Oct9 M3-Pediatric Neurology Flashcards
neuro hx in neuro peds
standard medical hx but with particular interest on
- gestational and perinatal hx
- FHx ask many qs, consanguinity
- dev history (school, plateau, regression)
- handedness (dominance of one hand over the other for movements) is abnormal before the age of 18 months
plateau vs regression def
plateau: acquired a developmental milestone (you ask about these)
regression: lose an already acquired milestone. NEVER normal.
handedness before 18 mo: what’s happening
focal neurological deficit
4 domains dev milestones are divided in
- gross motor
- fine motor
- language
- personal and social
- have charts for that. draw age of child and know what should be doing for their age*
examples of dev milestones
- walking at 12 mo
- primitive pincer grasp at 9 mo
- smiles at 6 weeks
global developmental delay def
- significant delay in at least 2 dev domains
- we say this for children <5 (5+ = intellectual delay)
imp thing on exam
- observation (alertness, tone, etc.)
- standard neuro exam with special interest on
- dysmorphism + look at parents
- growth parameters head circumference child + parents
- organomegaly
- skin exam (pigmentation hyper hypo)
- spine
- axial and appendicular (peripheral) tone
- primitive reflexes in babies (disappear at a certain age)
examples of way to test for hypotonia
- frog position when baby lies on bed on their back
- traction of hands up when baby lying on their back + head lags down
- lift baby by abdomen horizontally = body should be horizontal
- vertical suspension by the chest under the shoulders: no flexion = axial hypotonia
causes of axial and peripheral hypotonia in infants
CNS (Central) or PNS (peripheral) problem (axial hypotonia doesn’t mean CNS problem)
peripheral cause of hypotonia: charact
- decreased reflexes
- no other features except joint abnormalities
- Fhx of muscle or nerve prob
central cause of hypotonia charact
- increased muscles + sustained clonus (few beats of clonus is NORMAL)
- abnormal lvl of consciousness (encephalopathy)
- seizures
- dysmorphism
- Hx of posible CNS insult (infection, hypoxia), usually in low apgar at birth, acidotic fluids at birth, baby born flat
epilepsy def
- two UNPROVOKED seizure at at least 24hr apart
- one seizure with recurrence risk estim to be >60%
- child with palsy and extremely active EEG and recur risk >60% after ONE seizure
- dx of epilepsy syndrome with classical seizures and sx and features
classif of seizures
- generalized
- focal (starts at one location and can spread to adjacent and distant region = secondary generalization): with or without impairment of consciousness
ex of meds exclusively for focal seizures
CBZ and phenytoin (both gen and focal in another lecture)
ex of meds exclusively for generalized seizures
ethosuximide (absences)
ex of meds for both focal and generalized seizures
valproic acid (only generalized in another lecture), levetiracetam, lamotrigine, benzos, topiramate, pheno
Sandifer’s syndrome def
- GERD (reflux) syndrome
- in the infant, can cause body arching (due to discomfort) and gurgling sounds + may find regurgitation (milk for example)
- is NOT a seizure
Sandifer’s syndrome key point
when you’re not sure if it’s a seizure, call it a PAROXYSMAL event
breath holding spells def
Breath-holding spells are brief periods when young children stop breathing for up to 1 minute. These spells often cause a child to pass out (lose consciousness). KEY INFO ON HX IS IT’S ALWAYS THE SAME THING TRIGGERING IT
- can be crying for ex (the trigger)
- if baby turns blue = cyanotic type
link between seizures and breath holding spells
- can have 1-5 seizures after a breath holding spell
- these seizures would be considered PROVOKED
breath holding spells main things
- between 6 mo and 6 yrs
- FHx sometimes
- may have seizure after
- ALWAYS DO A CBC and IRON STUDY bc is assoc with iron deficiency anemia and if tx it = solved
18 month old with first seizure. everyone sick at home with a URTI. the patient is febrile. dx
Febrile seizure (provoked) *febrile is key info*
febrile seizure def
seizure occuring with fever WITHOUT CNS infection and WITHOUT electrolyte imbalance
febrile seizures charact
- 6 mo to 6 yrs
- FHx. 5% of general pop
- simple vs complex type
simple febrile seizures def
- typical
- generalized (GTC or any)
- single event (1 in 24hrs)
complex febrile seizures def
- atypical
- focal
- prolonged (>15 min)
- multiple seizures in 24 hrs
febrile seizures management
- tylenol and antipyretics don’t help
- often no tx
- simple febrile seizure = same risk of epilepsy as general pop
- atypical (complex) febrile seizure = increased risk of epilepsy
- dx epilepsy if other seizure after without fever
what kinds of seizures present as staring spells
- absence seizures
- focal seizures with IMPAIRED consciousness (partial complex)
absence seizure charact
- many per day. up to 100 per day
- <30 sec
- NEVER have an aura (are a generalized seizure)
- NEVER have post-ictal fatigue (just like putting pause on video, when stops, child back to activity)
- can often be activated by hyperventilation
- generalized on EEG
focal seizure charact
- rarely > 1-2 per day
- > 30 sec
- frequent AURAS (young child = can’t describe, may say: always runs to his mom before)
- frequent POST-ICTAL FATIGUE
- rarely activated by hyperventilation
- focal EEG
automatisms def
things that people do during a seizure. some seizures types have that. examples include
- lip smacking
- looking at something
- hand automatisms
- IS PRESENT IN BOTH ABSENCE AND COMPLEX PARTIAL TYPES SO CAN’T USE THAT TO DIFF THE TWO*
management of absence seizures
have to be tx bc can have an effect on learning (to be ‘‘absent’’ often in a day)
7 year old with convulsion 2 hours after falling asleep. remembers sensation in right side of cheek before falling asleep. then doesn’t remember anything. dx
secondarily generalized seizure (FOCAL ONSET, initially focal with retained awareness)
- Hx suggestive of self-limited Rolandic epilepsy
- it’s age dependent and goes away with time
- subtle changes later in life, increased chance of ADHD, etc.
precautions to take during a GTC seizure
- put patient on the side
- take out everything around them
- don’t restrict their mvmts
- nothing in mouth
- call 911 if concerned and always call if seizure >5 min
precautions in the typical epilepsy patient
- health bracelet
- shower instead of bath (may drown if seizure during bath)
- never lock the door in the bathroom
- watch pt in water if you know them (family member), don’t rely on lifeguard watching the whole pool
- always wear a helmet in sports where needed
