Neurology Flashcards
What is hypotonia and what are some causes
Hypotonia is reduced resistance to movement Systemic: - chromosomal disorders: Down Syndrome, Prader-Willi, Fragile X - Metabolic: hypoxic encephalopathy, hypokalemia, hypocalcenemia, hypomagnesia - Endocrine: hypothyroid, hypopituitary - Infection: TORCH CNS - Cerebral palsy PNS - spinal muscular atrophy Myopathy - muscular dystrophy
What is the presentation and management of hypotonia?
Presentation: - delayed motor skills - alteration in posture - decreased movements - hyperextensibility - inverted U when chest supported Investigations: - assess for dysmorphic features and rule out systemic disorders Management: - OT, PT referral for mobility and to aid with feeds
Discuss the presentation and management of microcephaly
Head circumference >2SD below mean for age, sex and gestation
Pathophysiology:
- lack or abnormal brain development due to alteration during major cellular migration reducing number of neurons
- injury to previous normal brain
Differential:
- environmental: TORCH, meningitis, teratogen (alcohol, drugs)
- metabolic: diabetes, phenylketonuria
- neuro-anatomic abnormalities: neural tube defects
- chromosomal syndromes
Investigations
- if no developmental delay or neurological findings and less than <3SD, then call follow clinically
- if have any of the above do MRI or ultrasound, and if non-specific consider metabolic and genetic testing
Discuss the presentation and management of macrocephaly
Head circumference >2SD’s above the mean for age, sex, gestation
Differential:
- megalencephaly: anatomic (neurofibromatosis, tuberous sclerosis, achondroplasia) metabolic (leukodystrophy, lysosomal)
- Increased CSF
- Increased blood
- Increased bone
- Increased ICP
- Mass lesion
Investigations: MRI, ultrasound for all
- metabolic panel, genetic study, electroencephalogram if have developmental delay or disorder
- plain radiograph if have skeletal
Discuss the pathophysiology of a tonic-clonic seizure
Tonic contraction of all muscles (20-40 seconds) -> forced expiration leading to respiratory arrest or cyanosis -> clonic movement (30-50 seconds) -> post-ictal flaccidity -> gradual return of cognitive function
Do abscence seizures have a post-ictal phase?
No
What is the difference in a partial seziure
Have one area of brain involved, so do not have impairement in cognitive function
- can lead to generalized though
Discuss the presentation and management of status epilepticus
Is a seizure lasting >30 minutes, but clinically as continuous seizure >=5 minutes or >=2 discrete seizures with incomplete recovery of consciousness in between
Management:
- Stabilize ABC: put patient on side, intube if needed
- Assessment: two large bore IVs, finger stick glucose, CBC, electrolytes and extended lytes, blood glucose, creatinine, blood toxicology
- Therapy: 1st Line: lorazepam 0.1mg/kg IV, 2nd line: Fosphenytoin 20mg/kg
- if refractory require intubation and , EEG monitoring, and Midazolam used for abortive
What is the presentation and management of Epilepsy?
Definition: >2 unprovoked seizures occurring >24hrs apart or 1 unprovoked seizure with high probability of reccurrence.
Presentation:
- Pre-ictal: aura (motor, somatosensory, special sensory, autonomic, psychic)
- Ictal: length, urinary incontinence, tongue bitting
- Post-Ictal: confusion
Investigations for recurrent:
- EEG awake and asleep
- MRI
Management:
- Na Channel blocker: Phenytoin, Lamotrigine
- GABA blocker: Benzodiazepine
- Na and GABA: Valproate (useful for any classification of seizure)
Discuss the presentation and management of febrile seizures
- provoked generalized tonic-clonic seizure occurring in 6 months to 6 years Criteria: - lasts <15 minutes - generalized - self-limiting - do not recur in 24hrs - no neurological abnormalities Investigations: - septic work-up if <3 months - LP if concern for meningitis - imaging not required Management: - age <18 months - lethargy post-ictal - complex and unstable - meningitis
What are the risks of developing recurrent febrile seizures?
- low Tmax when seizure occurred
- <1 year of age
- complex
- family history of febrile seizures
- multiple
Discuss the pathophysiology of vasovagal syncope
Reduced venous return -> increase force of ventricular contractions to maintain CO -> increased force with reduced volume results in C-fiber activation -> increase PNS activity -> bradycardia, vasodilation, hypotension -> reduced cerebral perfusion and LOC
List the lifestyle modifications for reducing headache
SMART
- Sleep: regular and sufficient
- Meals: regular and sufficient, including breakfast and good hydration
- Activity: regular aerobic exercise
- Relaxation: stress reduction
- Trigger avoidance: avoid triggers such as sleep deprivation, stress
Discuss the presentation and management of idiopathic intracranial hypertension
Epidemiology: Female, obesity, adolescence Presentation: - daily headache - nausea, vomiting - transient vision changes - tinnitus - diplopia - CN6 palsy Investigations: - MRI: normal - Lumbar puncture: high opening pressure, is diagnostic and therapeutic Treatment: - Azetazolamide
