epilepsy

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37
Q

sz can be d/t

A

Metabolic, truamatic, anoxic, infectious insult to brain

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38
Q

a benign condition of childhood with unilateral focal seizures and speech abnormalities, often hereditary.

A

rolandic epilepsy

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39
Q

sz that is in first 28 days (typically first few days)
Benign familial ( outgrow )
Secondary may progress ( HIE,Infex, IVH, thrombus)

A

neonatal sz

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40
Q

sz in 6 mo – 6 yrs, w no evidence of intracranial infection or defined cause

A

febrile

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41
Q

what is status epilepticus

A

Seizure > 30 min

Sequential seizures without regain LOC > 30min

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42
Q

do children out grow sz?

A

70-80% do

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43
Q

what are partial sz types

A 
simple partia (focal) 
Complex partial (psycho-motor)
 Benign rolandic epilepsy
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44
Q

what are generalized sz types

A 
Absence (petit mal)
Generalized tonic clonic (grand mal)
Tonic
Clonic
Atonic
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45
Q

what sz are unique to kids?

A

Infantile spasms (West syndrome)
Febrile seizures
Juvenile myoclonic

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46
Q

what is simple partial sz

A

No LOC

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47
Q

what is complex partial sz?

A

LOC (staring) – altered consciousness

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48
Q

what is 2ndarily gen sz?

A

: a simple or complex partial seizure that ends in a generalized convulsion

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49
Q

what is a partial sz?

A

Onset of seizure begins in one area of one cerebral hemisphere (apparent clinically or via the EEG)

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50
Q

can eeg tell us if someone has epilepsy?

A

No -

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51
Q

what is a generalized sz?

A

Seizures arise from both hemispheres, simultaneously

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52
Q

what szs are Frequently associated with underlying structural brain disease and
Difficult to treat and classify

A

Myoclonic,Tonic, Atonic and Atypical absence

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53
Q

symptoms of Stare Eyes fluttering Automatisms (such as lip smacking, picking at clothes, fumbling) if prolonged

A

Absence (petit mal)

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54
Q

what has symptoms of A cry Fall Tonicity (rigidity) Clonicity (jerking) May have cyanosis

A

Generalized tonic-clonic (Grand mal)

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55
Q

what has post-ictal of Amnesia for seizure eventsNo confusionPromptly resumes activity

A

absence

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56
Q

what has post-ictal of Amnesia for seizure eventsConfusionDeep sleep

A

tonic-clonic

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57
Q

what is are infantile spasms? (west syndrome?

A

Clinical Spasms ( 1-2 seconds)
Mistaken for colic, reflux, startle
Occur in clusters when drowsy

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58
Q

what could cause infantile spasm? and out comes of both?

A

-Brain insult at birth, malformation ,Tuberous Sclerosis, metabolic origin
Hard to control
Poor neurocognitive outcome

Cryptogenic = no identifyable cause.
Best outcome

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59
Q

Seizure description:
-When awake:
twitching and/or tingling on one side of body
speech arrest, speech difficulty, may drool / gag
no loss of consciousness, usually

A

Benign Rolandic EpilepsyBenign Focal Epilepsy of Childhood

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60
Q

what is the IQ of someone with rolandic epi?

A

normal

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61
Q

what is the Fhx of someone with rolandic epi

A

positive for

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62
Q

who gets rolandic epilepsy?

A

Boys>girls

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63
Q

when do you treat rolandic epi?

A

frequent (which is unusual)
Socially stigmatizing if occur in wakefulness
Anxiety provoking for parents if occur in sleep

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64
Q

what is status epilepticus?

A

30 minutes or more of continuous seizures or recurrent seizures without regaining consciousness
Medical emergency
Prolonged seizure may cause structural damage, hypoxia, hypotension, death

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65
Q

who is status epi common Most common in?

A

children under 5 (85%) , especially < 12 mo

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66
Q

how do you treat status epi?

A

ABCs, then IV anticonvulsants (Valium)

67
Q

what are most common causes of status epi?

A

Infection and metabolic disorders are most common causes in children.

68
Q

how do you work up sz?

A

EEG CT or MRI

EEG
Every case of suspected seizure disorder (but not necessary for febrile seizures)
Abnormal in 60-80%

Blood tests
Generally not helpful
Only if specifically suggested by presentation, history

CT scan or MRI
Generalized - Abnormal exam or difficult to control
Focal – Not for benign Rolandic epilepsy, but all others

69
Q

what specimens should be collected for Sz eval?

A 
-CBC 
WBC > 20k may suggest bacterial infection
Left shift often seen due to adrenocortical surge
-Blood cultures , Urine C+S , 
-Lumbar puncture
Some under age 2(younger the child, the more important)
Any suggestion of meningitis
-Electrolytes 
Na,K,Cl,HCO3,BUN,Cr,Ca,Phos,Mag
Glucose
-Neonates – consider metabolic
Lactate, Amonia, Urine ketones
70
Q

who should get labs for sz?

A

Neonatal,abnormal mental status persistent, diabetics, renal disease, diuretic use, Dehydration, malnourishment

71
Q

what is EEG most used for?

A

–>Most useful for classifying types and guiding therapy
Absence (petit mal), psychomotor (temporal lobe),
generalized tonic clonic (grand mal)
Infantile spasms
Mixed seizure disorders
–>Useful in evaluating worsening seizures or projecting recurrence of seizures if medicines were to be stopped

72
Q

how do you treat febrile sz

A

diazepam, phenobarbital, valproic acid

73
Q

how do you tx neonate sx

A

phenobarbital

74
Q

do you tx febrile sz

A

no - if you have to for continual sz - diazepam

75
Q

is a febrile sz epilepsy?

A

NO

76
Q

if a child presents with complex febrile sz

A

more likely will have epilepsy but as a whole does not progress they just have the increased risk

77
Q

lots of things that mimic seizure

A

Apnea / ALTE
GER
Sleep disorders (nocturnal myoclonus, night terrors, narcolepsy/cataplexy)
Migraine variants (esp. aura)
Benign breathholding spells
Syncope
Movement Disorders (tics, tremor, dystonia)
Pseudoseizures (psychogenic seizures)
-Strange posturing, back arching, writhing
-Alternating L and R limb shaking during same
seizure
-Psychosocial stressor

78
Q

what are the 3 common features of breath-holding spells?

A

-Involuntary:
Children < 4 can’t voluntarily hold breath
Most start before 18 mo
Resolve usually by 4, definitely by 8
-Brief loss of consciousness
-May have “seizure” activity while unconscious

79
Q

what are cyanotic spells precipitated by?

A

anger frustration and fear

80
Q

how does cyanotic spells occur?

A

Cries, stops breathing in expiration, becomes cyanotic

81
Q

what sz has symptoms of No loss of consciousness.Sudden jerkingsensory phenomena

A

simple partial

82
Q

what sz symptoms of May have auraAutomatisms (such as lip smacking, picking at clothes, fumbling)Unaware of environmentMay wander

A

complex partial

83
Q

what sz has postictal of transient weakness or loss of sensation

A

simple partial

84
Q

what sz has a postictal of Amnesia for seizure eventsMild to moderate confusion, sleepiness

A

complex partial

85
Q

what HA often has symptoms of depression and/or anxiety. Secondary gain is common (e.g., school avoidance)

A

chronic tension

86
Q

what HA has pain Bilateral and diffuse
Dull and aching
Often present upon awakening
Not associated with nausea, vomiting, neurologic problems

A

chronic tension

87
Q

how do you tx chronic tension HA?

A

Treatment is difficult but antidepressants seem helpful

88
Q

what may work up include for chronic tension HA

A

a CT scan or MRI

89
Q

syncope has prodrome T or F?

A

May have prodrome

Dissiness, lightheadedness, nausea, sweating, pallor

90
Q

what is Transient LOC and postural tone due to cerebral ischemia or anoxia.

A

syncope

91
Q

syncope absolutely does not have jerking motions when unconscious, T or F

A

F

92
Q

what is link in syncope

A

Family history + in 90% of patients

93
Q

what syncope is Neurally mediated
Transient hypotension from vasodilation and/or decreased heart rate
Arousal 1-2 min up to 1h

A

Vaso-vagal or neurocardiogenic

94
Q

what is the most common syncope type

A

Vaso-vagal or neurocardiogenic

95
Q

what syncope has CP and palpitations with it? and occurs during exercise?

A

cardiac

96
Q

how do you work up syncope?

A

Vitals , BP, Hgb, EKG

97
Q

how do you treat syncope?

A

Direct management of any cardiac cause

Reassurance and avoidance of triggers for vaso-vagal stimulation

98
Q

what may cause inc ICP?

A

Cerebral edema

Mass lesion

99
Q

Infant with symptoms of
Bulging fontanelle
Increasing head circumference, separating sutures
Lethary, vomiting, FTT, “setting-sun sign”

A

inc ICP

100
Q 
Children with symptoms of 
Headaches
Diplopia/Strabismus
Papilledema
Herniation syndromes
A

increased ICP

101
Q

what does setting sun sign go with?

A

hydrocephalus

102
Q

where is HA from elevated ICP located?

A

Supratentorial – eye, forehead, temple
Infratentorial – occiput, neck
Generalized

103
Q

when does the pain occur for elevated ICP

A

Worse in morning on awakening and standing up, or at night

Worsened by maneuvers that transiently increase ICP: Coughing, sneezing, straining

104
Q

what occurs along with pain d/t inc ICP? describe pain?

A

Often also have vomiting without nausea

Constant and unremitting

105
Q

what is assoc with Well person who suddenly experiences “worst headache in my life”

A

SAH

106
Q

classic pt who is girl obese with HA, tinnitus, papilledema,visual loss normal MRI increased opening pressure

A

psuedotumor cerebri

107
Q

what is Increased intracranial pressure without identifiable mass or hydrocephalus

A

pseudotumor cerebri

108
Q

what is cause of pseudotumor cerebri?

A

unknown (dx of exclusion)

109
Q

what are the most common causes of childhood stroke?

A

Cyanotic heart disease
Sickle cell anemia
Meningitis
Hypercoagulable states

110
Q

what presents as hemiplegia, unilateral weakness, seizures.

A

childhood stroke

111
Q

what hx do you want for childhood stroke?

A

Assess for history of infections, head/neck truma, familial clotting disorders, CHD

112
Q

what studies should you do for childhood stroke?

A

CBC, ESR, Chemistries, BUN/Cr , clotting studies, CXR, EKG,Urine tox, UA ( CSF not usually helpful unless eval infection)
CT or MRI

113
Q

how do you tx stroke?

A

No treatment to repair damage
Preventive management
Underlying disease , anticoagulants

114
Q

What is the most common cause of concussion in children?

A

Fall

115
Q

Brief loss of consciousness or stunned for minutes to hours No localizing neurologic signs
Amnesia is common and transient

A

concussion

116
Q

what is the major diagnostic for concussion?

A

CT

117
Q

All children with amnesia or who were unconcscious should be evaluated in ER t or f?

A

T

118
Q

what is post concussive syndrome and when does it resolve

A

Many children complain of headache, dizziness, forgetfulness, inability to concentrate, slowing of response time, mood swings, irritability
Resolve spontaneously
Can take weeks to months

119
Q

what are congenital malformations of neuro? 6

A

Meningomyelocele, encephalocele, Lissencephaly, pachygyria, absence of corpus callosum

120
Q

what is MMC identified by and is d/t?

A

Often identified on US, likely have elevated alpha fetoprotein on prenatal screen.
Folate during pregnancy

121
Q

what is displaced cerebellum through foramen magnum into spinal canal –

A

arnold chiari I

122
Q

how do you treat arnold chiari i?

A

posterior laminectomy

123
Q

what has sx of progressive ataxia or vertigo

A

arnold chiari I

124
Q

what is displaced cerebellum plus meningomyelocele

A

arnold chiari II

125
Q

which chiari has Varying degrees of paralysis depending on site/level of defect
hydroceph and sz

A

II

126
Q

how do you treat AC II

A

surgical repair and shunt

127
Q

what has low lying tonsils alone and asympt

A

chiari I

128
Q

what has low lying tonsils + hydrocephalus and diffuse HA

A

chiari II

129
Q

smooth brain

Severe delay, seizures. Associated with syndromes

A

lissencephaly

130
Q

Most common disorder of neuronal migration

A

lissenecephaly

131
Q

what is Premature closure of sutures

A

Craniosynostosis

132
Q

most common craniosynostosis?

A

saggital suture > coronal suture

133
Q

what limits lateral growth and has Elongated (scaphoid) head

A

saggital suture craniosyn

134
Q 
what Limits AP growth
Short wide (brachycephalic) head
A

coronal suture craniosyn

135
Q

does craniosyn affect brain

A

Doesn’t constrict brain unless many sutures involved (↓ head size)

136
Q

how do you dx craniosyn

A

Diagnosed on basis of palpable, raised, fixed suture lines and/or changing shape of head  Skull Xrays

137
Q

how do you treat craniosyn?

A

Treatment is surgical excision of fused suture line – best done prior to 6 months of age

138
Q

Impairment of coordination and balance of voluntary movement

A

ataxia

139
Q

where is the problem in the brain with ataxia?

A

cerebellar problem

140
Q

what is the most common cause of ataxia?

A

post infectious or drug intox

141
Q

what are other causes of ataxia?

A

Brain lesions or tumors
Infection (CNS ; encphalitis, meningitis)
Hereditary Ataxic (Friedreich Ataxia )
Metabolic

142
Q

what illness may cause ataxia?

A

usually viral (varicella, mono, URI, GI )

143
Q

what has symptoms of Sudden onset of ataxia,staggering, frequent falls
Nystagmus, vomiting, irritaility, lethargy possible
Sensory and reflexes preserved
No evidence increased ICP

A

post infectious acute cerebellar ataxia

144
Q

what is the prognosis of post infectious cerebellar ataxia

A

– 90% of children with acute cerebellar ataxia have complete recovery in 1-4 weeks

145
Q

disease at the Anterior Horn Cells

A

SMA – spinal muscular atrophy

146
Q

nerve NM d/o?

A

Guillian Barre – post viral autoimmune

147
Q

NMJ NM d/o?

A

Myasthenia Gravis

148
Q

neouromuscular d/o at the muscle

A

Muscular dystrophy

Myotonic dystrophy

149
Q

progressive weakness and wasting of skeletal muscles Normal mental, language and social skills
Eventual respiratory failure and death

A

anterior horn cell spinal musc atrophy (AR)

150
Q

muscle weakness, which may manifest with floppiness, delayed motor milestones, unsteady gait or muscle fatiguability you should think…

A

NM d/o

151
Q

Acute post-infectious polyneuropathy

often follows URI / GI infection (autoimmune)

A

GB syndrome

152
Q

ascending symmetrical weakness; starts as numbess or tingling in hand / feet… heavy feeling in legs
bulbar palsy and respiratory depression
Autonomic dysfunction –hyper/hypotension , tachycardia

A

GB syndrome

153
Q

> 10 years old, ophthalmoplegia and ptosis, loss of facial expression and difficulty chewing

A

Juvenile myasthenia

154
Q

presents later in life, less severe

Death usually in adulthood

A

Becker Muscular Dystrophy

155
Q 
X-Linked recessive
Onset at 2-6 yrs
Proximal muscles affected before distal
Waddling gait, difficulty with stairs
pseudohypertrophic calf
A

duchenne MD

156
Q

what has +Gower Sign (pelvic weakness)

Elevated CPK , Rx Steroids

A

DMD

157
Q

in MD weakness starts…

A

proximal and goes distal

158
Q

when does death occur in duchenne

A

DMD

159
Q

what is the most common CP

A

spastic - Monoplegia, paraplegia, hemiplegia, quadraplegia,

160
Q

what is Muscular – motor problem,

Non-progressive and originated before or at or near birth

A

CP

161
Q

what is an Autosomal Dominant

with Café au lait spots - >6 of 5mm prepubertal pt

A

NF

162
Q

AD, rare , characterized by benign tumors in vital organs such as the brain, eyes, kidneys, heart and skin.
tuber-like growths in the brain which calcify with age and become hard, or sclerotic.

A

tuberous sclerosis

163
Q

-Unilateral port wine stain over upper face
Follows cranial nerve V
-Intracranial leptomeningeal vascular anomaly and calcifications
-Buphthalmos with enlarged globe, corneal clouding
-Mental Retardation
Embryonal developmental anomaly

A

sturge weber

Pediatrics (9 decks)

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