Peds Neuro Flashcards
Altered mental status (AMS) in children is characterized by failure to respond to ________________ or ________________ stimulation in a manner appropriate to the child’s developmental level.
verbal, physical
The spectrum of AMS includes
1.
2.
3.
- lethargy- decreased self awareness of self and environment
- Stupor- decreased eye contact, motor activity, can be aroused with noxious stimulation
- comatose- unresponsive, not arousable
*girl just go back to slide 4 for the GCS scale :( *
What are some clinical features of a child with AMS?
fever, HA, head tilt, abdominal pain, weakness, hematuria, weight loss, rash, N/V, drug ingestion, seizures, gait disturbance
T/F every child with AMS needs imaging
false- all with acute AMS with uknown etiology needs to get scanned
In what case would you do a lumbar puncture?
suspected meningitis, encephalitis, to rule out SAH in a negative HCT.
What is the management for hypoglycemia ?
treat hypoglycemia
neonates D10W
children D25W
What is the management for hypo/hyperthermia ?
raising temp TOO quickly is BAD
< 32 degrees C internal and external warming
What is the management for trauma/hemorrhage?
neurosurg consult
protect airway (intubate if GCS is <8)
elevate HOB with head midline
Dont hyperventilate unless herniation is imminent
What is the management for seizures ?
post ictal pts should improve in 2-3 hrs (febrile = 1 hr)
focal deficits indicate a lesion… get HCT
drug levels
manage seizures with benzo x 2 (first line)
What is the management for infections ?
broad spectrum ABX ASAP
HCT
Lumbar puncture (CSF analysis)
What is the management for tumors?
consult neurosurgery/oncology - steroids may help but leave it to them.
What is the management of vascular disease?
hemorrhagic- treat seizures, investigate coagulopathy
ischemic- supportive care, PICU, neruology, heparin if indicated
What is the management of hydrocephalus?
neurosurg consult
no one touches shunt unless on neuro team
What is the management of intoxications?
NARCAN
urine tox screen, APAP, ASA and ETOH
EKG in cardio- active drugs
TOXIC INGESTIONS NEVER LEAD TO UNEQUAL PUPILS
Syncope is transient loss of consciousness and postural tone due to __________________ or _____________.
The three types are
1.
2.
3.
cerebral ischemia, anoxia
- vasovagal, neurocardiogenic (orthostatic, athleticism, breath holding, situational - stress, blood drawing)
- cardiac (obstructive, arrythmia, prolonged QtC)
- nonsyncope mimicker (migraine with confusion or stupor, seizure, hypoglycemia, hysteria, hyperventilation, vertigo)
What is the diagnostic workup for someone with syncope?
hemoglobin should always be checked, EKG, tilt test to check for orthostasis, EEG, neuro consult
Repeated seizures without an acute symptomatic cause or provocation are defined as ____________________. Seizures in children related to fever > ________________________
epilepsy
febrile seizures
Generalized seizures usually associated with _______________ and generalized _________________.
loss of consciousness, motor activity.
tonic posturing, tonic-clonic activity, myoclonus may occur
In those who experience seizures, they tend to only remember the ___________________
convulsive activity
Postictal sleep usually occurs in ______________ and _______________
complex partial, generalized convulsive seizures
What are the treatment options for partial seizures, generalized seizures, and absence seizures.
Partial:
-gabapentin
-lacosamide
- levetiracetam
-lamotigine
-oxcarbazepine
- topiramate
Generalized:
levetiracetam
lamotigine
lacosamide
topiramate
Absence:
lamotigine
Valproic acid
Nonpharm tx for seizures
keto diet, vagus nerve stimulator, corpus callostomy- option for children w drop attacks
AEDs should be continued until the patient is free of seizures for at least ________________. ALL AEDs must be weaned over approx _____________.
1-2 years
6-8 weeks
What are complications and sequelae of seizures?
cognitive delay
depression
injury and death
Sudden unexpected death in epilepsy- nocturnal seizure and die- causes can be due to an irregular heart rhythm or breathing difficulties after a seizure.
Status epilepticus is a seizure lasting at least _______________ or a series of seizures without complete recovery over a ______________ period. After 30 minutes, ___________ and ________ occurs which leads to cerebral edema, high fever, hypotension and respiratory distress
15 minutes, 30 minute.
hypoxia, acidosis
The two most common headaches in children are ______________ and ______________.
migraine, tension
What are the red flag symptoms in children with headaches?
- HA in child <5 years
- new and worsening of HA in healthy child
- worst HA of life
- unexplained fever
- night time or early morning awakenings
- HA worse with straining
- neurological deficit
- postural HA
- neurocutaneous stigmata
How does a migraine and tension HA present in children?
migraine:
episodic
unilateral but can be bilateral in children
throbbing
severe
photophobia/photophonia
N/V
tension:
tight band
dull sensation
episodic or daily
may have photophobia or photophonia but not both
Headaches are labeled as chronic when GREATER than __________ headaches per month for ___________ or more months. ______________ and ____________ are associated with chronic headaches.
15, 3
depression, anxiety
What is the first line treatment for managing headaches?
lifestyle modifications and HA log noting triggers such as stress, sleep deprivation, dehydration, skipped meals, caffeine, specific foods, menstrual cycle.
What is the abortive treatment option for headaches?
triptans
What are preventative meds for headaches?
antiepileptic (topamax), antihypertensive (BB), antidepressants (amitriptyline), antihistamine (cyproheptadine)
____________ is the most common cause of injury in children. A concussion is a brief alternation of _____________ with or without loss of ______________ and is associated with a TBI. Most pts will have a GCS score of _____________.
TBI, mental status, consciousness, 15
What are associated injuries to look for with a TBI?
scalp swelling
c spine injury
CSF rhinorrhea or otorrhea
hemotympanum
racoon eyes
battle sign
What is the diagnostic workup for TBI?
CBC should be serially monitored especially when bleeding suspected. coagulation profile, T& S, toxicology screen if unsure of hx of AMS
- What is the most helpful imaging when it comes to TBI?
- What are the indications of scanning in a patient with a closed head injury?
- What is the management of a patient with a concussion?
- What are complications of concussions?
- CT scan
- Indications:
- anisocoria
- GCS <12
- impact seizure
- amnesia
- progressive HA
- unreliable history
- LOC > 5 mins or uknown LOC
- signs of basilar skull fracture
- repeated vomiting
- cognitive and physical rest- at least a week off.
- epilepsy, cumulative effects of multiple brain injuries, post concussion syndrome (HA, dizziness a few days after a concussion may continue for weeks to a few months), post traumatic headaches, post traumatic vertigo, second impact syndrome (second concussion before s/s of the first have resolved= death)
What are the s/s of meningits?
What labs do you want to run?
fever, malaise, impaired heart, liver, kidney fxn, HA, cranial nerve palsy, STIFF NECK, seizures, focal deficits, bulging frontanelle, papilledema
Labs:
1. CBC
2. LP
-bacterial= high PML, high protein, LOW glucose
-viral =SLIGHT elevation in protein, NORMAL glucose, high lymphocytes
3. PCR positive = herpes
- Which type of meningitis is most dangerous? most common?
- How is bacterial(pts usually systemically ill w bacterial) /viral meningitis transmitted?
- What imaging is done?
- Antibiotic recommendations for bacterial meningitis
- Prognosis/prevention of bacterial and viral meningitis
- most common is viral most dangerous is bacterial
- bacterial- respiratory/throat secretions during close/lengthy contact
viral- fecal contamination of food, water or hands, respiratory droplets. non polio enterovirus is most common. herpes is seen in neonates/infants - CT head prior to tap
- birth - 4 weeks: ampicillin, cefotaxime
4 weeks - 12 weeks: ampicillin, cefotaxime
older than 12 weeks- Vanco, ceftriaxone - bacterial- death can occur in as little as few hours. most people recover but have deficits brain damage, hearing loss, learning disabilities. Protect pts with vaccines- neisseria meningitidis, strep pneumo, H influenza type B
Viral- most pts completely recover within 7-10 days. no vaccines, educate pts on hand washing and avoiding close contact to those who are sick
_____________ is when the baby is limp at birth and may not be able to keep knees or elbows bent. They may also struggle with feeding. It is caused by problem with _______________ or ________________.
hypotonia, muscular, neuro
____________ is when a baby presents with rigid muscles. They have difficulty with ______________ and _______________. They have _____________ when at rest. The primary cause is an injury to the ________ in utero, during birth or following birth.
hypertonia, mobility, flexing, muscle tension, CNS
Cerebral palsy is a disorder that affects the brain and causes ____________________. There’s an area of the brain that becomes paralyzed which leads to either partial or complete _______________.
3 types:
1.
2.
3.
motor deficiency, paralysis
- spastic(most common) > stiffness and problems with moving limbs
- Athetoid- involuntary, uncontrolled movements
- Ataxic- problems with sense of balance, depth-perception, walking
What are risk factors for cerebral palsy?
low birth weight, premature, multiple births, assisted reproductive tech, infections during pregnancy, jaundice and kernicterus, medical conditions of mother, birth complications, infection, injury, problem with blood flow to the brain
What is the treatment for cerebral palsy?
meds for spasticity- isolated (botox) generalized- baclofen, diazepam
OT/PT/Speech
surgery - baclofen pump, rhizotomy (nerve replacement), muscle/tendon release
T/F Cerebral palsy is a condition that tends to progress
F, it is a one time insult/injury
