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
2
Q
What is the DOC for benign infantile seizures
A
Phenbarbital
3
Q
What is the DOC for Benign myoclonic epilepsy in infancy
A
Levetiracetam
4
Q
___ seizure
neurons limited to part 1 of cerebral hemisphere
A
Foal seizures
5
Q
What are the types of focal seizures
A
- Motor onset
2. Non-motor onset
6
Q
What are the types of generalized seizure
A
- Motor
2. Non-motor (absence)
7
Q
What is the most common type of focal seizures
A
Benign childhood epilepsy with centrotemporal spike
8
Q
What are the types of benign epilepsy with occipital spikes
A
- Panayiotopoulos type - Early childhood, ictal vomiting
- Gastaut type
- later childhood, visual auras, migraine, headache
9
Q
What are the triad of West Syndrome
A
- Infantile Epileptic Spasm
- Developmental regression
- EEG = hypsarrythmia
10
Q
[Epilepsy]
___ type is associated with intractable seizures and developmental delay
A
Severe Generalized Seizures
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
12
Q
[Epilepsy]
1-2 months of life
Tonic seizures
Brain malformation
Syntaxin binding protein 1 mutation
A
Otahara Syndrome
Early Infantile Epileptic Encephalopathy
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
14
Q
[Epilepsy]
2-12 month old
Infantile spasm
developmental regression
EEC = Hypsarrhythmia
A
west syndrome
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
16
Q
[AEDs]
Focal Seizuresa nd Epilepsies
A
- Oxcarbamazepine
2. Carbamazepine
17
Q
[AEDs]
Absence seizures
A
Ethosuximide
18
Q
[AEDs]
Juvenile Myoclonic Epilepsy
A
Valproate
Lamotrigine
19
Q
[AEDs]
Lennox-Gestaut Syndrome
A
- Clobazam
- Valproate
- Topiramate
- Lamotrigine
20
Q
[AEDs]
Infantile spasms
A
ACTH
21
Q
[AEDs]
Dravel Syndrome
A
Valproate + Benzodiazepone
22
Q
[AEDs]
Benight myoclonic epilepsy
A
Valproate
23
Q
[AEDs]
Severe myoclonic epilepsy
A
- Topiramate
- clobazam
- Valproate
- Zonisamide
24
Q
[AEDs]
Partial and secondary generalized tonic and clonic seizures
A
- Oxcarbazepine
- Levitiracetam
- Carbamazepine
- Valproic acid
25
Patient <18 months old had his first episode of febrile seizure, what will you do?
1. Lumbar puncture
26
Patient at 18 months old had his first febrile seizure. What will you do?
1. Only do LP if with clinical signs of meningitis
27
What are the risk factors for recurrence of Febrile Seizures
1. Age <1 year
2. Fever <24 hours
3. Fever 38-39 deg C
28
What are the triad of imaging findings in TB Meningitis
1. Hydrocephalus
2. Basal enhancements
3. Infarcts
29
[Hydrocephalus]
obstruction within the ventricular system due to abnormality of the aqueduct or a lesion in the 4th ventricle
Non-communicating type
30
[Hydrocephalus]
Obliteration of the subarachnoid cisterns, malfunction of the arachnoid villi
Communicating type
31
What cells reabsorb CSF?
Arachnoid villus cell located in the superiro saggital sinus
via pinocytosis
32
[CSF findings]
Normal Values
Pressure:
WBC:
Protein:
Glucose:
```
Normal
Pressure: 50-80
WBC: <5, >/75% lymphocytes
Protein: 20-45 mg/dL
Glucose: >50 mg/dL (75% serum glucose0
```
33
[CSF findings]
Pressure: Elevated
WBC: PMN predominates
Protein: 100-500 mg/dL
Glucose: decreased
Acute bacterial meningitis
34
[CSF findings]
Pressure: normal
WBC: > 1000
Protein: 50-100
Glucose: Normal
Viral
If focal seizure, it can be HSV encephalitis
35
[CSF findings]
Pressure: elevated
WBC: lymphocytic predominance, 100-500 PMNs
Protein: 100 to 3000
Glucose: low
TB meningitis
36
What are the ABSOLUTE contraindications to lumbar puncture?
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
37
What are the RELATIVE contraindications of lumbar puncture?
1. Signs of shock, sepsis, hypotension
2. Coagulation defects
3. Focal neurological deficit
4. GCS 8
5. Epileptic seizures
38
[CNSI]
prefrontal headache
High fever
Disturbance in smell
swimming in warm water or lake
Naegleria fowleri
39
[CNSI]
Bell's palsy
Carditis
cutaneous lesion
systemic disease
Borreliela burgdorfori
40
[CNSI]
History of GIT infection
ascending paralysis
C. jejuni
41
[CNSI]
History of URTI
Ascending paralysis
H. influenza type B
42
[CNSI]
Lethargy and irritability
History of viral infection
Chicken Pox
Aspirin use
Reye Syndro,e
43
[CNSI]
Ocular nerve palsy
Previous Hx of TB
Active TB
TB Meningitis
44
most common age group affected by brain abscess
4-8 years old
45
What is the most common location of brain abscess in pediatric population
Cerebrum
46
What is the most reliable method in diagnosis brain abscess?
CT or MRI
47
[Treatment for brain abscess]
Unknown cause
3rd generation cephalosporin or Metronidazole
48
[Treatment for brain abscess]
Head trauma or neurosurgery
1. Oxacillin or Vancomycin
| 2. 3rd gen ceph + metronidazole
49
[Treatment for brain abscess]
Due to CHD
1. Penicillin + Metronidazole
50
[Treatment for brain abscess]
Infected VP shunt
Vancomyin + ceftazidime
51
[Treatment for brain abscess]
Immunocompromised
Broad spectrum + Ampho B
52
[Treatment for brain abscess]
Encapsualted abscess
Aspirate
53
What are the indications for neurosurgery in patients with Brain abscess?
1. Gas in the abscess
2. Multiloculated abscesses
3. Posterior fossa location
4. Fungal cause
5. Associated infections like mastoiditis, periorbital abscess, sinusitis
54
What is the antibiotic prophylaxis to prevent N. meningitidis?
Rifampin, Ceftraxine, Ciprofloxacin
If <15 yo, Ceftri 125mg IM SD
If >15 yo, Ceftri 250mg IM SD
55
What are the poor prognostic factors for patient with meningococcimea
1. Petechieae for <12 hours before admission
2. Absence of meningitis
3. Low or normal ESR
3. Rapid, fulminant progression
56
[Treatment for Meningococcimea]
Dose of penicillin
300,000 units/kg/day IM or IV
57
[Treatment for Meningococcimea]
Dose of Ampicillin
200 to 400 mg/kg/day IM or IV
58
[Treatment for Meningococcimea]
Dose of Cefotaxime
200 to 300mg/kg/day IM or IV
59
[Treatment for Meningococcimea]
Dose of Ceftriaxone
100mg/kg/day
60
What are the modes of transmission of meningococcemia?
1. Aerosol droplets
| 2. Contact with respiratory secretions
61
What is the period of communicability of meningococcemia?
until 24 hours after initiating effective treatment
Incubation period: 1-10 days or less than 4 days
62
Fulminant cases of meningococcemia can lead to diffuse adrenal hemorrhage called
Waterhouse- Friderichsen syndrome
63
[CNSI]
Headche, photophobia, lethargy, vomiting, nuchal rigidity
petechiae or purpura
Meningococcemia
64
Who are considered exposed in meningococcemia?
Household, School or daycare contacts during the 7 days before onset of illness
65
What do you give to the exposed individuals? (Meningococcemia)
1. Rifampicin 10mg/kg PO q12hours x 4 doses
OR
2. Ceftriaxone 125mg SD IM for <12 years old
OR Ciprofloxacin 500mg PO SD for >18 years old
66
[CNSI]
```
<2 months old
sepsis
seizure
irritability, lethargy
bulging fontanelles
Rigidity
```
GBS
67
[CNSI]
Headache, fever, confusion, lethargy, nuchal rigidity, vomiting
not vaccinated
<5 years old
Hib
68
[CNSI]
Headache, fever, confusion, lethargy, nuchal rigidity, vomiting
complete vaccination
rashes all over the body, toxic looking
Meningococcemia
69
[CNSI]
Headache, fever, confusion, lethargy, nuchal rigidity, vomiting
Young adult
Pneumococcu
70
[CNSI]
Headache, fever, confusion, lethargy, nuchal rigidity, vomiting
Renal transplant patient
Listeria
71
[CNSI]
Headache, fever, confusion, lethargy, nuchal rigidity, vomiting
gradual onset, not toxic looking
Enterovirus
72
[CNSI]
Headache, fever, confusion, lethargy, nuchal rigidity, vomiting
RBCs in the CSF
HSV
73
What is the empiric antibiotics for bacterial meningitis for neonates?
1 Ampicillin OR cefotaxime
PLUS
2. Aminoglycoside
74
What is the empiric antibiotics for bacterial meningitis for 1 month to 18 years old?
1. Ceftriaxone OR Chloramphenicol
75
What is the empiric antibiotics for bacterial meningitis due to Hib?
Ceftriaxone for 7 to 10 days
76
What is the empiric antibiotics for bacterial meningitis due to S. pneumoniae?
Penicillin for 10 to 14 days
77
What is the empiric antibiotics for bacterial meningitis due to N. meningitidis?
Peniccilin for 7 days
78
What is the empiric antibiotics for bacterial meningitis due to E. coli?
Cefotaxime for 21 days
79
What is the empiric antibiotics for bacterial meningitis due to GBS?
1. Cefotaxime OR
| 2. Ceftriaxone for 14 days
80
[Meningocele]
Closure of Neural Tube happens in what age of gestation
3rd to 4th week
81
What is the recommended dose of folic acid to prevent NTDs during the first pregnancy?
400 micrograms of folic acid
82
What is the recommended dose of folic acid to prevent NTDs in the succeeding pregnancies?
4 milligram folic acid
same as with recurrent NTDs
83
What are the manifestations of meningocele
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
[Arnold Chiari type]
elongation of cerebellar tonsils extending in vertebral canal
Chiari type I
85
[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
Chiari Type II
86
What are the features of migraine?
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
What are the indications for cranial CT or MRI in patients with migraine?
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
What do you do with status migrainosus?
Give Prochlorperazine IV 0.15mg/kg max 10mg
89
When do you give prophylactic therapy for migraine?
1. More than 2-4 severe episodes
2. Unable to attend school regularly
3. PedMIDAS >20
90
What is status migranosus?
persistent headache lasting >3 days
91
What are the drugs used as prophylaxis for migraine?
1. Propranolol 10-20mg TID for >7 years old
| 2. Flunarizine 5mg at bedtime
92
TSC1 encodes for what protein?
hamartin
93
TSC2 encodes for what protein?
Tuberin
TSC2 = TWOberin
94
[Tuberous sclerosis]
____ patch
roughened, raised lesion with orange peel consistency located in the lumbosacral area
Shagreen patch
95
[Diagnossi]
Generalized seizure disorder and skin lesions; shagreen patch
if adolescent: subungual or periungual fibromas from the fingers and toes
Tuberous sclerosis
96
What are the retinal lesions found in patients with Tuberous Sclerosis?
1. Mulberry tumors
| 2. Round, flat gray lesions
97
What is the renal manifestation of tuberous sclerosis
Bilateral Angiomyolipomas and cyst
98
What is the eponym of Neurofibromatosis?
Von Recklinghausen Disease
Chromosome 17
99
Neurofibromatosis is due to
abnormality of neural crest differentiation and migration during the early stages of embryogenesis
100
What is the most prevalent type of neurofibromatosis?
NF1
101
What are the diagnostic criteria to diagnose NF?
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
What are the diagnostic criteria for NF 2?
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
[Diagnose]
History of diarrhea
cranial nerve deficits leading to dysphagia, dysarthria, facial weakness, papilledema, autonomic dysfunction, respiratory muscle paralysis
GBS
104
What are the components of Miller-Fisher Syndrome assocated with GBS
1. Acute ophthalmoplegia
2. Ataxia
3. Areflexia
105
What are the clinical features of GBS that is predictive of poor outcome?
1. Cranial nerve involvement
2. Need for intubation
3. Maximum disability at the time of presentation
106
What is the CSF finding in GBS?
1. Increased protein
2. Normal glucose
3. No pleocytosis
Called: Albuminocytologic dissociation
107
What is the treatment for rapidly ascending paralysis due to GBS?
IVIG 0.4g/kg/day for 5 consecutive days
108
What is the treatment for relapses in GBS?
High-dose pulse methylprednisolone
109
Medulloblastoma is usually seen in the ___
cerebellum
Heterogenous enhancements often invading the 4th ventricle and cause obstructive hydrocephalus
110
___ rosettes are circular patterns of tumor cells surrounding a center of neutrophils
Related to Medulloblastoma
Homer-Wright rosettes
111
What is the most common infratentorial tumor?
Cerebellar Astrocytoma
best prognosis, 90% 5 year survival rate
112
[Diagnosis]
Short stature
bitemporal hemoianopsia
solid mass in the supretentoral area
Craniopharyngioma
113
Most common cause of arterial ischemic stroke in pediatric population/
Arteriopathy
114
Type of intracranial hemorrhage almost always associated with trauma
Epidural
115
Pediatric arterial ischemic stroke usually involve what artery?
Middle Cerebral Artery
116
What is the diagnostic of choice for pediatric arterial ischemic stroke?
MRI
CT scan demonstrates mature AIS and rules out hemorrhage
117
Cerebral Sinovenous Thrombosis has a greater risk in what pediatric population
Neonates
118
What is the imaging of choice for patients with cerebral sinovenous thrombosis?
CT venography or MR venogrpahy
119
What is the highly sensitive diagnostic imaging study to diagnose Hemorrhagic Stroke?
CT scan
120
What type of brain hemorrhage frequently happens in pediatric patients with brain atrophy?
subdural hemorrhage
121
What is the most common cause of childhood subarachnoid and intraparenchymal hemorrhagic stroke?
AV malformation
