Pediatric Neurology Flashcards
1
Q
tissue from which nervous system arises
(and the implication)
A
same tissue as hair, skin, nails
defects in skin, teeth, nails may be sign fo nerologic defects
2
Q
cafe au lait spots sign of…
A
neurofibromatosis
3
Q
ash leaf spot sign of…
A
tuberous sclerosis
4
Q
head circumference:
<3rd %tile or not progressing
or
>97th %tile or rapidly progressing
A
microcephaly / macrocephaly
5
Q
misshapen head
(2 types)
A
plagiocephaly
(postional or craniosynostosis)
6
Q
premature closure of sutures
A
craniosynostosis
7
Q
emergent mishapen head
A
bulging fontonel
(r/o hydrocephalus, meningitis)
8
Q
closing time of anterior & posterior fontanels
A
posterior - a few weeks
anterior - about 15 months
9
Q
imaging for head evaluation
(craniosynostosis, hydrocephalus, detail)
A
- plain film - craniosynostosis
- US - ventricle size to evaluate hydrocephalus
- CT/MRI if fontanel size doesn’t permit US or more detail needed
10
Q
what to check with eye exam
A
red reflex, position/shape, movement
(don’t miss amblyopia or strabismus)
11
Q
cover / uncover test
A
- cover test - heterotropia/ablyopia
- (always deviated)
- normal, fixating eye covered
- observe uncovered eye - focuses
- uncover test - heterophoria/strabismus
- (sometimes dev.)
- one eye covered, other fixates on object
- uncovering causes movement
12
Q
excessive cerebrospinal fluid in CNS
A
hydrocephalus
13
Q
malformation of these vertebrae to varying extent
(spina bifida)
A
L5-S1
14
Q
3 causes of hydrocephalus
A
- obstruction
- mass, stenosis, malformation
- Dandy Walker malformation
- Arnold Chiari malformation
- overproduction of CSF
- Choroid plexus papilloma
- communicating hydrocephalus
- defective reabsorption of CSF
15
Q
sign of hydrocephalus in infant
A
abnormal increase in head circumference
(infant will be protected by head expansion -
CT indicated)
16
Q
4 symptoms of hydrocephalus
&
which ventrical causes symptom
A
- ataxia/spasticity of LE
- d/t expansion of lateral ventricals
- endocrine dysfunction
- d/t 2nd and 3rd ventrical distention
- visual dysfunction
- d/t anterior 3rd ventrical distention
- sunsetting eyes
17
Q
surgical tx for hydrocephalus
A
ventriculoperitoneal shunt
18
Q
benign cause increased intracranial pressure
s/s, dx, tx
A
pseudotumor cerebri
- s/s
- overweight teen
- papilledema
- severe HA
- normal brain imaging
- dx
- increased pressure on LP
- tx
- serial LPs, diuretic, corticosteroids
19
Q
spina bifida -
completely covered, dimple/hair tuft
(what s/s)
A
spina bifida occulta
- bladder incontinence
- recurrent UTI
- recurrent meningitis
US to be sure dimple not open to spinal cord
20
Q
spina bifida -
exposed canal but SC covered by mininges
(what s/s)
A
meningocele
functionally intact
21
Q
spina bifida -
spinal cord completely exposed, not covered by skin, meninges, or bone
(what s/s)
A
myelomeningocele
- total paralysis of legs
- bowel and bladder incontinence
- assoc. with Arnold Chiari defect of brainstem
22
Q
what checked with neonate neurological exam
A
primitive reflexes
23
Q
what checked with infant/child neurological exam
(4 areas)
A
- mental status
- cranial nerves
- motor exam
- sensory exam
24
Q
primitive reflex -
head drop: arms abduct and extend
(when disappears)
A
moro reflex
disappears at 3-6 mo
25
primitive reflex -
infant held vertically will flex/extend legs alternately
(when disappears)
stepping reflex
disappears at 1-2 mo
26
primitive reflex -
palmar and plantar flexion when touched,
open when back stroked
(when disappears)
grasp reflex
disappears at 3 mo
27
primitive reflex
turn head & neck, limbs extend to side face turned
(when disappears)
tonic neck reflex
disappears at 3-4 mo
28
common cause of HA in children
URI, febrile illness
29
uncommon cause of HA in children
familial HA (consider role modeling)
30
common cause of chronic HA in children
anxiety
31
mild, global, squeezing HA
no NAV, photo/phonophobia
(what age group MC)
tension HA
school age and beyond
32
intense pounding/throbbing, localized HA
assoc. w/ NAV, aura, photo/phonophobia
(what age group MC)
migraine HA
most often adolescence (teen),
but can present in toddler
33
Tension HA Tx
* often no tx required
* keep diary it ID triggers
* acetaminophen or ibuprofen
* caution rebound HA w/ frequent NSIADs
34
Migraine Tx
* detailed HA diary to ID triggers
* initial:
* ibuprofen, rest, dark room
* acute tx:
* Triptans (SSR agonists)
* preventive tx (HA \>1/week):
* Cyproheptadine
* Propranolol
* Flunarizine
* Amitriptyline
* Topiramate
* Valproate
* lifestyle modifications: diet, exercise, sleep
* CBT
35
description of seizure in children
any focal or generalized body movement
that can be set to music
36
MC seizure in toddlers & characteristics
febrile seizures
* mostly in ages 1-2
* can occur from 6mo to 6y
* usually in first 24h of febrile illness
* simple or complex
37
Simple Febrile Seizure
| (S/s, Tx)
* S/s
* single episide of gen. tonic clonic activity
* \< 15 min
* no focal features
* brief post ictal period
* Tx
* none needed
38
Complex Febrile Seizure
| (S/s, Tx)
* S/s
* any focal features -OR-
* \> 15 min -OR-
* more than 1 in 24h
* Tx
* consider EEG or Tx
39
Absence Seizures
| (S/s, Tx)
* S/s
* typically school age
* brief "checking out", ADHD, daydreaming
* possible mild focal signs
* lip smacking, eye flutter
* provoked by hyperventilation
* EEG: 3 Hz spike and wave
* Tx
* anticonvulsants
40
seizure of sleep transition
face/arm movements
Rolandic Epilepsy (Benign Focal Epilepsy)
* ages 5-10
* induced by lack of sleep
* Tx: anti-epileptics NOT always indicated
41
jacknife contractions of neck, trunk, arms
(may occur at sleep transitions)
infantile spasm
* peak is 3-8mo
* assoc. w/ tuberous sclerosis (or idiopathic)
* difficult to treat
* assoc. w/ poor intellect, may progress to other seizure types
42
inflammation of the meninges
meningitis
43
2 types of minigitis
* aseptic
* viral, Lyme dz, TB
* septic
* bacterial: H. flu, S. pneumonia, N. menin.
44
Top Neonatal Causes of Bacterial Meningitis
* Group B strep
* E. coli
* Klebsiella
* Enterobacter
these inhabit female vaginal tract - no immunization
45
Top 1mo+ Cause of Bacterial Meningitis
* Strep pneumoniae
* Neisseria miningitides
* H. flu
* G-
46
age/demographic w/ highest rates of meningitis
* \< 1 year old (d/t immunocompetence)
* demographics:
* Native Americans, Alaskan natives, Australian aboriginals (complement fixation)
* immunodeficiency
* asplenia
* CSF leak
* implanted devices (cochlear, VP shunt)
47
5 signs of meningitis
* fever
* irritability
* HA
* **nuchal rigidity**
* Kernig and Brudzinski signs (infant not wanting to be moved)
48
signs to look for w/ newborn meningitis
* maternal fever, +culture for GBS, HSV, others
* \< 48 hours of life
* temp instability
* poor feeding
* irritable, lethargic
* bracycardia, hypotension
* \> 48 hours of life
* seizures
* bulging anterior fontanel
* extensor posturing
* focal cerbral signs: gaze deviation, hemiparesis
* cranial nerve palsies
49
tests for meningitis
* CBC - neutrophilia, left shift
* CSF - cell counts, neutrophil v. lymphocyte, gram stain, protein and glucose levels
* blood, urine, CSF cultures
* PCR of nasopharynx, skin, blood, CSF for virus
50
Tx of pediactric meningitis
* supportive care
* empiric antibiotics
* G+, G-, and antivirals in neonate
* specific Tx when labs return
* consider Rifampin if TB suspected
51
Tx of meningitis survivors
* follow for vision and hearing deficits
* assess development at regular intervals
52
inflammation of brain parenchyma
encephalitis
53
causes of encephalitis in children
* acute or post infection
* immune mediated
* typically viral (HIV common in children)
54
S/s of encephalitis in children
* prodrome of URI symptomes
* fever, HA, progressive lethargy
* neurologic deficits and seizures later
55
Dx of encephalitis
* must r/o meningitis
* CSF analysis:
* lymphocytosis
* protein elevation
* normal glucose
* PCR or specific antibodies of virus
56
Tx of Encephalitis
* supportive care
* antiviral if appropriate
* Acyclovir - HSV, varicella
* Gancyclovir - CMV
* antiretroviral therapy - HIV
57
traumatically induced alteration of consciousness
(with or w/out LOC)
pediatric concussion
58
Concussion S/s
* staring, confusion
* blank expression, blunted affect
* dizziness, vision problems (more significant)
* retrograd/anterograde amnesia min. to days
59
concussion vs. serious head injury
| (signs for CT)
* worsening HA
* changing level of consciousness
* focal changes
* pupillary changes
* single sided weakness
* extended LOC
* bruising behind ears
60
3 factors in concussion return to play
* previous concussions (longer time to recover, sequential evaluations)
* duration of symptoms (must be totally gone)
* severity of symptoms (return to baseline)
61
Hx of repeated brain trauma w/
memory loss, confusion, impaired judgement, aggression, explosive anger
chronic traumatic encephalopathy
62
3 tools to assess concussion
* Glasgow coma scale (\> 14 okay)
* Sport concussion assessment tool (SCAT)
* CDC toolkit online
63
assessment of head injury
* ABCs
* head/neck exam for tenderness and mobility
* facial bones for pain and deformity
* neuro exams:
* eye movement
* coordination and balance
* extremity exam for mobility, weakness, sensation
* CT if GCS \< 13, focal findings, signs incr. cranial pressure
* MRI if prolonged symptoms (delayed bleed)
