Neurology/Developmental Flashcards
1
Q
seizure
A
- synchronoous dc of electrical activity or chonic disorder or recurrent, idiopathic seizures not reporduced by 2ary cause
- causes: 4Ms and 4Is
- Metabolic (hyponatremia, H2O tox, hypoglycemia, hyperglyc, hypocalc, uremia, thyroid storm, hypertherm
- Mass lesions (brain met, 1ary brain tumor, hemorrhage)
- Missing drugs (noncompliance w/ anticonvusants, withdrawal from ETOH, benzos, barbituates)
- Miscellaneous: pseudosiezures (psych), eclampsia, HTN enceph, febrile
- Intox (cocaine, lithium)
- Infxn (septic shock, bact, viral meningitis, brain abscess)
- Ischemia (embolic stroke, TIA, syncope)
- Increased ICP (dt trauma)
2
Q
epilepsy
A
- chronic, reccurent seizures not produced by 2ary cause
- Triggers: sleep dep, emotional stress, meds, infxn, alc
- Causes: childhood and age
- sxs: dz requires 2+ separate seizures (unprovoked)
- dx: if known epileptic → check anticonculsant levels, if 1st seizure → CBC, CMP, gluc, renal fn, urinalysis
- EEG (abnormal pattern is NOT dx on its own), CT, MRI, LP, preg, PRL (serum levels rise abruptly in postictal state only in true epilepsy)
- tx: ABCs, check for noncompliance, check drug levels, increase dose of first anticonvulsant if persistent, add second drug if szs still uncontrolled. if controlled on 2 drugs, continue for 2y and then taper
- first seizure: EEG with neuro consult, if normal then recurrence is low.
- dont tx most pts with only one seizure
- start antiepileptics only if EEG abnl, MRI abnl or status epilepticus
3
Q
simple partial seizure (focal), or aura
A
- sxs: consciousness INTACT (not impaired)
- seizure is localized but may evolve - can be described as a sensation (N, epigastric sensation), abnl thought (fear, deja vu), or involuntary mvmt
- pt can interact normally w/ enviro except for limitations imposed by seizure itself on local brain fns
- may involve transient unilateral clonic-tonic mvmt
- 60% of pts with partial epilepsy
- dx: EEG
- tx: phenytoin and carbamazepine (alternatives = phenobarb, depakote, primidone)
4
Q
complex partial seizure
A
- consciousness IMPAIRED (spans from minimal to complete unresponsiveness), preceding aura, ictal manifestations (1-3 mins), eyes usually open during ictus, automatisms (purposeless, involuntary, repetitive mvmts), epigastric sensation or vague cephalic sensation, olfactory or gustatory hallucinations, deja vu, micropsia, macropsia, fear, pleasure, anger, voices, music, speech arrest, absence-like sxs
- contralateral: eye dev, arm extens, fencing posture, clonic mvmts of face, fingers, hand, foot
- postictal confusion (fatigue, ipsilateral HA, mins to hours)
- dx: EEG
- tx: trileptal, lamictal, phenytoin and carbamazepine
5
Q
generalized tonic clonic (grand mal) seizure
A
- eyes open and “roll to back of head”, begins with sudden LOC, apnea, urinary incontinence, vomiting
- Tonic phase: extensor posturing for 20-60s (rigid trunk, limb extension, bilaterally symmetrical)
- clonic phase: progressively longer periods of inhibition → lasting up to 60s
- postictal phase: transient deep stupor → 15-30min of lethargy, confusion → hours to days of HA, muscle soreness, mental dulling, mood changes
- signs: cyanosis, foaming at mouth, tongue biting, hypoxemia
- dx: lactic acidosis, elevated catecholamines, increased CK, PRL, corticotropin, cort
- EEG: generalized high amp rapid spiking
- tx: roll pt onto side, levetiracetam, topiramate, zonisamide, phenytoin and carbamazepine, phenobarb, depakote, primidone
6
Q
absence (petitmal) seizures
A
- school aged children, resolves with age
- sxs: disengage from current activity, “stare into space”, minor clonic activity (eye blinks, head nodding), brief (lasts a few seconds), but quite frequent (up to 100x/d), impairment of consciousness, no loss of postural tone and no postictal confusion
- dx: EEG shows 3/s spike and slow wave activity
- tx: ethosuximide, depakote, zonisamide
7
Q
myoclonic seizures
A
- rapid recurrent, brief muscle jerks of face or hands → massive bilat spasms simultaneously affecting head, limbs, trunk
- occurs bilaterally, synchronously or asynchronously, may occur shortly after waking up, but can occur at any time
- dx: EEG
- tx: keppra (levatiracetam), depakote (valproic acid)
8
Q
status epilepticus
A
- causes: noncompliance, ETOH widrawal, intracranial infxn, neoplasm, metabolic dz, drug overdose
- sxs: prolonged, sustained unconsciousness w/ persistent convulsive activity lasting longer than 30 min OR 2 or more sequential seizures without full recovery of consciousness between them
- dx: EEG, MRI
- tx: ABCs, IV, O2, monitor, CMP, Ca, Mg, Phos, CBC, UTox, troponin, AED levels, gluc
- if hypoglyc, give 100mg IV thiamine and 50ml 50% dextrose, 0.1 mg/kg IV lorazepam, repeat if persistent
- IV fosphenytoin or IV phenytoin 20mg/kg IV, monitor HR and BP
- Intubation, IV phenobarb
9
Q
anticipatory guidance
A
- infants and toddlers: rear facing car seat until 2yo or until reach ht/wt limits for convertible car seat; infants may ride in infant-only seats (handle and snap into a base that is secured in the car) until they reach the ht/wt limit for that seat
- 2yo: forward facing car safety seat with harness, belt-positioned booster
- 8-12yo (height of 4ft9inch): vehicle’s lap and shoulder belt fits properly (child can sit with back against seat, bend knees at edge of seat, have belt positioned in center of shoulder and across chest, have lap belt touching thighs)
- <13yo: restrained in rear seats of vehicle
- Misc: scalding is MC type of burn in children, most fire-related deaths result from smoke inhalation, sunburn is MC thermal inj (avoid sun between 10-4, use SPF 15 or higher), children <3 have high risk choking because they have not fully coordinated chewing and swallowing and are able to put small objects into their mouths
10
Q
teething
A
- infants with primary teeth eruption who is cranky, chewing on objects, excessive drooling
- sxs: irritable, drooling, inc temperature (NOT fever or temp >38.5), D, other systemic sxs
- dx: clinical dx
- tx: palliative (chewing on chilled teething ring or other teething device, systemic analgesics
- health maintenance - do not recommend OTC or prescription strength analgesics (lidocaine, benzocaine) as they may be harmful and risk > benefit
11
Q
simple febrile seizures
A
- sz occuring with fever, no CNS infxn, children <5yo, inc risk of developing epilepsy later in life
- sxs: fever >38 (100.4), must meet all 3 criteria:
- lasts <15 min, gen tonic clonic, once in 24h
- dx: no blood studies, neuroimaging, or EEG for most; LP in infants <12mo, LP in infants 12-18mo somewhat recommended (if previous febrile sz, do not r/o meningitis as cause)
- tx: tylenol and motrin will NOT prevent subsequent seizures, although indicated, anticonvulsant tx not recommended - AE outweigh risk of recurrence, 30% recur before age 1 or if family hx of febrile sz
12
Q
complex febrile sz
A
- HHV-6, magnitude of temperature or rate of temp may precipitate sz
- RF: CP, MR, early onset febrile sz <1y, FH of epilepsy
- sxs: fever >38,
- one or more: lasts >15min, focal sz, recurs within 24h period
- no serious signs of infxn, dx of exclusion
- dx: CBC with blood cx, UA with cx, LP (CSF with cx), EEG, MRI
- tx: if neg results, dc without abx, follow up in 24h to review cx and repeat physical, tylenol will NOT prevent subsequent sz although indicated
- prophylaxis: phenobarb or valproic acid (DONT USE diazepam, phenytoin, carbamazepine)
13
Q
lennox-Gastaut syndrome
A
- generalized epilepsy caused by diffuse or multifocal brain dysfunction, age 2-10yo, 60% have preexisting encephalopathy and developmental delay, 20% have infantile spasms, associated with MR
- sxs: akinetic (atonic), myoclonic seizures (drop attacks), developmental delay
- dx: EEG (2.5 Hx or slower generalized spike and slow wave with bursts of diffuse fast rhythms during sleep)
- tx: requires supervision and most live in group homes, if drop seizures are present, helmets must be prescribed, valproic acid = initial, can add lamotrigine, topiramate, levetiracetam, zonisamide, vagus nerve stim
14
Q
bacterial meningitis etiology, RF, and sxs
A
- acute = hours to days, chronic = within weeks to months, commonly caused by mycobacteria, fungi, Lyme dizease, or parasites
- inflamm of meningeal membs, infxs agents colonize nasopharynx and resp tract, neonatal = listeria monocytogenes
- MCC: strep pneumo, H flu, N meningitidis
- sxs: TRIAD = fever, nuchal rigidity, change in mental status
- HA (more severe lying down), N/V, stiff painful neck, malaise, photophob, AMS (confusion, lethargy, coma)
- signs: Rash (maculopap rash with petechiae for N mening) or vesicular lesions (varicella/HSV), inc ICP and its manifestations (papilledema, szs)
- cranial nerve palsies, +Kernig, +Brudzinski
15
Q
bacterial meningitis dx and tx
A
- dx: lumbar puncture - unless evidence of space-occupying lesion (neut predom, cell count >1000, low gluc, elevated prot)
- CT scan of head - recommended before performing LP if focal neuro signs or evidence of space-occupying lesion with high ICP
- blood cx - prior to abx
- tx: empiric tx after LP, IV abx immediately if CSF cloudy or bact suspected, steroids if cerebral edema present
- early onset (<7d) = amp
- late onset (7d-3mo) = amp + cefotaxime
- late late (>3mo) = cefotaxime (3rd gen) + vanco
- health maint: vaccinate asplenic pts and immunocomp for meningococcus
- prophylax: rifampin or ceftriaxone for close contacts of meningococcal
