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Clin Med IV: Pediatrics > Pediatric Neurology > Flashcards

Pediatric Neurology Flashcards

1
Q

when in the incidence of seizures greatest during childhood

A

neonatal (birth to 8 weeks of life)

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2
Q

what is an abnormal, synchronous electrical activity of neurons in the cerebral cortex

A

seizure

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3
Q
A
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4
Q

what are causes if seizures in children

A

usu. d/t acute illness/injuyr:
electrical abnormalities
ingestion of toxins
trauma/intracranial bleeding
meningitis
fever

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5
Q

is a seizure in a child diagnostic for epilepsy

A

no

epilepsy is recurrent, unprovoked seizures

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6
Q

How are seizures classified

A

generalized onset
focal onset (partial)
unknown onset
unclassified

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7
Q

What are the types of generalized seizures

A

motor (convulsive) and non-motor (nonconvulsive, absence)

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8
Q

what are the types of motor (convulsive) seizure

A

tonic-clonic: m/c
clonic
tonic
myoclonic
atonic (“drop attacks”)

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9
Q

what are the types of non-motor seizures

A

typical
atypical
myoclonic
eyelid myoclonic

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10
Q

What are focal seizures

A

limited to one hemisphere
1. intact awareness (simple partial seizure)
2. impaired awareness (complex partial seizure)

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11
Q

what. isa complex partial seizure

A

focal onset seizure with impaired awareness

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12
Q

what. isa simple partial seizure

A

focal onset seizure with intact awareness

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13
Q

what is Jacksonian March

A

Start as a focal seizure but progress to a generalized seizure

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14
Q
A
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15
Q

what is a condition that is characterized by recurrent (2+) seizures, unprovoked by any immediate identified causes, > 24 hours apart

A

Epilepsy

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16
Q

What is. themost common seizure disorder of childhood

A

generalized non-motor absence seizure

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17
Q

what is the median onset of age for absence seizures

A

6 years old
most present between 4-10 years old

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18
Q

what is a typical absence seizure

A

brief loss of awareness, staring, eye fluttering; head bobbing/lip smacking
lasts < 10 seconds
can be provoked by hyperventilation

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19
Q

what is a atypical absence seizure

A

head atony (“drop attack of the head”)

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20
Q

What is the treatment of absence seizures

A

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)

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21
Q

What is SUDEP

A

Sudden unexpected death in Epilepsy

sudden, unexpected, non-traumatic, non-drowning death, no structural or toxicologic cause

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22
Q

what is the evaluation of the first afebrile seizure

A

ABCs
History
fundoscopic exam
neurologic exam
cardiac
skin exam

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23
Q

what skin disorders can be associated with epilepsy

A

tuberous sclerosis
neurofibromatosis
Sturge Weber syndrome

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24
Q

what is Sturge Weber syndrome

A

port wine stain
vascular malformations
seizures
focal neuro deficits
cognitive impairment

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25
what is Tuberous Sclerosis
ash-leaf spots, angiofibroma's, fibrous plaques, shagreen patch
26
what post seizure labs should be ordered
glucose electrolytes, including mag and calcium consider tox screening
27
what is the imaging test of choice for afebrile seizures
MRI CT is often the first study in the ED
28
are antiepileptic medications started after the first seizure?
Not routinely, the decision to start medication should be made with great care
29
what is the most common neurologic disorder in infants and children
Febrile seizures
30
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
31
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
32
what are the types of Febrile seizures?
Simple febrile (M/C) Complex Febrile
33
what is simple febrile seizures
most common lasts LESS than 15 min gemeralized motor seizure 1 seizure in 24 hour period
34
what is a complex febrile seizure
focal features LONGER than 15 min multiple episodes within 24 hours
35
what are risk factors for febrile seizures
high fever infection (M/c in viral (HHV6 and influenza)) after immunization family hx
36
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
37
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
38
how quickly do most children with febrile seizures return to baseline
5-10 minutes well appearing, with post-ictal drowssiness resolved
39
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
40
what are meningeal signs/symptoms
nuchal rigidity, alterned conciousness, petechial rash
41
What kids need neuroimaging
abnormally large heads persistent abnormal neurologic exam, paticularly with focal features signs/sx of increased ICP
42
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
43
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
44
what are causes of acute localized HA
associated with URI, or viral infection; brain abscess post-traumatic oral cavity first migraine
45
what are causes of acute generalized HA in children
fever/systemic infection HTN intracranial hemorrhage exertional trauma toxins, meds, or illicit substances
46
what are worrisome HA features?
awakens the child or occurs upon waking sudden severe HA ("thunderclap" assoc. neuro signs/symptoms
47
What is the most frequent acute recurrent headache in children
migraine
48
when do migraines usually onset
start before age 20 in most patients
49
what are the phases of migraine headache
Premonitory phase Aura Headache phase
50
what premonitory phase
symptoms that can appear up to a day prior to onset -fatigue, irritable, food cravings, yawning
51
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
52
53
what is. thetreatment of Migraine HAs
lie down in a dark room ibuprofen, acetaminophen or naproxin triptans combo
54
What is a hat band-like pressure type of headache
tension headache
55
what is the treatment of tension headaches
analgesics heat/shower low doese amitriptyline for chronic or frequent HA bio-behavioral techniques
56
when are cluster headaches most common
between ages of 10-20 years
57
what are associations with cluster headaches
ipsilateral autonomic findings: lacrimation rhinorrhea opthalmic injection horner syndrome
58
59
what is CP
a group of syndrome: non-progressive, but often clinically changing motor impairment due to an abnormality in developing brain
60
61
how is CP characterized
abnormal muscle tone, posture and movement
62
what are risk factors for CP
prematurity low birth weight intrauterine growth restriction intrauterine infection antepartum hemorrhage severe placental pathology multiple pregnancy
63
what are the findings that are diagnostic for CP
motor delay neurologic signs - increased tone resistence of primitive reflexes abnormal postural reactions
64
when is CP usually diagnosed
by 18 months of age | when child fails to reach milestones
65
what are the 5 diagnostic types of CP
spastic ataxic dyskinetic- athetoid, hypotonic mixed type
65
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67
how is CP diagnosed
standard eval of motor and neruological function all children should have MRI
68
what prevention measured can be used for CP
prenatal care magnesium sulfate in women with preterm labor supportive measures after delivery
69
what is the primary symptom of Muscular Dystrophy
muscle weakness
70
What is Duchene MD
onset by 2-3 yo, symmetrical leg weakness, before arms often have cognitive impairement ## Footnote caused by mutation of the dystrophin gene; xlinked chromosomal disorder
71
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
72
what are s/sx of duchennes
gait disturbances trouble running slow to reach milestones calf pseudo-hypertrophy Gower sign
73
What is Becker MD
laster onset and milder course can often walk into their late teens and early 20s live into late adulthood
74
how do you diagnose MD
elevated CK genetic testing Muscle biopsy
75
what are common risk factors for Tourettes syndrome
low birth weight smoking during pregnancy
76
what are diagnostic requirements for Tourettes
2+ motor tics 1+ voal tics tics present for at least 1 ywar onset prior to age 18
77
what are the hallmarks of concussions
confusion and amnesia ## Footnote with most cases, there is no LOC
78
79
what are sequelae/ complications of concussions
increased risk of future concussions second impact syndrome post concussive syndrome chronic, posttraumatic encephalopathy
80
what are the indications for head CT
presenting wtihin 24 hours for isolate CHI LOC > 60 seconds evidence of skull fx focal neurologic deficit

Clin Med IV: Pediatrics (16 decks)

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