Pediatric Neurology Flashcards
What are common etiologies of neonatal seizures?
What defines the neonatal period for neonatal seizures?
- Electrolyte disturbances
- Bleeding
- Infection
- Inherited disorders
- Malformations
- Drugs
Birth to 8 weeks (about 4 weeks after the first 30 days, which is normal
What are common causes of seizures in children?
- Electrolyte disturbance
- Ingestion of toxins
- Trauma/intracranial bleeding
- Meningitis
- Fever
Is a seizure in a child diagnostic for epilepsy?
What defines epilepsy?
No
Epilepsy is recurrent, unprovoked seizures
Epilepsy: characterized by recurrent (2+) epileptic siezures, unprovoked by any immediate identified cause, at least > 24 hours apart
Generalized seizures are defined as motor (convulsive) or non-motor
What are the types of motor (convulsive) seizures?
- Tonic-clonic (most common)
- Clonic
- Tonic
- Myoclonic
- Atonic
Generalized seizures are defined as motor (convulsive) or non-motor
What are the types of non-motor (non-convulsive) seizures?
- Typical
- Atypical
- Myoclonic
- Eyelid myoclonic
Are febrile seizures and neonatal seizures included in the classification of epilepsy?
No, they are excluded as there is usually an identified cause
What is the most common seizure disorder of childhood?
What is the median age of diagnosis and why?
Absence Seizures
6 years is the median onset, most between 4-10 years old
Most likely diagnosed after starting school
What is the presentation of typical absence seizures?
- Brief oss of awareness, starting, eye fluttering, head bobbing/lip smacking
- Last < 10 seconds, but can have multiple in a 24 hour period
- Can be provoked by hyperventilation
What is the first line treatment for absence seizures?
Do patients with typical absence seizures require lifelong treatment?
- Ethosuximide (Zarontin) BID: first line
- Valporic acid
- Lamotrigine
No, may only require a few years of treatment
Patients with atypical require lifelong treatment
After a seizure, when should the child be evaluated by pediatric neurology?
Within 2 weeks
What is sudden enexpected death in epilepsy (SUDEP)
- Sudden, unexpected, non-traumatic, non-drowning death in a patient with epilpsy with no structural or toxicologic cause
- Usually happens in the setting of a seizure
- Risk is higher with more severe epilepsy
What skin disorders are associated with epilepsy?
- Tuberous sclerosis
- Neurofibromatosis
- Sturge Weber Syndrome
What should be included on physical exam in evaluating for an afebrile seizure?
- Fundoscopic exam (evaluate for increased ICP)
- Neurologic exam (full neuro)
- Cardiac (including pulses)
- Skin exam
What diagnosis is associated with Cafe Au Lait Spots?
Are they typical in adults presenting with this condition?
Neurofibromatosis
No, will typically see neurofibromas in adults
What is the neuroimaging study of choice for afebrile seizures?
Is this true if the child presents to the ED?
MRI
CT is often 1st study in the ED
How many EEG’s are ordered in evaluating for seizures in children?
2: both awake and asleep
Are antiepileptic medications commonly prescribed after the first seizure?
No, typically withheld due to high side effect profile
When do febrile seizures typically occur?
Can febrile seizures be the presenting sign of illness?
First day of illness
Yes, and can also present with status epilepticus
What value of elevated fever is associated with febrile seizures?
> 38 C (100.4)
What are the two types of febrile seizures?
How are the differentiated?
Simple febrile seizures and Complex febrile seizures
Simple < 15 minutes and one seizure, Complex > 15 min and multiple
What infections are most commonly associated with febrile seizures?
Human herpes virus 6 and influenza
What is the work-up for febrile seizures?
- Most kids do not need any testing and will return to baseline
- Only get lab work if clinical situation worsens
What are worrisome headache features in kids?
- Awakens the child or occurs upon waking
- Sudden severe headache
- Associated neurologic signs/symptoms (i.e. n/v, AMS, ataxia)
- Chronic progressive pattern
- Abnormal neuro exam
What is the most frequent acute recurrent headache in children?
Migraine Headache
Migraines are classically unilateral, in children where are they most likely located?
Bifrontal or Bitemporal
What is the treatment for pediatric migraines?
- Lie down in a dark room
- Tier 1: Ibuprofen, acetaminophen, or naproxen for pain, caffeine?
- Tier 2: Triptans (prescribed by neuro as there are many rules)
- Tier 3: Combinations
What is the presentation of tension headaches in pediatrics?
Do you need imaging?
- Pressing or tightness, hat band-like pressure
- Mild-moderate pain
- Bilateral
- NOT aggravated by usual activity
No, not usually indicated
Can you see cluster headaches in kids?
Should they worry you?
Yes, between ages 10-20 years old
Yes, usually secondary to other aotonomic findings
NEED MRI
What are the risk factors for cerebral palsy?
What is the most indicative?
- Prematurity (< 28 weeks GA)
- Low birth weight
- Intrauterine growth restriction
- Intrauterine infection
- Multiple pregnancy
Prematurity is number one and associated with the other factors
What two neonatal morbidities are associated with CP?
IVH and PVL (periventricular keukomalacia)
What are the presenting signs of Muscular Dystrophy?
What is Gower Sign?
- Gait disturbances
- Trouble running
- Slow to reach milestones
- Calf pseudo-hypertrophy
- Gower sign
The child assumes the hands-and-knees position and then climbs to a stand by “walking” his hands progressively up his shins, knees, and thighs
What is included in the work-up of Muscular Dystrophy and Becker’s?
What lab value will be elevated?
- Creatine Kinase
- Genetic testing (usually confirms dx)
- Muscle Biopsy (rarely needed due to genetic testing)
CK
What are the most common risk factors for Tourette Syndrome?
Is it more common in girls or boys?
- Low birth weight
- Smoking during pregnancy
Boys
What are the diagnostic requirements of Tourette Syndrome?
Are there any specific lab testing or imaging required?
- 2+ motor tics (i.e. blinking, shoulder shrugging)
- 1+ vocal tics (humming, throat clearing, yelling out word or phrase)
- Tics present for at least 12 months
- Tics onset prior to age 18
- Symptoms are not result of medication or other medical condition
No
What are the sequelae/complications associated with concussion?
- Increased risk of future concussions
- Second impact syndrome
- Post concussion syndrome
- Chronic, posttraumatic encephalopathy
What are red flag symptoms in concussions?
What are the red flag sx in toddlers/infants?
- Drowsiness or inability to wake up
- One pupil larger than the other
- Loss of consciousness
- Repeated vomitting
Any of the sx listed above, plus will not stop crying and won’t eat
What are the indications for imaging in concusions?
- Presenting within 24 hours of injury
- Loss of consciousness > 60 seconds
- Evidence of skull fracture
- Focal neurologic deficit
