Neurology Flashcards
What is the International Headache Society definition of migraine?
At least 5 attacks, lasting 4-72 hours with 2/4: A. Unilateral B. Pulsatile C. Moderate-severe intensity D. Aggravated by or causing avoidance of routine physical activity During the headache at least 1/2: A. Nausea/vomiting B. Photo/phonophobia Not attributable to other causes
What are features of migraine with aura?
Reversible focal neurological symptoms lasting <60 minutes, develop progressively over 5-20 minutes
+/- typical migraine headache
What is the treatment of migraine headache?
NSAIDs
parenteral dopamine antagonist ie. metaclopramide
may add dexamethasone 10 mg IV x 1 to prevent recurrence of migraine (NNT = 9)
What are 10 can’t miss headache diagnoses
Which show up on CT?
SAH* Traumatic ICH* Meningitis/Encephalitis CVST Temporal arteritis CO toxicity Angle closure glaucoma Cerebral artery dissection Tumor* Idiopathic intracranial HTN
Criteria for simple febrile seizure?
developmentally normal child
38
NOT result of CNS infection/metabolic abnormality
normal neurologic exam pre and post
Features of complex febrile seizure?
focal features
>15 minutes
>1 episode in 24 hours
When to consider a lumbar puncture in febrile seizures?
signs of meningitis
antibiotic treatment (? partially treated)
incomplete/no vaccinations
When to consider a lumbar puncture in febrile seizures?
signs of meningitis
antibiotic treatment (? partially treated)
incomplete/no vaccinations
What investigation do you need to do in a first unprovoked seizure in pediatrics? (in absence of focal neurologic
outpatient EEG
What investigation do you need to do in a first unprovoked seizure in pediatrics? (in absence of focal neurologic
outpatient EEG
What is first line anticonvulsant therapy in neonates?
IV phenobarbital
What is first line anticonvulsant therapy in neonates?
What is an adjunctive therapy for infants in status epilepticus to consider?
IV phenobarbital Consider pyridoxine (vit B6)
Describe infantile spasms
brief contractions of neck, trunk, extremities
followed by phase of sustained muscular contraction
Most frequent when awakening/going to sleep
often followed by small gasp
What is the classic EEG finding in infantile spasms?
Hypsarrhythmia
What is the #1 cause of infantile spasm?
Tuberous sclerosis Others: metabolic disorders genetic disorders infectious
What is the #1 cause of infantile spasm?
Tuberous sclerosis Others: metabolic disorders genetic disorders infectious
Describe an episode of benign paroxysmal vertigo in pediatrics
Will be playing/active, followed by sudden episode where they will not move, be terrified, stunned, lasts a few minutes and they will go back to activity immediately after
- often have hx of motion sickness or migraines
- migraine equivalent
Describe an episode of benign paroxysmal vertigo in pediatrics
Will be playing/active, followed by sudden episode where they will not move, be terrified, stunned, lasts a few minutes and they will go back to activity immediately after
- often have hx of motion sickness or migraines
- migraine equivalent
What is the difference between vestibular neuritis vs. labrynthitis?
Vestibular neuritis - acute onset vertigo, N/V, ataxia
Labrynthitis - includes hearing loss, tinnitis
What is the difference between vestibular neuritis vs. labrynthitis?
Vestibular neuritis - acute onset vertigo, N/V, ataxia
Labrynthitis - includes hearing loss, tinnitis
What are the diagnostic criteria for migraine headaches in children?
bilateral pain
1-72 hours (shorter duration)
need to infer associated symptoms ie. photophobia, phonophobia or the presence of
nausea aggravated by physical activity
consider other associated symptoms, ie. difficulty thinking, fatigue, and
lightheadedness
3 migraine variants in pediatrics
abdominal migraine
benign paroxysmal vertigo
cyclic vomiting
3 migraine variants in pediatrics
abdominal migraine
benign paroxysmal vertigo
cyclic vomiting
When to consider imaging in pediatric headaches?
awakens from sleep occipital location AM headache that improves when upright, aggravated by valsalva maneuvers associated with neurologic deficits rapidly increasing headache frequency nonresolving focal neurologic deficits
What are features of guillan barre syndrome?
symmetric ascending weakness
areflexia
post infectious autoimmune polyneuropathy
What are 3 characteristics of the Miller Fisher variant?
ophthalmoplegia
ataxia
areflexia
(often no limb weakness)
List 8 ddx considerations in acute cerebellar ataxia
intoxication (ETOH) cerebellar/brainstem tumors neuroplastoma (opsoclonus-myoclonus-ataxia syndrome) encephalitis labrynthitis vascular disorders (lupus, cerebellar hemorrhage) post infectious/immune disorders trauma
List 8 ddx considerations in acute cerebellar ataxia
intoxication (ETOH) cerebellar/brainstem tumors neuroplastoma (opsoclonus-myoclonus-ataxia syndrome) encephalitis labrynthitis vascular disorders (lupus, cerebellar hemorrhage) post infectious/immune disorders trauma
What are the rules of 50 in dextrose replacement?
1 cc/kg of D50W
2 cc/kg of D25W
5 cc/kg of D10W
10 cc/kg of D5W
What are the rules of 50 in dextrose replacement?
1 cc/kg of D50W
2 cc/kg of D25W
5 cc/kg of D10W
10 cc/kg of D5W
What diagnosis to consider in lethargy out of proportion to clinical findings and workup?
abdominal intussuception
List 5 stroke mimics
seizure hypoglycemia migraine hypo/hypernatremia hepatic encephalopathy multiple sclerosis peripheral neuropathies conversion disorder
