Neurology

Question 1

When suspecting pseudotumour cerebri, what is management?

Answer 1

rule-out tumour and get imaging!
high opening pressure, remove enough to get to 150 mm H20
diuretics: acetazolamide
dietary changes, low salt, manage weight
serial LPs in some cases
\+/- steroids

Question 2

Name the three elements of Cushing’s triad

Answer 2

Bradycardia
Hypertension
Irregular, ineffective respirations

Question 3

How to manage cerebral edema in DKA?

Answer 3

decrease fluid rate by 1/3
hypertonic saline 5-10 mL/kg over 30 minutes
mannitol 0.5-1g/kg IV over 20 minutes, repeat if not better
intubate
hyperventilate
CT to rule out alternate explanation, ie: thrombosis

Question 4

What age does infantile spasms present?

Findings and treatment?

Answer 4

• 4-7 months: infantile spasms, developmental arrest, hypsarrhythmia
• meds: ACTH, prednisone

Question 5

Describe features of juvenile myoclonic epilepsy

Answer 5

Autosomal Dominant
classic presentation with morning myoclonic sz
EEG generalized irregular spikes and polyspikes
generally well controlled on VPA but txt needs to be life-long

Question 6

Describe features of an epidural hematoma

Answer 6

• blood btw skull and dura, elliptical or convex on CT
• classic lucid interval, rare in kids (<30%)
• arterial bleeding with middle meningeal artery
• 60-80% w/ ass’ skull #

Question 7

Describe subdural hematomas

Answer 7

• 5-10x more common than EDH
• concave or lens shaped on CT
• skull #s more rare
• underlying brain injury or cerebral contusion
• ** non accidental injury
• motor or sensory deficits, irritability, coma, seizures, herniation
• worse outcomes than EDH

Question 8

Describe features of an acute confusional migraine

Answer 8

atypical migraine
suddes onset of mental status changes: confusion, dysarthria, altered mental status
looks bad: stroke vs other

Question 9

What are the mean ages of onset of migraines in boys and girls?

Answer 9

7 year old boy

11 year old girl

Question 10

What are features of a classic migraine?

Answer 10

prodrome lasts up to 1 hr
throbbing, dull, unilateral
most common symptom: visual disturbance
lip, face, hand tingling, aphasia and weakness can occur
nausea and vomiting is common

Question 11

Where are brain tumours most commonly located? Features?

Answer 11

• posterior fossa accounts for 50% of brain tumours, most common in ages 1-8
• gait disturbances
• ocular nerve palsy #6
• good history and physical exam