Pediatric Neurology Flashcards

1
Q

What are common etiologies of neonatal seizures?

What defines the neonatal period for neonatal seizures?

A
  • Electrolyte disturbances
  • Bleeding
  • Infection
  • Inherited disorders
  • Malformations
  • Drugs

Birth to 8 weeks (about 4 weeks after the first 30 days, which is normal

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2
Q

What are common causes of seizures in children?

A
  • Electrolyte disturbance
  • Ingestion of toxins
  • Trauma/intracranial bleeding
  • Meningitis
  • Fever
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3
Q

Is a seizure in a child diagnostic for epilepsy?

What defines epilepsy?

A

No

Epilepsy is recurrent, unprovoked seizures

Epilepsy: characterized by recurrent (2+) epileptic siezures, unprovoked by any immediate identified cause, at least > 24 hours apart

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4
Q

Generalized seizures are defined as motor (convulsive) or non-motor

What are the types of motor (convulsive) seizures?

A
  • Tonic-clonic (most common)
  • Clonic
  • Tonic
  • Myoclonic
  • Atonic
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5
Q

Generalized seizures are defined as motor (convulsive) or non-motor

What are the types of non-motor (non-convulsive) seizures?

A
  • Typical
  • Atypical
  • Myoclonic
  • Eyelid myoclonic
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6
Q

Are febrile seizures and neonatal seizures included in the classification of epilepsy?

A

No, they are excluded as there is usually an identified cause

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7
Q

What is the most common seizure disorder of childhood?

What is the median age of diagnosis and why?

A

Absence Seizures

6 years is the median onset, most between 4-10 years old

Most likely diagnosed after starting school

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8
Q

What is the presentation of typical absence seizures?

A
  • 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
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9
Q

What is the first line treatment for absence seizures?

Do patients with typical absence seizures require lifelong treatment?

A
  • Ethosuximide (Zarontin) BID: first line
  • Valporic acid
  • Lamotrigine

No, may only require a few years of treatment

Patients with atypical require lifelong treatment

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10
Q

After a seizure, when should the child be evaluated by pediatric neurology?

A

Within 2 weeks

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11
Q

What is sudden enexpected death in epilepsy (SUDEP)

A
  • 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
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12
Q

What skin disorders are associated with epilepsy?

A
  • Tuberous sclerosis
  • Neurofibromatosis
  • Sturge Weber Syndrome
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13
Q

What should be included on physical exam in evaluating for an afebrile seizure?

A
  • Fundoscopic exam (evaluate for increased ICP)
  • Neurologic exam (full neuro)
  • Cardiac (including pulses)
  • Skin exam
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14
Q

What diagnosis is associated with Cafe Au Lait Spots?

Are they typical in adults presenting with this condition?

A

Neurofibromatosis

No, will typically see neurofibromas in adults

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15
Q

What is the neuroimaging study of choice for afebrile seizures?

Is this true if the child presents to the ED?

A

MRI

CT is often 1st study in the ED

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16
Q

How many EEG’s are ordered in evaluating for seizures in children?

A

2: both awake and asleep

17
Q

Are antiepileptic medications commonly prescribed after the first seizure?

A

No, typically withheld due to high side effect profile

18
Q

When do febrile seizures typically occur?

Can febrile seizures be the presenting sign of illness?

A

First day of illness

Yes, and can also present with status epilepticus

19
Q

What value of elevated fever is associated with febrile seizures?

A

> 38 C (100.4)

20
Q

What are the two types of febrile seizures?

How are the differentiated?

A

Simple febrile seizures and Complex febrile seizures

Simple < 15 minutes and one seizure, Complex > 15 min and multiple

21
Q

What infections are most commonly associated with febrile seizures?

A

Human herpes virus 6 and influenza

22
Q

What is the work-up for febrile seizures?

A
  • Most kids do not need any testing and will return to baseline
  • Only get lab work if clinical situation worsens
23
Q

What are worrisome headache features in kids?

A
  • 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
24
Q

What is the most frequent acute recurrent headache in children?

A

Migraine Headache

25
Migraines are classically unilateral, in children where are they most likely located?
Bifrontal or Bitemporal
26
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
27
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
28
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 ## Footnote NEED MRI
29
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
30
What two neonatal morbidities are associated with CP?
IVH and PVL (periventricular keukomalacia)
31
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 ## Footnote 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
32
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
33
34
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
35
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
36
What are the sequelae/complications associated with concussion?
* Increased risk of future concussions * Second impact syndrome * Post concussion syndrome * Chronic, posttraumatic encephalopathy
37
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
38
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