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Pediatrics > Pediatric Neurology > Flashcards

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
Q

Migraines are classically unilateral, in children where are they most likely located?

A

Bifrontal or Bitemporal

26
Q

What is the treatment for pediatric migraines?

A
  • 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
Q

What is the presentation of tension headaches in pediatrics?

Do you need imaging?

A
  • Pressing or tightness, hat band-like pressure
  • Mild-moderate pain
  • Bilateral
  • NOT aggravated by usual activity

No, not usually indicated

28
Q

Can you see cluster headaches in kids?

Should they worry you?

A

Yes, between ages 10-20 years old

Yes, usually secondary to other aotonomic findings

NEED MRI

29
Q

What are the risk factors for cerebral palsy?

What is the most indicative?

A
  • 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
Q

What two neonatal morbidities are associated with CP?

A

IVH and PVL (periventricular keukomalacia)

31
Q

What are the presenting signs of Muscular Dystrophy?

What is Gower Sign?

A
  • 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

32
Q

What is included in the work-up of Muscular Dystrophy and Becker’s?

What lab value will be elevated?

A
  • Creatine Kinase
  • Genetic testing (usually confirms dx)
  • Muscle Biopsy (rarely needed due to genetic testing)

CK

33
Q
A
34
Q

What are the most common risk factors for Tourette Syndrome?

Is it more common in girls or boys?

A
  • Low birth weight
  • Smoking during pregnancy

Boys

35
Q

What are the diagnostic requirements of Tourette Syndrome?

Are there any specific lab testing or imaging required?

A
  • 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
Q

What are the sequelae/complications associated with concussion?

A
  • Increased risk of future concussions
  • Second impact syndrome
  • Post concussion syndrome
  • Chronic, posttraumatic encephalopathy
37
Q

What are red flag symptoms in concussions?

What are the red flag sx in toddlers/infants?

A
  • 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
Q

What are the indications for imaging in concusions?

A
  • Presenting within 24 hours of injury
  • Loss of consciousness > 60 seconds
  • Evidence of skull fracture
  • Focal neurologic deficit

Pediatrics (16 decks)

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