Neurology COPY Flashcards
What do you know about age of onset and sex of kids with absence seizures?
Eped: children >5 years, girls>boys,
What is the modified sarnat score for neonatal HIE?
What are the clinical features of tension headaches?
-dull/aching, bilateral: frontal or band-like
Acute treatment of tension headaches?
- Reassurance + rest + + Treat stress/anxiety/depression
- Wean caffeine
- Tylenol/ibuprofen
…Avoid opioids when possible
Migraine Epedimiology?
- Most frequent type of headache in children:
- 5% of school aged children
- 50% spont remission after age 10
Aura = cortical spreading depression (CSD)
What are the 5 criteria for Migraine without aura?
No of attacks, duration, headache features, asociated Sx and no other Dx likely
How many attacks do you need to have to Dx Migraine with aura?
A. . >2 attacks
How do you abort migraine?
- Rest in dark, quiet room
- ibuprofen probably more effective. Acetaminophen monotherapy not recommended
- Gravol or IV metaclopromide for nausea
- Triptans (eg sumatriptan) = 5-HT agonists to abort if above ineffective in adolescents
N.B. Caffeine not recommended in children
Non-pharm prophylaxis: Migraine prevention?
Non-pharm prophylaxis:
1. Food diary, avoid TRIGGERS, Nutraceuticals (magnesium, riboflavin, butterbur)
2. Behavior mgmt: biofeedback, self-hypnosis, relaxation technique
How do you treat Status migrainosus?
Status migrainosus (>3 d):
- Dark, quiet room, IVF, sedation
- IV NSAID (Keterolac)
- Chlorpromazine or Prochlorperazine IV is highly effective
What is the Epid of cluster headaches?
(Trigeminal Autonomic Cephalalgias)
Epid: Mainly boys, onset after 10y, rare
How doyou treat cluster headaches?
Acute:
- Oxygen inhalation
- Triptans
- Steroids
Chronic
Lithium
What are the ICP Pseudotumour cerebri details?
Characterized by increased ICP
- > 200 mm H2O in infants;
- > 250 mm H2O in children
Broad classes of Etiology of pseudotumour cerebri ?
MIDHV…idiot
Metabolic:
Infectious:
Drugs:
Hematologic:
Vascular:“
idiopathic intracranial hypertension”
General management of PTC?
- identification and treatment of underlying cause
- If due to obesity -weight loss
- If due to drug stop drug! - For most patients, repeated follow-up and monitoring of visual acuity is all that is required
- The initial lumbar tap may that follows a CT/MRI is diagnostic and can be therapeutic
What do you know about Epedimiology of Infantile spasms (West syndrome)?
Epid: Peak onset - 3 to 8 months, 90% < 1 year.
What do you know about Cyanotic breath-holding spells age of onset and disappearance?
Peak - 2 yr of age, abate by 5-8 yr , rare < 6 mths
What do you know about triggers for Pallid breath-holding spells?
painful experience, such as falling and striking the head or a sudden startle.
What do you know about Masturbation/self-stimulating behavior Eped- age, sex and situations?
GIRLS, 2 months and 3 yo, when bored
Other causes of headaches
Medication overuse - OTC medications more than 3 times per week for 3 mths
Indications for Neuroimaging in headaches?
Indications for Neuroimaging - questionable v1
Indications for Neuroimaging - questionable v2
What are the features of floppy baby with ecntral hypotonia?
What are the causes for Central Hypotonia?
What are the features of Peripheral Hypotonia?
What are the causes of Peripheral Hypotonia?
Juvenile myoclonic epilepsy (“of Janz”) Epedimiology?
Eped: adolescence, AD , chromosome 6 with variable penetrance
What no of attacks do you need to Dx migraine without aura?
> 5
What duration is needed to Dx migraine without aura?
1-72 hrs
What headache features are needed to Dx migraine without aura?
C. > 2 of:
- Unilateral
- Pulsating quality
- Mod or severe intensity
- Aggravation by routine px activity
What other features are needed to Dx migraine without aura?
D. During HA, > 1 of
- Nausea, vx
- Photo/phonophobia
E. Not attributable to another disorder
What % of Px with migraine without aura have a family Hx?
90%
What are the clical features of abscence seizures?
no aura
-
- no post-ictal state.
- Can provokein the office by hyperventilation.
What is the treatment for abscence seizures?
- 1st line Ethosuximide.
- If GTC..Valproic
Recent peds in review series on seizure types and management
· Since 40-50% of children with absence seizures will have GTC seizures, VPA optimal choice as it covers for GTC as well.
· Carbamazepine first-line for partial seizures