Neurology Flashcards
1
Q
When do infantile spasms occur?
A
< 1 y.o.
Peak: 4-6 mo.
NOT newborn
2
Q
What is the EEG pattern for infantile spasm
A
Hypsarrhythmia
- high amp
- multiple spike
- chaotic
3
Q
How do you treat infantile spasm
A
Vigabatrin (AE: Retinal toxicity)
OR
ACTH (irritable, adrenal suppression)
4
Q
What is the AE you worry about with vigabatrin?
A
Retinal toxicity
5
Q
EEG appears chaotic. High amplitude background with multifocal spikes. Likely Dx?
A
Infantile Spasm
Hypsarrhythmia
6
Q
List two conditions associated with infantile spasm?
A
TS
Down Syndrome
7
Q
List 3 things on ddx for infantile spasm:
A
- Benign Myoclonus of infancy (<6 mo; normal EEG)
- Sandifer syndrome (don’t see cluster but AbN movement due to GERD)
- Breath Holding Spells (6-6 yo; ~1min. LOC; cyanotic or pallid; link with Fe deficiency; 100% resolve by 8 y.o.)
- Infantile Masturbation (F >M, pelvic rocking, adduct leg, pelvic pressure, autonomic like flush or sweat, distractible)
8
Q
What is West Syndrome?
A
Infantile Spasm + Hypsaarhythmia + Developmental Regression
9
Q
What is the definition of epilepsy?
A
min. 2 unprovoked seizures
10
Q
What % of pop’n have epilepsy?
A
1%
11
Q
if first unprovoked seizure- what do you do?
A
Sleep deprived EEG
MRI if focal symptom or P/E finding.
12
Q
Describe childhood absence epilepsy?
A
6-7 y.o. absence +++/d otherwise N Tx: ethosuximide, VPA, lamotrigine 70% outgrow as teens
13
Q
Preschool. Atypical absence + atonic + myoclonus. Behavioural issue when older. Often pmhx (+) neurocutaneous or brain injury.
A
Lennox-Gastaut Syndrome
Behav or IQ issue when older.
EEG: 1.5-2Hz SLOW spike-wave
Steroids
VPA etc.
14
Q
Seizures + lang loss in 3-8 y.o. Epileptic Dx?
A
Landau-Kleffner Syndrome
- acquired epileptic aphasia
- partial and GTC
- lang loss
Tx: VPA (or Ethosuximide)
+ ** Steroids (for lang)
15
Q
Preteen. Myoclonic jerk in morning with no LOC. Toothbrush jerk away. FHX absence sz.
A
Juvenile Mycolonic Epilepsy
EEG: generalized polyspike
Tx: VPA
Lamotrigine
16
Q
10 y.o. Falling asleep and then child run in with focal facial mvmt x 1-2 minute. Drooling. One per night. Normal LOC.
A
Benign Rolandic Epilepsy
No meds needed (Keppra if frequent, prolonged, or secondary gran mal associated)
Resolve by puberty
17
Q
What is the EEG finding in benign rolandic epilepsy?
A
Centro Temporal Spikes
18
Q
List two meds for seizures in kids < 2 y.o.
A
Phenobarb
AE: sedation, reversible acquisition of milestones
Levetiracetam (keppra; fatigue, dizzy, SJS/TEN)
** except spasm= vigabatrin (retinal toxicity) or ACTH
19
Q
List two meds for seizures in kids > 2 y.o.
A
Levetiracetam (keppra)
Valproate (hair thinning, wt gain, bone health, tremor, hepatitis, teratogen
** except Lennox-Gastaut (preschool absence, myotonic, clonic)= steroids +
** except Landau-Kleffner (3-8 y.o. sz + lang loss)= steroids +
** except Childhood Absence Syn (peak 6-7)= Ethosuximide.
** except Benign Rolandic Epilepsy at night w/ face no meds. If need Keppra
20
Q
T or F: you can use carbamazepine for absence or myoclonic sz
A
False
21
Q
T or F: safe to give phenytoin IM
A
False.
- very toxic and cause necrosis
** FOSphenytoin can be given IM
22
Q
T or F: you SHOULD NOT give VPA in with potential metabolic dx
A
TRUE
23
Q
Generalized 3 Hz spike and wave d/c in EEG. Dx?
A
Childhood Absence Epilepsy
24
Q
T or F: you generally outgrow childhood absence seizures by adolescence.
A
True
25
6 y.o. Recurrent staring. Learning problem. EEG 3 Hz spike and wave. What do you tell family
- high chance of GTC sz
- tx not needed b/c benign nature of condition
- reasonable to start oxcarbazepine
- likely outgrown by adolescence
Likely outgrow by adolescence.
- GTC not common
- Need to tx= Ethosuximide
- DO NOT give carbamazepine as makes it worse
26
List the dx criteria for paediatric migraine:
```
min. 5 attack
last 1-72 hr
H/a has 2 of:
- uni/bil lateral
- pulsating/throb
- mod-severe pain
- worse w/ activity
```
PLUS one of:
N/V
photo/phonophobia
Not better explained by another condition
27
How do you know if someone has used OTC enough to cause med overuse h/a?
3X per week
| x 3 month
28
What are absolute indications for head imaging in pt with h/a?
1. New neuro symp (focal neuro in h/a, focal neuro on aura, seizure, abN gait)
2. new focal P/E
3. papilledema
Other questionable:
- sudden onset worst of life (subarachnoid)
- wake from sleep
- worst in am
- am emesis
- worse with cough (chair)
- recent head injury
- change in type of h/a
- occiput location
29
What are non pharma measures you can recommend for migraines or non migraine h/a in kids?
Regular meals + sleep
Exercise
Avoid Caffeine
Limit OTC to < 3X per week
30
15 y.o. with migraine w/ aura. Healthy otherwise. Lifestyle optimized. P/E normal. Recommend:
- propranolol
- ibuprofen
- flunarizine
- sumatriptan
Flunarizine 1st line prevention migraine med.
Ca2+ channel blocker
Studied in kids
Well tolerated
Rare AE:
- wt gain
- low BP
31
What is Tourette syndrome often associated with:
- OCD
- Anxiety
- ADHD
- ODD
- Learning Diff
32
T or F: spastic diplegia associated with B/L PVL.
True
- prem
- ofte not seen until 6 mo. where ppt with early hand preferencd
33
Floppy Baby. How can you tell between central versus peripheral cause?
Central:
- low LOC (not bright)
- Floppy but strong limb (if weak is axial like head lag)
- Normal or ++ DTR
+/- other neuro deficit (sz, abN movement)
```
Peripheral
- weak + floppy
BUT bright, crying etc.
- LOW DTR
- no other neuro deficit (i.e. sz, abN movement)
```
34
2 day old term with hypotonia. Signif head lag. Alert + crying. ABSENT DTR. Likely dx:
- SMA
- DMD
- Myotonic dystrophy
- Prader will.
Spinal muscular atrophy.
Myotonic dystrophy possible but reduced DTR not absent.
DMD not in infancy.
Prader Willi= central hypotonia.
35
What is trigonalocephaly. What tx if severe?
Trigonal cephaly
= Triangle head
= Metopic closed
If severe= craniotomy to remove mitotic suture
36
What is the most common craniosynostosis?
Scapho cephaly
- Sagittal suture fused
- long + narrow football
37
Most common reason for Sx in child born with myelomeningocele:
Hydrocephalus
38
Which anomaly is most associated with SC anomaly in newborn:
- Anorectal
- Arthrogryposis (contracture)
- Malrotation
- Dislocated hip
Anorectal Defect
39
Vascular malformation on upper face. What do you monitor for:
- Hearing loss
- Cerebral AVM
- Glaucoma
Glaucoma
- Skin= Port wine
- Brain= Leptomeningeal Angioma
- Eyes= Glaucoma
40
Baby with right facial droop. can wrinkle forehead. Able to close eye. Dx?
Asymmetric Crying Face
= Absence of depressor anguli iris muscle.
- cosmetic issue only
41
How can you tell asymmetric versus facial palsy from compression of facial n. (forceps)?
Asymmetric Crying Face:
- eye and forehead unaffected.
- only see with crying
Facial Palsy= generalized expression
- resolve 2-3 mo. on their own
42
How do you differentiate plagiocephaly from craniosynostosis?
- AbN shape a birth
- NO bald spot
- plagio: ipsilateral face anteriorly displaced versus craniosyn. posterior displaced
43
What CT head finding is expected in child with facial nevus V1?
Name 2 other complications
Leptomeningeal capillary-venous malformation (Angioma)
Other:
- Glaucoma
- Other CNS findings: Seizure, hemiparesis, DD, stroke like episodes
44
Is sturge weber inheritable?
No
- Sporadic mutation on GNAQ mutation
45
List 3 neurocutaneous syndromes?
```
NF
TS
Sturge-Weber
Incontinentia pigmenta
PHACES
Ataxia- Telangiectasia
Von-Hippel Lindau
```
46
Child with infantile spasm. Hypo pigmented patch of skin. Underlying condition? What test to confirm this?
Tuberous Sclerosis
Genetic Testing (TSC1 or TSC2)
Or MRI
47
List Criteria for TS:
2 major or 1 major + 2 minor.
Listed Major...
"FAT SEGA RASH"
- Fibroma: Ungal (min. 2), angiofriboma (min. 3)
- Angiomyolipoma of kidney
- Tubers (Cortical dysplasia)
SEGA
- subependymal nodules
- subependymal giant cell astrocytoma
- Retinal hamartoma
- Ashleaf spot (min. 3 min. 5 mm hypo pigment)
- Shagreen patch (raised firm plaque)
- Heart= rhabdomyoma
Minor= confetti skin, dental pits, intramural fibromas, multiple renal cyst etc.
48
How is TS inherited?
AD
| w/ variable expression.
49
What is TS surveillance?
MRI q1-3 yr for SEGA
Renal image q1-3 yr
Neurodevelop testing
Watch for ICP, Sz
50
How many criteria do you need to dx NF1?
2 of 7 criteria.
"CAFEFOGS"
- Cafe au lait
- axillary or inguinal freckling
- neurofibroma
- Eye: lisch nodule
- (+) FHX
- optic glioma
- Skeletal= sphenoid dysplasia, cortical thinning, pseudoarthroses
51
Name 3 traits of NF2
**hearing**
- (+) FHX
- Vestibular schwannoma, meningioma, glioma, neurofibroma etc.
52
3. 5 y.o. F developing well. over 6 month regression. Consistent with:
- TS
- GM-1 gangliosidosis
- Adrenoleukodystrophy
- MELAS
GM-1 Gangliosidosis
- neurodeg (ataxia, sz, regression)
- HSM
- cherry-red spot
Versus GM-2 Tay Sach= neurodeg < 1 and big head, cherry red spot
Versus Adrenoleukodystrophy degenerate by 3-4 y.o. but MALES. Adrenal insuff.
53
List 4 features of Rett Syndrome:
- Developmental regression
- acquired microcephaly (normal neo)
- hypotonia
- autistic like (lose eye contact, and mvmt)
- lose hand skill, hand wringing
- breath holding spells
- sz
- scoliosis
54
2 y.o. trunk writhing. flushed. diaphoretic. Grunt, rapid breathing. No LOC, can talk to distract, Next step:
- refer EEG
- GI to R/O GERD
- Reassure
- Refer psychologist
Reassure
= pleasurable behaviour similar to masturbation occur infancy onward
Masturbation may occur in girl 2-3 y.o.
55
Child in status. Unable to get IV. What do do:
- Na nitroprusside
- Rectal diazepam
- Intubate
- IM dilatin
Rectal diazepam
56
CPS statement. Sz management?
ABC (note bradycardia and low BP ominous signs)
- 2 large bore IV
- BG bedside
Pre hosp:
- Ativan 0.1 mg/kg buccal (max 4)
- diazepam 0.5mg/kg PR (max 20 mg)
IV:
- Ativan 0.1mg/kg IV (max 4 mg)
Still sz= repeat
Still sz=
IV: Fosphenytoin 20mg/kg
No IV: same IM
Infusion: midaz infusion
57
All can cause neonatal sz except:
- ++ K
- LO Na
- LO Mg
- LO Ca
- alkalosis
++ K
alkalosis can cause decreased ionized Ca2+ due to increased binding of Ca2+ to albumin.
58
T or F: metachromatic leukodystrophy has HSM
False.
59
List 5 things on neonatal sz ddx.
DIMS:
Drugs > channelopathy (benign familial neonatal sz)
Infection
> Sepsis
> Meningitis
> Encephalitis
```
Metabolic
**> Low BG
> Low Ca
> Low Mg
> Low/High Na
> High Bili
**> IEM (a.a, galactosemia, urea cycle defect etc.)
```
Structural/ Sz/ Stroke
> ** HIE (60%)
> Focal hypoxia-ischemia (15%= **stroke)
> Intracranial **hemorrhage/ infarct (IVH, parenchymal, subarachnoid, subdural)
> Structural (lissencephaly, polymicrogyria)
60
Best Med for absence seizures. Second option? What not to use?
Ethosuximide
Valproate
Lamotrigine
NO carbmazepine
61
Febrile sz. What questions do you ask to assess risk of developing epilepsy?
Absolute risk of developing epilepsy?
If RF (+) risk of epilepsy?
Increased risk of epilepsy:
- **FHX epilepsy
- ** abnormal neurodevelopment
- **complex febrile sz (focal, > 15 min., > 1 sz in 24)
Risk recurrent feb sz= 30-50%
Risk of epilepsy in general popn= 1%
Risk of epilepsy if typical febrile = 2%
Risk epilepsy if feb sz and (+) RF= 2-50%
62
What is the typical age range for febrile seizures?
6 mo- 6 year
63
T or F: risk of febrile seizure increased on day 1 of DTP vaccine and up to 2 week after MMR Vaccine
True
64
List features of complex or atypical febrile seizures?
Focal
> 15 min duration
> 1 sz/ 24h
65
T or F: you should work up a febrile sz?
False if typical.
LP if < 12 month, signs of meningitis.
66
T or F: antipyretic will reduce risk of febrile sz
False.
67
Kid w/ facial twitch in middle of night. Sz pattern on EEG?
Centro temporal
= Benign Rolandic Seizures
= No meds as resolve 2-4 yr from onset
68
List AE for VPA and Phenytoin:
VPA
* *- wt gain
- hyper ammonia
* *- tremor
* *- alopecia
- menses irregular
- hepatic and pancreatic toxicity
Phenytoin
* *- gingival hyperplasia
* *- coarse facies
* *- hirsutism
* *- cerebellar (nystagmus, taxis)
- SJS
- Liver toxicity
69
Phenytoin and VPA. Gums big can't eat. Which med is responsible.
Phenytoin
AE:
- gingival hyperplasia
- coarse facies
- hirsutism
- cerebellar (nystagmus, taxis)
- SJS
- Liver toxicity
70
What are night terrors?
2-7 y.o.
child terrified
unresponsive
worsen if try to console
Tx: reassure; outgrow by puberty
+/- scheduled awakening 15-30 min. than usual time x 2-4 week
RARE: If violent or injury consider benzo x fe months
71
Child has frightening awakening, scream, cries. No recollection in am. Likely dx?
Night terror
72
Most specific indication of sz in neonate:
- high HR
- irregular RR
- high RR
- abnormal eye mvmt
AbN eye mvmt
73
When do you give pyridoxine for neo sz?
B6
Sz right after birth + RESISTANT to conventional tx
74
Best treatment for tension h/a?
Simple analgesic (ibuprofen or acetaminophen)
+ Non-pharma
75
Most frequent cause of school absence in teenage F:
- h/a
- dysmenorrhea
- asthma
- sore throat
Dysmenorrhea
76
5 y.o. Constant h/a x 3 month. Worse. Impacting f'n. Dx to consider:
- brain tumour
- migraine
- tension
- behaviour
Brain tumour
77
What age is sumatriptan approved for ?
Min. 12 y.o.
78
List two periodic syndromes associated with migraine development as an adult.
Childhood periodic syn= occur in f with kids with migraine.
> GI
**- cyclic vomiting syn
**- abdo migraine (AP + N/V, pallor)
> Sleep
- sleep walking
- sleep talking
- night terrors
79
What is the most common cause of childhood h/a
Migraines
80
List the layers of the brain (areas you think about when interpreting CT)
```
Skin
>Skull Bone
>Dura
>Arachnoid
> Subarachnoid Space
> Pia Layer
> Brain
```
81
What is the shape of epidural bleed on CT?
FOOTBALL
- arterial
- assoc w/ skull #
- brief LOC -> lucid -> then unconscious
82
What is the shape of a subdural bleed?
CRESCENT
Football is E= epidural
Subdural- most common abusive head trauma
- gradual increase h/a and confusion
83
How does a subarachnoid bleed look like on CT?
Within fissures
- venous
- traumatic or non-traumatic
84
What type of brain injury is most commonly seen in abusive head trauma:
- epidural
- subdural
- intraventricular hemm
Subdural
85
T or F: Sickle cell stroke typically clinically seen.
False. Subclinical.
86
GBS has been associated with the following infections?
- E coli gastro
- Shigella
- Campylobacter
Campylobacter
GBS usually follow non-specific GI or resp 10d after
- Campylobacter, Helicobacter pyloric
- Mycoplasma
- West Nile
- Vaccine (rabies, flue, polio, Men C)
- EBV, Lyme, CMV, H influ
87
14 y.o. Duchenne. FVC and FEV1 fall. Likely complaint?
Morning H/A
Other:
daytime fatigue
daytime sleepiness
Point: nocturnal hypoventilation
88
Dermatomyositis and Duchenne. Which help distinguish?
- proximal muscle wk
- rash on face + knuckle
- abN muscle BW
- onset < 5 y.o.
- F >M
Dermatomyositis
F>M
Rash on face + knuckle
symmetric proximal weakness
BOTH onset usually after 5 y.o.
89
T or F: If CK is normal - it can still be Duchenne.
False.
CK greatly elevated even at birth.
90
How do you dx Duchenne?
Blood PCR for dystrophin gene.
OR
Muscle Bx
- connective tissue proliferation, degenerating and regenerating myofibers, inflammatory cell infiltrate
91
How do you tx Duchenne
Steroids (keep prolong ambulatory, may improve long-term prognosis)
92
List 3 comorbidities with Duchenne?
Cardiomyopathy
Scoliosis
Intellectual impairment (in all pt)
Depression
93
Bilateral proximal weakness. Dysphagia, b/l ptosis. Upward gaze. Slow onset. CK normal. TSH normal. Give Dx.
Myasthenia Gravis
= rapid fatiguability of striated muscle.
- AI, familial, congenital, toxin induced (botulism)
Earliest sign: ptosis, EOM, dysphagia
- RAPID fatigue
- ** EMG = decremental response to repetitive stem
Tx: cholinesterase inhibitors (Neostigmine)
94
What is dx of Duchenne on bx? What do you want to know to help with genetic counselling?
Lack of dystrophin.
What we want to know:
- Mom a carrier?
- Planning more kids?
- Mom have sib and they want kids?
95
4 complications of Duchenne:
1. gross motor delay
2. obesity
3. cardiomyopathy
4. restrictive lung dx
5. scoliosis
6. contracture
7. steroid AE
96
Hypotonic. Inverted V shaped mouth. Distal muscle wasting. Myotonia (slow relax after contraction like grip). Cataract. Hypothyroid common. CK high.. Dx and testing?
Myotonic Dystrophy
Dx: DNA analysis (expansion of CTG)
97
Child with Duchenne. What is best test:
- serum dystrophin assay
- bx
- molecular study
- EMG
Bx
CC: hip girdle weakness by 2 y.o.
CK ++
Dx: PCR dystrophin gene mutation
If normal= Bx
98
When an Duchenne be seen in a F?
If they are Turner's (XO)
99
List 3 complications of myotonic dystrophy
Weakness (initial distal then proximal; braces needed)
Cataracts
Speech difficulty
Altered Cardiac (heart block)
Endo: low thyroid, adrenal insuff, T1DM
GI: constipation, slow emptying
Low IgG
Increase CA risk
100
Post traumatic pain. Burning. Allodynia. Neuropathic Pain. Tx?
Gabapentin
Other option: TCA (amitriptyline), Lamotrigine
101
What is Erb's Palsy?
C5+ C6
Shoulder adduct, internal rotation, elbow extended with finger flexed (waiter's tip)
Recover > 80%
102
What is Brachial Plexus Injury RF:
Multiparous mom
Shoulder dystocia
LGA
IDM
Protective: Twins, triplets, C/S
103
What is Klumpke's palsy
C8-T1
"Claw hand"
Usually associated w/ underlying anatomic abN or complete plexus injury
104
Which is true about Erb's palsy?
- extension at wrist
- preserved grasp
- symmetric moro
Preserved Grasp
Extension at Elbow
Wrist + finger flexed
105
Define cerebral palsy:
Non progressive in fetal or infant brain
Permanent
Disorder of mvmt
106
Describe:
- Spastic diplegia
- Spastic quad
- Hemiplegia
- Extrapyramidal (athetoid, dyskinetic)
Hemiplegia: Unilateral
- **infarct (stroke, IVH, malformation)
- **hand preference
- seizure, cognitive issue
```
Diplegia:
B/L
- **PVL, cyst, big ventricle (prem)
If term: ischemia, infection
- commando crawl, scissor
- normal intellect
```
Quad: whole body
- Same etiology as diplegia
* * swallowing
- IQ issue + sz
Extrapyramidal (athetoid, dyskinetic)
* * birth asphyxia
- low tone > high tone > rigid > posturing
- feeding issue, drooling
107
T or F: red flag for ATNR - fixed x 30 sec or while crying or > 6 mo. age
True
108
How can you help prevent CP
Maternal MgSO4 if < 32 wk
Cooling term if x 3d if HIE
109
PVL and CP. What would you see on CT?
PVL = NECROTIC lesions in PV white matter.
110
3 signs/symp that might confirm CP.
- Spasticity
- Scissoring
- Brisk DTR
- Difficulty swallowing
- Developmental regression
111
What management do you recommend for CP?
```
MRI for pathology
No Routine BW
Multi-D (PT, OT +/- SLP, rehab team if severe)
Contracture
- passive stretch
- bracing
- botox
- baclofen
- rarely benzo
```
112
List 5 RF or CP:
Antenatal:
- prem
- low BW
- IUGR
Perinatal
- birth asphyxia
- complicated delivery
Post natal
- abuse
- trauma
- meningitis/ encephalitis
- cardiopul arrest
113
What pop'n affect breath holding spell. What are the 2 types?
6 month- < 6 y.o.
Pallid: vasovagal -> anoxic
Cyanotic: cry -> apnea -> shunt -> cyanosis x < 15 second + LOC
114
If you have breath holding spells what possible contributor must you R/O?
Iron deficiency anemia.
115
How do you manage breath holding spells?
- try to intercede before distress
- ignore breath holding behaviour if start
- educate on CPR, sz management
- if no response consider mental health referral
116
T or F: you are at increased risk of epilepsy if you had a sz with a breathing holding spell.
False
If recurrent anoxic sz can treat with anticholinergic like atropine.
117
T or F: breath holding spells are typically self-limited.
True
Grow out within few years.
Can last until 5 y.o.
118
What is atypical GBS (Miller Fisher Syn)?
Miller Fisher Syn
= external ophthalmoplegia
= ataxia
= areflexia
Papilledema can occur.
119
Girl w/ acne with pseudo tumour cerebri. Likely etiologic drug?
- OCP
- Tetracycline
- topical tretinoin
- linda
- EMG
tetracycline.
120
List aetiologies for idiopathic intracranial HTN.
- excess fat-soluble compound (**minocyline, metabolic dx)
- infection (GBS, sinusitis, chronic otitis)
- Drugs (**doxycycline, tetracycline, **isotretinoin)
- renal (nephrotic)
- heme (**polycythemia)
- connective tissue (**antiphosphlipid)
- endo (menarche, PCOS, hypothyroid)
121
T or F: Idiopathic Intracranial HTN has normal CSF.
Yes
| BUT high ICP
122
What test must you do if you suspect increased ICP:
MRI + MRV
| then LP
123
How do you treat idiopathic increased HTN?
Tx underlying cause
+/- Serial LP
+/- acetazolamide (diamox)
124
6 y.o. hx diplopia, h/a, ataxia. Where i lesion? What are two most likely brain tumour?
Posterior Fossa Tumour
Likely :
- cerebellar astrocytoma
- medulloblastoma
125
Child with ataxia, diplopia, head tilt. Most likely:
- Craniopharyngioma
- Brainstem glioma
- Cerebellar astrocytoma
- Posterior fossa hemm
Brainstem glioma
- Cerebellar astrocytoma= limb ataxia, h/a, vomiting
- Brainstem glioma: diplopia, gait Cranial nerve.
- Crania pharyngioma: endo abnormalities (Growth failure, delayed puberty, panhypopit)
- posterior fossa hematoma: h/a, vomit, dizzy
126
What are signs of cerebral herniation:
HTN + low HR + irregular breath
pupillary dilation
extensor posturing
127
severe h/a collapse with progressive posturing. After intubation what do you do?
- urgent CT
- mannitol
Either...
Mannitol b/c med emergency and want to R/O reversible causes.
128
Facial tics. What support dx of Tourette:
- tic x 6 mon.
- fhx of tic
- ADHD
FHX of tics!
129
Choreiform movement. Difficulty writing. Emotional lability. Throat swab normal. Likely dx?
- huntington
- sydenham's
- lupus
Sydenham's chorea
130
What treatment do you provide for stereotypic movement (like hand banging)
1. Reassure
2. Avoid trigger
3. Don't scold
4. Ensure not ASD
131
4 absolute contraindication to LP:
1. Cardioresp instability
2. Possible high ICP (mass, herniation)
3. Infection over targeted site
4. Bleeding (plt < 20, DIC)
5. Spinal anomalies
132
Child presents w/ ataxia and inability to sit up 2 wk after chicken box. What is dx?
- most common acquired cause
- post infectious, AI cerebellar demyelinated
- 2-4 y.o.
- common viral (varicella, post vaccine MMR)
- NO FEVER
- brain imaging normal
- improve within 1 week and full recovery in 3 mon
133
How do you differentiate post infectious acute cerebellar ataxia from meningoencephalitis?
1. normal LOC (no encephalopathy)
2. No meningeal signs
3. Lack systemic (fever, tachy HR)
4. W/U: MRI normal, CSF may be helpful (no pleocytosis)
134
What are the top two causes of acute ataxia:
1. post infectious cerebellar ataxia
| 2. drug ingestion
135
Most common episodic and chronic ataxia?
Metabolic or genetic
136
List a ddx for ataxia:
```
Infectious
AI
Toxin
Mass (tumour, vascular, abscess)
Hydrocephalus
Trauma (post concussion syn)
Stroke
Sensory ataxia (GBS)
```
137
Tonic movement. Ataxia, can't close mouth. Started after mother gave suppository. Treatment:
- rectal diazepam
- nothing
- diphenhydramine
- phenobarb
EPS
| = Diphenhydramine
138
AE: hepatotoxic, pancreatitis, low plt. Which drug:
- phenytoin
- carbamazepine
- pheobarb
- VPA
VPA
139
Why is diazepam not used as anticonvulsant in neonates?
LESS Liver metabolism
140
On dilantin. Started septra for an infection. Return ataxia and abN speech. What mechanism?
- septra UP dilantin absorption
- septra displace dilatin from protein binding sites
- septra causes LESS metabolism of dilantin
- septra causes LESS excretion of dilantin
LESS metabolism of dilantin via septra
141
Risk of recurrent sz within 1 year if afebrile GTC?
25%
