Pediatric Neurology Flashcards
when in the incidence of seizures greatest during childhood
neonatal (birth to 8 weeks of life)
what is an abnormal, synchronous electrical activity of neurons in the cerebral cortex
seizure
what are causes if seizures in children
usu. d/t acute illness/injuyr:
electrical abnormalities
ingestion of toxins
trauma/intracranial bleeding
meningitis
fever
is a seizure in a child diagnostic for epilepsy
no
epilepsy is recurrent, unprovoked seizures
How are seizures classified
generalized onset
focal onset (partial)
unknown onset
unclassified
What are the types of generalized seizures
motor (convulsive) and non-motor (nonconvulsive, absence)
what are the types of motor (convulsive) seizure
tonic-clonic: m/c
clonic
tonic
myoclonic
atonic (“drop attacks”)
what are the types of non-motor seizures
typical
atypical
myoclonic
eyelid myoclonic
What are focal seizures
limited to one hemisphere
1. intact awareness (simple partial seizure)
2. impaired awareness (complex partial seizure)
what. isa complex partial seizure
focal onset seizure with impaired awareness
what. isa simple partial seizure
focal onset seizure with intact awareness
what is Jacksonian March
Start as a focal seizure but progress to a generalized seizure
what is a condition that is characterized by recurrent (2+) seizures, unprovoked by any immediate identified causes, > 24 hours apart
Epilepsy
What is. themost common seizure disorder of childhood
generalized non-motor absence seizure
what is the median onset of age for absence seizures
6 years old
most present between 4-10 years old
what is a typical absence seizure
brief loss of awareness, staring, eye fluttering; head bobbing/lip smacking
lasts < 10 seconds
can be provoked by hyperventilation
what is a atypical absence seizure
head atony (“drop attack of the head”)
What is the treatment of absence seizures
Zarontin (ethosuximide) 250 PO BID - first line
valproic acid or Lamotrigine(lamictal)
children with typical absence seizures may need to be on medications for
(atypical need lifelong treatment)
What is SUDEP
Sudden unexpected death in Epilepsy
sudden, unexpected, non-traumatic, non-drowning death, no structural or toxicologic cause
what is the evaluation of the first afebrile seizure
ABCs
History
fundoscopic exam
neurologic exam
cardiac
skin exam
what skin disorders can be associated with epilepsy
tuberous sclerosis
neurofibromatosis
Sturge Weber syndrome
what is Sturge Weber syndrome
port wine stain
vascular malformations
seizures
focal neuro deficits
cognitive impairment
what is Tuberous Sclerosis
ash-leaf spots, angiofibroma’s, fibrous plaques, shagreen patch
what post seizure labs should be ordered
glucose
electrolytes, including mag and calcium
consider tox screening
what is the imaging test of choice for afebrile seizures
MRI
CT is often the first study in the ED
are antiepileptic medications started after the first seizure?
Not routinely, the decision to start medication should be made with great care
what is the most common neurologic disorder in infants and children
Febrile seizures
when are febrile seizures most common to occur
on the first day of the illness
may be presenting sign of illness, can present with status epilepticus
what are the criteria for febrile seizure
seizure activity associated with elevated temp (>100.4)
child 6 mo - 6 years
NO CNS infxn/inflam
NO acute systemic metabolic abnormality that may produce convulsions
NO hx of previous afebrile seizure
what are the types of Febrile seizures?
Simple febrile (M/C)
Complex Febrile
what is simple febrile seizures
most common
lasts LESS than 15 min
gemeralized motor seizure
1 seizure in 24 hour period
what is a complex febrile seizure
focal features
LONGER than 15 min
multiple episodes within 24 hours
what are risk factors for febrile seizures
high fever
infection (M/c in viral (HHV6 and influenza))
after immunization
family hx
what are key portions of the hisotry for febrile history
characterisitcs of the seizure, esp focal features
any underlying medical/neuro conditions
immunization status
personal/family hx of seizure
any hx of neurologic issues or developmental delays
what are key parts of the exam for febrile seizures
vital signs
level of conciousness
meningismus
bulging fontanelles
focal difference in muscle tone, movement, strength
how quickly do most children with febrile seizures return to baseline
5-10 minutes
well appearing, with post-ictal drowssiness resolved
who gets an LP with febrile seizures?
meningeal signs/symptoms
features that suggest intracranial infxn
infants btwn 6-12 months with unkonw of lack HiB immunization
pt already on abx
seizure that occurs on 2nd day of illness
what are meningeal signs/symptoms
nuchal rigidity, alterned conciousness, petechial rash
What kids need neuroimaging
abnormally large heads
persistent abnormal neurologic exam, paticularly with focal features
signs/sx of increased ICP
what is the treatment of febrile seizures
most do not require treatment
anti-seizure meds are NOT routinely used
anti-pyretic do not seem to change recurrence rate
what are the causes of headaches in children
acute (and recurrent) - migraine/cluter
chronic and non-progressive. -tension, psychiatric, med overuse
chonic and progressive- space occupying lesion, post-traumatic, post-concussive
what are causes of acute localized HA
associated with URI, or viral infection; brain abscess
post-traumatic
oral cavity
first migraine
what are causes of acute generalized HA in children
fever/systemic infection
HTN
intracranial hemorrhage
exertional
trauma
toxins, meds, or illicit substances
what are worrisome HA features?
awakens the child or occurs upon waking
sudden severe HA (“thunderclap”
assoc. neuro signs/symptoms
What is the most frequent acute recurrent headache in children
migraine
when do migraines usually onset
start before age 20 in most patients
what are the phases of migraine headache
Premonitory phase
Aura
Headache phase
what premonitory phase
symptoms that can appear up to a day prior to onset
-fatigue, irritable, food cravings, yawning
what is the aura
m/c visual (flashing lights), but can be sensory (numbness or tingling), language
aura develops over > 5 min
can last between 5-60 min
can start before headache or during
what is. thetreatment of Migraine HAs
lie down in a dark room
ibuprofen, acetaminophen or naproxin
triptans
combo
What is a hat band-like pressure type of headache
tension headache
what is the treatment of tension headaches
analgesics
heat/shower
low doese amitriptyline for chronic or frequent HA
bio-behavioral techniques
when are cluster headaches most common
between ages of 10-20 years
what are associations with cluster headaches
ipsilateral autonomic findings:
lacrimation
rhinorrhea
opthalmic injection
horner syndrome
what is CP
a group of syndrome: non-progressive, but often clinically changing motor impairment due to an abnormality in developing brain
how is CP characterized
abnormal muscle tone, posture and movement
what are risk factors for CP
prematurity
low birth weight
intrauterine growth restriction
intrauterine infection
antepartum hemorrhage
severe placental pathology
multiple pregnancy
what are the findings that are diagnostic for CP
motor delay
neurologic signs - increased tone
resistence of primitive reflexes
abnormal postural reactions
when is CP usually diagnosed
by 18 months of age
when child fails to reach milestones
what are the 5 diagnostic types of CP
spastic
ataxic
dyskinetic- athetoid, hypotonic
mixed type
how is CP diagnosed
standard eval of motor and neruological function
all children should have MRI
what prevention measured can be used for CP
prenatal care
magnesium sulfate in women with preterm labor
supportive measures after delivery
what is the primary symptom of Muscular Dystrophy
muscle weakness
What is Duchene MD
onset by 2-3 yo, symmetrical leg weakness, before arms
often have cognitive impairement
caused by mutation of the dystrophin gene; xlinked chromosomal disorder
what are the complications of duchenne MD
dilated cardiomyopathy and arrhythmias
usu. wheelchair bound by age 12
die in late teens - pneumonia or cardiac disease
what are s/sx of duchennes
gait disturbances
trouble running
slow to reach milestones
calf pseudo-hypertrophy
Gower sign
What is Becker MD
laster onset and milder course
can often walk into their late teens and early 20s
live into late adulthood
how do you diagnose MD
elevated CK
genetic testing
Muscle biopsy
what are common risk factors for Tourettes syndrome
low birth weight
smoking during pregnancy
what are diagnostic requirements for Tourettes
2+ motor tics
1+ voal tics
tics present for at least 1 ywar
onset prior to age 18
what are the hallmarks of concussions
confusion and amnesia
with most cases, there is no LOC
what are sequelae/ complications of concussions
increased risk of future concussions
second impact syndrome
post concussive syndrome
chronic, posttraumatic encephalopathy
what are the indications for head CT
presenting wtihin 24 hours for isolate CHI
LOC > 60 seconds
evidence of skull fx
focal neurologic deficit
