Pediatric Enhancement topics in neurology (Dow)

Question 1

HSV encephalitis

Answer 1

when you tap these kids you’ll get blood

associated with temporal lobe hemorrhagic encephalitis

Question 2

which type of seizures are more common in children and what are some difference in peds vs adults

Answer 2

generalized

generalized tonic-clonic seizures are RARE before 2 years of age

children older than 6 will have seizures similar to adults

younger children have less complex behaviors, especially with complex partial seizures

Can be difficult to determine altered LOC in infants/young children

Question 3

Port wine stain

Answer 3

neurocutaneous syndrome

churg-strauss syndrome with hemangioma

affects trigeminal nerves

Question 4

ash leaf macules

adenoma sebacium

Answer 4

tuberous sclerosis

Question 5

most common type of seizure in childhood

Answer 5

febrile seizures

single brief 15 minute generalized

Question 6

start around 5-6 years
short lapses in consciousness, speech or motor activity 
no aura
no postictal drowsiness
may have automatism

Answer 6

absence seizures

EEG shows 3 cycles per second generalized spike and wave activity

Question 7

infantile spasms?

Answer 7

Any disorder that can produce brain damage can be associated with infantile spasms.

2% of childhood epilepsies but 25% of epilepsy with onset in the first year of life.

EEG shows hypsarrhythmia.

Long-term overall prognosis for patients with infantile spasms is poor. Associated with cognitive impairment.

spasm of the upper neck and shoulders

Question 8

what is West Syndrome

Answer 8

West syndrome = severe epilepsy syndrome with

1. infantile spasms
2. Hypsarrhythmia on EEG
3. mental retardation

Question 9

what is the imagining procedure of choice in child seizures

Answer 9

MRI

Question 10

do most seizures cause brain damage

Answer 10

no

Question 11

why are kids at more risk with trauma to the head

Answer 11

developing brain is more sensitive to concussion injury in an adult athlete

developing brain is not able to recover as quickly as adult brain

axons in pediatric brain are not as well myelinated. more vulnerable to injury

younger have less well developed cervical and shoulder muscles, less stability to absorb impact

may not use proper techniques to reduce risk for injury

Question 12

when must you image the child

Answer 12

altered mental status GCS 5 seconds

severe mechanism

signs of basilar skull fracture

severe headache

Question 13

emergent head CT is recommended if…

Answer 13

penetrating injury

GCS < or = to 14 or other altered mental status

depressed or basilar skull fx

worsening HA

in addition to the above, for age <1 year old

Question 14

what is considered a high risk mechanism of injury <2 years old

Answer 14

fall greater than 3 feet

struck by high impact object

ejection from motor vehicle

MVA

auto bike without helmet

Question 15

what is considered high risk mechanism of injury >2 years

Answer 15

fall greater than 5 feet
struck by high impact object
ejection from motor vehicle
motor vehicle crash with death of another or auto pedestrian

auto bike without helmet

Question 16

management of concussion

Answer 16

no same day return to play
no driving
don’t leave them alone
limit texting, video games, internet, tv

educate parents that symptoms may get worse over 1st 24-48 hours but child should not have worsening LOC, 3-4 episodes of vomiting

Question 17

what is the step wise return to play protocol

Answer 17

no activity

symptom free for day can start step 1 –> light aerobic exercise

in general the athlete who has sustained a concussion should proceed to the next level if without symptoms at the current level. each step generally takes 24 hours

if symptoms recur, then the pt drops back to the previous symptomatic level