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Pediatrics > Neurology > Flashcards

Neurology Flashcards

1
Q

What is the most common cause of meningitis?

A

Viral infections

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2
Q

What is the pathophysiology of bacterial meningitis?

A

Bacterial infection of the meninges usually follows bacteraemia. Much of the damage caused by meningitis results from the host response to infection and not from the organism itself. The release of inflammatory mediators and activated leukocytes, together w/ endothelial damage, leads to cerebral edema, raised ICP and decreased cerebral blood flow. The inflammatory response below the meninges cause a vasculopathy resulting in cerebral cortical infarction and fibrin deposits, which may lead to hydrocephalus.

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3
Q

What are the organisms that cause bacterial meningitis according to age?

A

Neonatal to 3 months: Group B streptococcus, E. Coli, Listeria monocytogenes

1 month to 6 years: Neisseria meningitides, Streptococcus pneumoniae, Haemophilus influenza

> 6 years: Neisseria meningitides, Streptococcus pneumoniae

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4
Q

What is a positive Brudzinski sign?

A

Flexion of the neck w/ the child supine causes flexion of the knees and hips.

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5
Q

What is a positive Kernig sign?

A

With the child lying supine and with the hips and knees flexed, there is back pain on extension of the knee.

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6
Q

What are contraindications to lumbar puncture?

A 
Cardiorespiratory instability 
Focal neurological signs 
Signs of raised ICP (e.g. coma, high BP, low HR or papilloedma) 
Coagulopathy 
Thrombocytopenia 
Local infections at the site of the LP
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7
Q

What are the symptoms of meningitis?

A 
Fever 
Headache 
Photophobia 
Lethargy 
Poor feeding/vomiting 
Irritability 
Hypotonia 
Drowsiness 
Loss of consciousness 
Seizures
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8
Q

What is a skin manifestation that is likely to be associated with meningitis?

A

Purpura

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9
Q

What investigative method is used to confirm the diagnosis of meningitis, identify the organism responsible and its antibiotic sensitivities?

A

Lumbar puncture

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10
Q

What is the best antibiotic that can cover the most common bacterial causes of meningitis?

A

Ceftriaxone (3rd gen. cephalosporin)

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11
Q

What is the most common complication of bacterial meningitis?

A

Hearing impairment

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12
Q

What are some cerebral complications of meningitis?

A
  1. Hearing impairment
  2. Local vasculitis → cranial n. palsies or other focal neurological lesions
  3. Local cerebral infarctions → focal or multifocal seizures → epilepsy
  4. Subdural effusion
  5. Hydrocephalus
  6. Cerebral abscess (confirmed by cranial CT or MRI)
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13
Q

What can be given as prophylaxis to the household contacts for meningococcal meningitis?

A

Rifampcin and cipfrofloxacin

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14
Q

What can cause encephalitis?

A
  • Direct invasion of the brain by a neurotoxic virus (HSV)
  • Delayed brain swelling following a dysregulated neuroimmunological response to an antigen (postinfectious encephalopathy)
  • A slow virus infection such as HIV or subacute sclerosing panencephalitis (SSPE) following measles
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15
Q

What are the most common viruses that can cause meningitis?

A

Enteroviruses and parechoviruses

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16
Q

The incidence of meningitis is highest in what age group?

A

Under 1 year of age, especially in infants <2 months

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17
Q

What is the most effective investigative method to diagnose viral meningitis?

A

PCR

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18
Q

What can be used to treat encephalitis caused by HSV or VZV

A

Acyclovir

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19
Q

What is the neuroimaging study of choice for encephalitis?

A

MRI

20
Q

What is a common feature of encephalitis?

A

Behavioral changes and altered mental status

21
Q

What is the most common risk factor for cerebral palsy?

A

Prematurity

22
Q

What are the motor deficits classically found in cerebral palsy?

A

Negative phenomena:
Weakness, fatigue, incoordination

Positive phenomena:
Spasticity, clonus, rigidity, spasms (can lead to muscle stiffness and functional impairment if not treated)

23
Q

What are the different types of cerebral palsy?

A
  1. Cortical (pyramidal) = spasticity
  2. Basal ganglial (extrapyramidal) = abnormal movements like choreoathetosis
  3. Cerebellar = hypotonia
  4. Mixed
24
Q

What is the most common type of cerebral palsy?

A

Spastic CP

25
Q

What is a leading cause of extrapyramidal cerebral palsy?

A

Kernicterus (bilirubin encephalopathy)

Affected neonate appears weak, listless and hypotonic w/ poor feeding.

26
Q

What is the most common etiology of cerebral palsy?

A

Prenatal causes (can be congenital or acquired)

27
Q

What is the strongest and most independent risk factor for the development of cerebral palsy?

A

Periventricular leukolamacia (PVL)

28
Q

What is the most common type of paralysis in cerebral palsy?

A

Spastic diplegia

29
Q

What are the associated manifestations of cerebral palsy?

A

Mental retardation
Epilepsy
Problems with feeding, nutrition and growth delay
Bladder dysfunction (incontinence is common)
Bowel dysfunction (constipation is common)
Sleep disturbances
Drooling
Hearing loss
Visual abnormalities
Progressive joint contractures, shortened muscles and hip or foot deformities (due to spasticity)

30
Q

What is the most common type of seizures associated with cerebral palsy?

A

Focal seizures with or without secondary generalization

31
Q

What is the most likely cause of growth delay in cerebral palsy?

A

Poor nutrition secondary to pseudobulbar palsy

another cause is due to gastroesophageal reflux

32
Q

What can be done to cerebral palsy patients suffering from growth delay due to poor nutrition?

A

Attach a nasogastric (NG) or gastrotomy tube (GT)

33
Q

What is the most commonly used oral medication in children with generalized spasticity?

A

Baclofen

34
Q

What is hypotonia?

A

A state of low muscle resistance to movement.

35
Q

Atrophy and fasciculations are commonly seen with what type of motor neuron disorders?

A

Lower motor neuron disorders

36
Q

What are the types of SMA diseases?

A

Type 1 - Werdnig-Hoffmann disease:

  • 25% of patients
  • Most severe form
  • Occurs in infants before the age of 6 months

Type 2 - Kugelberg-Welander syndrome:

  • 50% of patients
  • Slowly progressive form
  • Occurs between 6-18 months

Type 3 - Juvenile form:

  • 25% of patients
  • Occurs between 18 months to childhool

Type 4:

  • Occurs in early adulthood
  • Less severe form
37
Q

In SMA, do infants have normal cognitive, social and language skills and sensation?

A

Yes

38
Q

What do infants with SMA type 1 usually present with?

A

Severe hypotonia, generalized weakness and facial involvement (tongue fasciculations are usually present).

39
Q

What is the treatment of SMA?

A

No specific treatment delays progression of SMA, so treatment mainly involves symptomatic treatment.

40
Q

What is Guillain-Barre Syndrome (GBS)?

A

It is a postinfectious autoimmune peripheral neuropathy that can occur 10 days after a respiratory or GI infection (Mycoplasma pneumonia or Camplylobacter jejuni).

41
Q

What is the most common cause of acute flaccid paralysis in children?

A

Guillain-Barre Syndrome (GBS)

42
Q

What are the classic characteristics of Guillain-Barre Syndrome (GBS)?

A

Areflexia
Flaccidity
Symmetrical ascending weakness

43
Q

Where does the numbness and parasthesia in Guillain-Barre Syndrome (GBS) usually start?

A

In the hands and feet

44
Q

What happens to the deep tendon reflexes in Guillain-Barre Syndrome (GBS)?

A

Absent

45
Q

What is the Miller Fisher triad?

A
  1. Ataxia
  2. Partial opthalmoplegia
  3. Areflexia
46
Q

What does the CSF fluid show in Guillain-Barre Syndrome (GBS)?

A

Elevated protein levels without significant pleocytosis (presence of large amounts of lymphocytes).

47
Q

What is part of the treatment of Guillain-Barre Syndrome (GBS)?

A
  • Admission to hospital (usually in the ICU)
  • Monitoring of pulmonary and cardiac functions
  • Endotracheal intubation for patients w/ impending respiratory failure or an instability to clear secretions
  • Treatment with intravenous immunoglobulins (IVIG)
  • Plasma exchange and immunosuppressive drugs
  • Physical, occupational and speech therapies

Pediatrics (9 decks)

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