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X Pediatrics 2 > Neurology > Flashcards

Neurology Flashcards

1
Q

What is cerebral palsy?

A

Central motor impairment secondary to fetal or infantile brain injury (nonprogressive but might not recognize sxs until later)

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2
Q

Etiologies of cerebral palsy

A 
Hypoxia
Trauma
Premature birth
Infections
Toxins
Structural abnormalities
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3
Q

What are the subtypes of cerebral palsy based on?

A

Where in the brain the problem is

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4
Q

Sxs of cerebral palsy

A

Abnormal tone/posture
Retained primitive reflexes (to 9-12 mos)
Not reaching milestones (sit by 8 mos and walk by 18)
Excessive irritability
Poor feeding/drooling
Poor visual attention
Difficult to hold, cuddle

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5
Q

Management of cerebral palsy

A

Early recognition, referral intervention

Sxs

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6
Q

What is the chiari type 1 malformation?

A

Cerebellar tonsils displaced caudally below foramen magnum (can be associated with syringomyelia which is a fluid filled cyst in the spinal cord)

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7
Q

Sxs of chiari malformation type 1

A 
Might not see until teen or adult
Loss of abdominal reflex
HA
Neurologic sxs associated with syringomyelia
(cape like distribution of numbness)
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8
Q

What is a chiari type II malformation?

A

Type 1 + myelomeningocele

Usually detect prenatally or at birth

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9
Q

Sxs of chiari type II malformation

A

Hydrocephalus
Dysphagia
UE weakness
Apneic spells and aspiration

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10
Q

What is spina bifida occulta?

A

Incomplete closure of spinal canal (usually lower back)
No or mild signs
Hairy patch, dimple, dark spot, swelling on back at site of gap

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11
Q

What is a meningocele?

A

Outpouching of spinal fluid and meninges through vertebral cleft
Mild problems with sac protrusion

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12
Q

What is a myelomeningocele?

A

Most severe!
Spinal cord and nerves protrude from vertebral cleft
Weakness, loss of bladder and/or bowel control, hydrocephalus, inability to walk
Learning probs

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13
Q

Reasons for spinal dyraphisms

A

Genetics
Low folate
Meds during pregnancy
Poorly managed diabetes

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14
Q

Tx of spinal dyraphisms

A

Early recognition with US of AFP blood test
Prevention by taking folate
Neuro referral so surgery or shunt

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15
Q

What is hydrocephalus?

A

Increased volume of CSF and causing ventricular dilation and increased ICP

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16
Q

2 types of hydrocephalus

A

Obstructive (blockage)

Non-obstructive (impaired absorption or rarely overproduction)

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17
Q

Etiologies of hydrocephalus

A 
CNS malformations
Infection
Intraventricular hemorrhage
Genetic defects
Trauma
CNS tumors
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18
Q

Sxs of hydrocephalus

A 
Asymptomatic
Bradycardia, HTN, altered respiration
HA, n/v, behavior
Papilledema
Macrocephaly
Spasticity
Diplopia
Spinal abnormalities
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19
Q

Diagnostic testing for hydrocephalus

A

Newborns: US

Older infants/kids: MRI or CT

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20
Q

Management of hydrocephalus

A

Refer to neuro and shunt (from head to peritoneal space)

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21
Q

What is microcephaly?

A

Head circumference > 2 standard deviations below mean or <5th percentile

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22
Q

Primary or secondary microcephaly

A

Primary: lack of brain development or abnormal development due to timing of insult
Secondary: injury or insult to previously normal brain

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23
Q

Reasons for microcephaly

A 
Genetic
Prenatal and perinatal injury
Craniosynostosis (sutures close too early)
Postnatal injury
Metabolic
Toxin exposure
24
Q

Possible sxs of microcephaly

A

Delayed milestones
Seizures or spasticity
Fontanelle may close early and sutures are prominent

25
Q

What is macrocephaly?

A

Head circumference >2 SD above mean or above 95th percentile

26
Q

What causes macrocephaly?

A 
Due to increase in size of any components of cranium (brain CSF etc)
Rapid growth (Increased ICP), catch up growth, normal growth rate and genetic
27
Q

Manifestations of NF1

A 
Cafe au lait macules
Axillary and inguinal freckling
Lisch nodules
Optic glioma
Neurofibromas
(macrocephaly, seizures, cognitive)
28
Q

Most common primary HA

A

Migraine and tension

29
Q

Most common secondary HA

A

Acute febrile illness

30
Q

Characteristics of a migraine

A 
Focal, unilateral or bilateral
2-72 hrs
Moderate to severe
Pulsatile/throbbing
Aggravated with activity or reduced activity
31
Q

Characteristics of a tension HA

A 
Diffuse, frontal or temporal (hat band distribution)
30 min-7 days
Mild to moderate
Constant pressure, non-throbbing
Not aggravated with activity
32
Q

When to worry with a HA

A 
Abnormal neuro of visual exam
Severe when wake up or awaken in middle of night
Daily sxs with progressive worsening
Accompanied with vomiting
Acute onset with previous history
Increased with coughing or bending
33
Q

What is a pseudotumor cerebri?

A

Idiopathic intracranial HTN
Increased ICP without mass or hydrocephalus
*obese teenage girl

34
Q

Sxs of pseudotumor cerebri

A

HA and papilledema!
Visual sxs
Visual field loss, visual acuity loss
Pulsatile tinnitus

35
Q

Diagnostics for pseudotumor cerebri

A 
Neuro eval (MRI or LP)
Opthalmo
36
Q

Management for pseudotumor cerebri

A

Manage sxs and preserve vision
Acetazolamide (reduce rate of CSF production)
Topiramate (control HA and reduce weight)
Furosemide (reduce fluid and pressure)
Weight loss, shunt fluid etc

37
Q

What classifies epilepsy?

A

> 2 seizures occurring more than 24 hrs apart

38
Q

Types of seizures

A

Focal/partial
Generalized
Unknown
Unclassified

39
Q

Features of an absence seizure

A

Sudden impairment of consciousness w/o loss of tone
Provoked by hyperventilation!!
Genetic
B/w 4-10 and most spontaneous remission by puberty
Arrest in activity (9-10 sec and over 10x/day)

40
Q

1st line med for absence seizure

A

Ethosuximide

41
Q

Features of febrile seizure

A

Convulsion with temp >38C (100.4F)
Age 6 mos-5 yrs
Associated with virus
Maybe genetic

42
Q

Simple vs complex febrile seizure

A

Simple: most common, <15 min
Complex: focal, >15 min or >1/24 hrs

43
Q

Management for febrile seizure longer than 5 min

A

IV benzodiazepines

44
Q

What is the most common cause of acute flaccid paralysis in healthy infant/child?

A

Guillian-Barre syndrome

45
Q

What happens before Guillian Barre syndrome?

A

Illness (mostly campylobacter)

46
Q

Sxs of Guillian Barre syndrome

A

Ascending symmetric weakness
Neuropathic pain
Gait instability or refusal to walk
Absent reflexes

47
Q

Most specific diagnostic for guillian barre syndrome

A 
Electrodiagnostic studies (EMG)
Others are CSF (increased protein with normal WBC) or spinal MRI and maybe contrast
48
Q

Management of guillian barre syndrome

A

Hospitalize

Tx with IVIG or plasma exchange

49
Q

Sxs of botulism

A

Descending weakness
Constipation, poor feeding
Hypotonia, loss of DTRs
Irritable and lethargic

50
Q

How to diagnose botulism?

A

Stool sample and EMG

51
Q

Tx for botulism

A

Hospitalize

Botulism immune globulin (BIG-IV or babyBIG)

52
Q

What is duchenne muscular dystrophy?

A 
X-linked recessive disorder
Defect in genes responsible for muscle function
Elevated muscle enzymes
Age 2-3 onset with more severe sxs
Wheelchair by 13
53
Q

Sxs of duchenne muscular dystrophy

A 
Progressive weakness (proximal before distal, LE first)
Gower's sign (hands to get up)
Pseudohypertrophy of calves
Growth delay
Cognitive impairement
54
Q

Associations with duchenne muscular dystrophy

A

Cardiomyopathy
Orthopedic complications
Cognitive impairment

55
Q

Management for DMD

A

Glucocorticoids

56
Q

Features of becker muscular dystrophy

A

Sxs onset later
Muscle involvement is not as severe
CK elevated over 5x more
Cardiomyopathy may be more predominant

X Pediatrics 2 (10 decks)

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