Pediatrics Flash Cards - Case 20 - Headache
Headaches that occur after a period of recumbency (e.g. morning awakening) think?
incr ICP
Headache red flag ROS?
standing from recumbancy, forceful vomiting, awakens you from sleep, cough/valsalva worsens it, photophobia+fever
Dennie’s lines?
Infraorbital transverse creases and are associated with mild chronic inflammation of the conjunctivae, as in allergic conjunctivitis
DDx of acquired ataxia in school-aged child?
post-infectious cerebellitis, infectious cerebellitis, med/toxin, intracranial mass, Opsoclonus-myoclonus syndrome (paraneoplastic syn usu. w/ neuroblastoma), migraine HA, hydrocephalus, metabolic derrangement (E.g. MSUD or pyruvate decarboxylase def), neurodegenerative dz (e.g. ataxia-telangectasia or Fredrich’s ataxia), psychiatric dz
Pts w/ cerebellar lesions tend to fall (towards/away from) the side of the lesion?
toward
Pts w/ cerebellar lesions tend to have nystagmus (towards/away from) the side of the lesion?
towards
which imagine modality is best at visualizing the posterior fossa?
MRI»_space; CT
Top four most common types of brain tumors in children?
Medulloblastoma (20%),; Juvenile pilocytic astrocytoma (20%); Lo-grade astrocytoma (15%); Hi-grade astrocytoma (7%)
Brainstem gliomas: Px and TX?
prognosis highly variable based on invasiveness; tx is surgicaly resection only
Ependymomas: presenting S/Sx, Prognosis and Tx?
Grow near 4tyh ventricle so s/sx of hydrocephalus; 5-yr surv rate is %50; tx is resection then radiation
In which age groups are infratentorial vs. supratentorial tumors more common?
Supra (0-2 y/o) -> Infra (childhood) Supra -> (adolescents and adults)
Astrocytoma of the cerebellum: Prognosis and Tx?
> 90% 5-yr if completely resected, less if partial; if complete resection, no rad needed; otherwise partially resectable and/or hi-grade neoplasms get surg + rad
Medullublastoma: prevalence, Prognosis and tx?
Along w/ infratentorial neuroectodermal tumors, the most common brain tumor of childhood. Can disseminate and prog is based on degree of metastasis. Tx involves surf + rad +chemo, usually
Migraine prophylaxis in children?
TCAs
Classic presentation, work-up findings and patient population commonly seen with pseudotumor cerebri.
presents w/ ICP sx—HA, nausea, blurred vision, diplopia, photophobia, and tinnitus—in the absence of intracranial mass. CT/MRI will be neg, but LP opening pressures are up. Typically occurs in obese women of childbearing age; median dx age ~30 y/o. Cause unknown, but risk factors = OCPs, GH, excess vit A, and discontinuing steroids
