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Pediatrics > Neurology > Flashcards

Neurology Flashcards

1
Q

What is the criteria to diagnose epilepsy?

A

2 or more unprovoked seizures occurring in a time frame of >24 hours

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2
Q

What is the DOC for benign infantile seizures

A

Phenbarbital

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3
Q

What is the DOC for Benign myoclonic epilepsy in infancy

A

Levetiracetam

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4
Q

___ seizure

neurons limited to part 1 of cerebral hemisphere

A

Foal seizures

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5
Q

What are the types of focal seizures

A
  1. Motor onset

2. Non-motor onset

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6
Q

What are the types of generalized seizure

A
  1. Motor

2. Non-motor (absence)

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7
Q

What is the most common type of focal seizures

A

Benign childhood epilepsy with centrotemporal spike

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8
Q

What are the types of benign epilepsy with occipital spikes

A
  1. Panayiotopoulos type - Early childhood, ictal vomiting
  2. Gastaut type
    - later childhood, visual auras, migraine, headache
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9
Q

What are the triad of West Syndrome

A
  1. Infantile Epileptic Spasm
  2. Developmental regression
  3. EEG = hypsarrythmia
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10
Q

[Epilepsy]

___ type is associated with intractable seizures and developmental delay

A

Severe Generalized Seizures

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11
Q

[Epilepsy]

Starts 1-2 months of life
severe myoclonic seizures
burst suppression pattern on EEG

Caused by inborn errors of metabolism

A

Early myoclonic infantile encephalopathy

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12
Q

[Epilepsy]

1-2 months of life
Tonic seizures
Brain malformation
Syntaxin binding protein 1 mutation

A

Otahara Syndrome

Early Infantile Epileptic Encephalopathy

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13
Q

[Epilepsy]

Starts as focal febrile status epilepticus

Later manifests as myoclonic and other seizure type

A

Dravet Syndrome

Severe myoclonic epilepsy of infancy

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14
Q

[Epilepsy]

2-12 month old

Infantile spasm
developmental regression
EEC = Hypsarrhythmia

A

west syndrome

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15
Q

[Epilepsy]

2 to 10 years of age
Developmental delay
Multiple seizure type
EEG = 1-2Hz spike and slow waves, polyspike bursts in sleep and slow background in wakefulness

A

Lennox-Gastaut Syndrome

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16
Q

[AEDs]

Focal Seizuresa nd Epilepsies

A
  1. Oxcarbamazepine

2. Carbamazepine

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17
Q

[AEDs]

Absence seizures

A

Ethosuximide

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18
Q

[AEDs]

Juvenile Myoclonic Epilepsy

A

Valproate

Lamotrigine

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19
Q

[AEDs]

Lennox-Gestaut Syndrome

A
  1. Clobazam
  2. Valproate
  3. Topiramate
  4. Lamotrigine
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20
Q

[AEDs]

Infantile spasms

A

ACTH

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21
Q

[AEDs]

Dravel Syndrome

A

Valproate + Benzodiazepone

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22
Q

[AEDs]

Benight myoclonic epilepsy

A

Valproate

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23
Q

[AEDs]

Severe myoclonic epilepsy

A
  1. Topiramate
  2. clobazam
  3. Valproate
  4. Zonisamide
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24
Q

[AEDs]

Partial and secondary generalized tonic and clonic seizures

A
  1. Oxcarbazepine
  2. Levitiracetam
  3. Carbamazepine
  4. Valproic acid
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25
Q

Patient <18 months old had his first episode of febrile seizure, what will you do?

A
  1. Lumbar puncture
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26
Q

Patient at 18 months old had his first febrile seizure. What will you do?

A
  1. Only do LP if with clinical signs of meningitis
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27
Q

What are the risk factors for recurrence of Febrile Seizures

A
  1. Age <1 year
  2. Fever <24 hours
  3. Fever 38-39 deg C
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28
Q

What are the triad of imaging findings in TB Meningitis

A
  1. Hydrocephalus
  2. Basal enhancements
  3. Infarcts
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29
Q

[Hydrocephalus]

obstruction within the ventricular system due to abnormality of the aqueduct or a lesion in the 4th ventricle

A

Non-communicating type

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30
Q

[Hydrocephalus]

Obliteration of the subarachnoid cisterns, malfunction of the arachnoid villi

A

Communicating type

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31
Q

What cells reabsorb CSF?

A

Arachnoid villus cell located in the superiro saggital sinus

via pinocytosis

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32
Q

[CSF findings]
Normal Values

Pressure:
WBC:
Protein:
Glucose:

A 
Normal 
Pressure: 50-80
WBC:  <5, >/75% lymphocytes
Protein: 20-45 mg/dL
Glucose: >50 mg/dL (75% serum glucose0
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33
Q

[CSF findings]

Pressure: Elevated
WBC: PMN predominates
Protein: 100-500 mg/dL
Glucose: decreased

A

Acute bacterial meningitis

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34
Q

[CSF findings]

Pressure: normal
WBC: > 1000
Protein: 50-100
Glucose: Normal

A

Viral

If focal seizure, it can be HSV encephalitis

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35
Q

[CSF findings]

Pressure: elevated
WBC: lymphocytic predominance, 100-500 PMNs
Protein: 100 to 3000
Glucose: low

A

TB meningitis

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36
Q

What are the ABSOLUTE contraindications to lumbar puncture?

A
  1. Signs of elevated intracranial pressure
  2. Local infection at desired puncture site
  3. Radiologic signs of obstructive hydrocephalus, cerebral edema, herniation, presence of intracranial mass, midline shift
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37
Q

What are the RELATIVE contraindications of lumbar puncture?

A
  1. Signs of shock, sepsis, hypotension
  2. Coagulation defects
  3. Focal neurological deficit
  4. GCS 8
  5. Epileptic seizures
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38
Q

[CNSI]

prefrontal headache
High fever
Disturbance in smell
swimming in warm water or lake

A

Naegleria fowleri

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39
Q

[CNSI]

Bell’s palsy
Carditis
cutaneous lesion
systemic disease

A

Borreliela burgdorfori

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40
Q

[CNSI]

History of GIT infection
ascending paralysis

A

C. jejuni

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41
Q

[CNSI]

History of URTI
Ascending paralysis

A

H. influenza type B

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42
Q

[CNSI]

Lethargy and irritability
History of viral infection
Chicken Pox
Aspirin use

A

Reye Syndro,e

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43
Q

[CNSI]

Ocular nerve palsy
Previous Hx of TB
Active TB

A

TB Meningitis

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44
Q

most common age group affected by brain abscess

A

4-8 years old

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45
Q

What is the most common location of brain abscess in pediatric population

A

Cerebrum

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46
Q

What is the most reliable method in diagnosis brain abscess?

A

CT or MRI

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47
Q

[Treatment for brain abscess]

Unknown cause

A

3rd generation cephalosporin or Metronidazole

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48
Q

[Treatment for brain abscess]

Head trauma or neurosurgery

A
  1. Oxacillin or Vancomycin

2. 3rd gen ceph + metronidazole

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49
Q

[Treatment for brain abscess]

Due to CHD

A
  1. Penicillin + Metronidazole
50
Q

[Treatment for brain abscess]

Infected VP shunt

A

Vancomyin + ceftazidime

51
Q

[Treatment for brain abscess]

Immunocompromised

A

Broad spectrum + Ampho B

52
Q

[Treatment for brain abscess]

Encapsualted abscess

A

Aspirate

53
Q

What are the indications for neurosurgery in patients with Brain abscess?

A
  1. Gas in the abscess
  2. Multiloculated abscesses
  3. Posterior fossa location
  4. Fungal cause
  5. Associated infections like mastoiditis, periorbital abscess, sinusitis
54
Q

What is the antibiotic prophylaxis to prevent N. meningitidis?

A

Rifampin, Ceftraxine, Ciprofloxacin

If <15 yo, Ceftri 125mg IM SD

If >15 yo, Ceftri 250mg IM SD

55
Q

What are the poor prognostic factors for patient with meningococcimea

A
  1. Petechieae for <12 hours before admission
  2. Absence of meningitis
  3. Low or normal ESR
  4. Rapid, fulminant progression
56
Q

[Treatment for Meningococcimea]

Dose of penicillin

A

300,000 units/kg/day IM or IV

57
Q

[Treatment for Meningococcimea]

Dose of Ampicillin

A

200 to 400 mg/kg/day IM or IV

58
Q

[Treatment for Meningococcimea]

Dose of Cefotaxime

A

200 to 300mg/kg/day IM or IV

59
Q

[Treatment for Meningococcimea]

Dose of Ceftriaxone

A

100mg/kg/day

60
Q

What are the modes of transmission of meningococcemia?

A
  1. Aerosol droplets

2. Contact with respiratory secretions

61
Q

What is the period of communicability of meningococcemia?

A

until 24 hours after initiating effective treatment

Incubation period: 1-10 days or less than 4 days

62
Q

Fulminant cases of meningococcemia can lead to diffuse adrenal hemorrhage called

A

Waterhouse- Friderichsen syndrome

63
Q

[CNSI]

Headche, photophobia, lethargy, vomiting, nuchal rigidity

petechiae or purpura

A

Meningococcemia

64
Q

Who are considered exposed in meningococcemia?

A

Household, School or daycare contacts during the 7 days before onset of illness

65
Q

What do you give to the exposed individuals? (Meningococcemia)

A
  1. Rifampicin 10mg/kg PO q12hours x 4 doses

OR

  1. Ceftriaxone 125mg SD IM for <12 years old

OR Ciprofloxacin 500mg PO SD for >18 years old

66
Q

[CNSI]

<2 months old
sepsis
seizure
irritability, lethargy
bulging fontanelles
Rigidity
A

GBS

67
Q

[CNSI]

Headache, fever, confusion, lethargy, nuchal rigidity, vomiting

not vaccinated

<5 years old

A

Hib

68
Q

[CNSI]

Headache, fever, confusion, lethargy, nuchal rigidity, vomiting

complete vaccination

rashes all over the body, toxic looking

A

Meningococcemia

69
Q

[CNSI]

Headache, fever, confusion, lethargy, nuchal rigidity, vomiting

Young adult

A

Pneumococcu

70
Q

[CNSI]

Headache, fever, confusion, lethargy, nuchal rigidity, vomiting

Renal transplant patient

A

Listeria

71
Q

[CNSI]

Headache, fever, confusion, lethargy, nuchal rigidity, vomiting

gradual onset, not toxic looking

A

Enterovirus

72
Q

[CNSI]

Headache, fever, confusion, lethargy, nuchal rigidity, vomiting

RBCs in the CSF

A

HSV

73
Q

What is the empiric antibiotics for bacterial meningitis for neonates?

A

1 Ampicillin OR cefotaxime

PLUS
2. Aminoglycoside

74
Q

What is the empiric antibiotics for bacterial meningitis for 1 month to 18 years old?

A
  1. Ceftriaxone OR Chloramphenicol
75
Q

What is the empiric antibiotics for bacterial meningitis due to Hib?

A

Ceftriaxone for 7 to 10 days

76
Q

What is the empiric antibiotics for bacterial meningitis due to S. pneumoniae?

A

Penicillin for 10 to 14 days

77
Q

What is the empiric antibiotics for bacterial meningitis due to N. meningitidis?

A

Peniccilin for 7 days

78
Q

What is the empiric antibiotics for bacterial meningitis due to E. coli?

A

Cefotaxime for 21 days

79
Q

What is the empiric antibiotics for bacterial meningitis due to GBS?

A
  1. Cefotaxime OR

2. Ceftriaxone for 14 days

80
Q

[Meningocele]

Closure of Neural Tube happens in what age of gestation

A

3rd to 4th week

81
Q

What is the recommended dose of folic acid to prevent NTDs during the first pregnancy?

A

400 micrograms of folic acid

82
Q

What is the recommended dose of folic acid to prevent NTDs in the succeeding pregnancies?

A

4 milligram folic acid

same as with recurrent NTDs

83
Q

What are the manifestations of meningocele

A
  1. Flaccid paralysis of the LE
  2. Absence DTRs
  3. Lack of response to pain and touch
  4. Hip subluxation
  5. Clubfeet
  6. bowel and bladder incontinence
  7. Type II chiari
84
Q

[Arnold Chiari type]

elongation of cerebellar tonsils extending in vertebral canal

A

Chiari type I

85
Q

[Arnold Chiari type]

Elongation of inferior vermis and brain stem with their displacement in cervical spinal canal with myelomeningpcele and hydrocephalus

posterior fossa shallow, torcular is low

A

Chiari Type II

86
Q

What are the features of migraine?

A

At least 3 of the following

  1. Family History
  2. Relief following sleep
  3. Unilateral location
  4. Associated aura
  5. Abdominal paon
  6. Nausea and vomiing
  7. Throbbing in character
87
Q

What are the indications for cranial CT or MRI in patients with migraine?

A
  1. Abnormal neurologic findings
  2. Behavioral changes, recent school failure, fall-off in linear growth rate
  3. Headache awakens the child during sleep
  4. Migraine and seizure occur in the same time
  5. Focal neurologic signs
  6. cluster headaches esp. in <5 years old
88
Q

What do you do with status migrainosus?

A

Give Prochlorperazine IV 0.15mg/kg max 10mg

89
Q

When do you give prophylactic therapy for migraine?

A
  1. More than 2-4 severe episodes
  2. Unable to attend school regularly
  3. PedMIDAS >20
90
Q

What is status migranosus?

A

persistent headache lasting >3 days

91
Q

What are the drugs used as prophylaxis for migraine?

A
  1. Propranolol 10-20mg TID for >7 years old

2. Flunarizine 5mg at bedtime

92
Q

TSC1 encodes for what protein?

A

hamartin

93
Q

TSC2 encodes for what protein?

A

Tuberin

TSC2 = TWOberin

94
Q

[Tuberous sclerosis]

____ patch

roughened, raised lesion with orange peel consistency located in the lumbosacral area

A

Shagreen patch

95
Q

[Diagnossi]

Generalized seizure disorder and skin lesions; shagreen patch

if adolescent: subungual or periungual fibromas from the fingers and toes

A

Tuberous sclerosis

96
Q

What are the retinal lesions found in patients with Tuberous Sclerosis?

A
  1. Mulberry tumors

2. Round, flat gray lesions

97
Q

What is the renal manifestation of tuberous sclerosis

A

Bilateral Angiomyolipomas and cyst

98
Q

What is the eponym of Neurofibromatosis?

A

Von Recklinghausen Disease

Chromosome 17

99
Q

Neurofibromatosis is due to

A

abnormality of neural crest differentiation and migration during the early stages of embryogenesis

100
Q

What is the most prevalent type of neurofibromatosis?

A

NF1

101
Q

What are the diagnostic criteria to diagnose NF?

A

2 out of 7

  1. 6 or more cafe au lait macules > 5mm and >15mm in postpubertal individuals
  2. Axillary or inguinal freckling (2-3mm diameter)
  3. 2 or more Lisch nodules
  4. 2 or more neurofibromas
  5. Distinctive osseous lesion
  6. Optic glioma
  7. 1st degree relative with NF-1
102
Q

What are the diagnostic criteria for NF 2?

A

1 of the following

  1. Bilateral 8th nerve mass (acoustic neuroma)
  2. Parent, sibling, child with NF2 and either unilateral 8th nerve mass or any 2 of: neurofibroma, meningioma, glioma, schwannoma
103
Q

[Diagnose]

History of diarrhea

cranial nerve deficits leading to dysphagia, dysarthria, facial weakness, papilledema, autonomic dysfunction, respiratory muscle paralysis

A

GBS

104
Q

What are the components of Miller-Fisher Syndrome assocated with GBS

A
  1. Acute ophthalmoplegia
  2. Ataxia
  3. Areflexia
105
Q

What are the clinical features of GBS that is predictive of poor outcome?

A
  1. Cranial nerve involvement
  2. Need for intubation
  3. Maximum disability at the time of presentation
106
Q

What is the CSF finding in GBS?

A
  1. Increased protein
  2. Normal glucose
  3. No pleocytosis

Called: Albuminocytologic dissociation

107
Q

What is the treatment for rapidly ascending paralysis due to GBS?

A

IVIG 0.4g/kg/day for 5 consecutive days

108
Q

What is the treatment for relapses in GBS?

A

High-dose pulse methylprednisolone

109
Q

Medulloblastoma is usually seen in the ___

A

cerebellum

Heterogenous enhancements often invading the 4th ventricle and cause obstructive hydrocephalus

110
Q

___ rosettes are circular patterns of tumor cells surrounding a center of neutrophils

Related to Medulloblastoma

A

Homer-Wright rosettes

111
Q

What is the most common infratentorial tumor?

A

Cerebellar Astrocytoma

best prognosis, 90% 5 year survival rate

112
Q

[Diagnosis]

Short stature
bitemporal hemoianopsia
solid mass in the supretentoral area

A

Craniopharyngioma

113
Q

Most common cause of arterial ischemic stroke in pediatric population/

A

Arteriopathy

114
Q

Type of intracranial hemorrhage almost always associated with trauma

A

Epidural

115
Q

Pediatric arterial ischemic stroke usually involve what artery?

A

Middle Cerebral Artery

116
Q

What is the diagnostic of choice for pediatric arterial ischemic stroke?

A

MRI

CT scan demonstrates mature AIS and rules out hemorrhage

117
Q

Cerebral Sinovenous Thrombosis has a greater risk in what pediatric population

A

Neonates

118
Q

What is the imaging of choice for patients with cerebral sinovenous thrombosis?

A

CT venography or MR venogrpahy

119
Q

What is the highly sensitive diagnostic imaging study to diagnose Hemorrhagic Stroke?

A

CT scan

120
Q

What type of brain hemorrhage frequently happens in pediatric patients with brain atrophy?

A

subdural hemorrhage

121
Q

What is the most common cause of childhood subarachnoid and intraparenchymal hemorrhagic stroke?

A

AV malformation

Pediatrics (15 decks)

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