Peds NEURO 2 - HA, Cerebral Palsy, Spina Bifida, Chiari Flashcards
MCC of HA
URI due to strep
The following are ___________ causes of HAs
Meningitis, encephalitis, cerebral abscess
Subarachnoid hemorrhage
Increase ICP
life-threatening
What are other causes of HAs?
Toxin/substance abuse
Postictal phase
HTN (*consider pre-eclampsia in adolescent females & nephrotic syndrome)
Psychogenic
Sleep deprivation
What must you ask about when trying to figure out the cause of a child’s HA?
**Ask about pattern, school absences, changes at home**
What are the 4 types of HA patterns?
Acute
Acute Recurrent
Chronic progressive
Chronic Nonprogressive/Daily
Acute HA pattern (single episode w/o prior hx) is usually due to what?
febrile illness
Acute recurrent HA pattern (episodes separated by pain-free intervals) is usually due to what?
typical migraine
tension HA
Chronic progressive pattern (most concerning pattern) is usually due to what?
inc. ICP
Chronic Nonprogressive/Daily pattern (>4 mo or >15 mo) is usually due to what?
psych factors
Most severe on awakening, awaken in middle of night
Severely exacerbated by coughing or bending
Acute onset without previous history
Present daily with progressive worsening
Accompanied with vomiting
Focal neurologic signs
Aggravated by Valsalva-like maneuvers
What do these sx describe?
A worrisome condition
If HA worse when lying flat, think increased _____.
If HA worse when lying flat, think increased ICP
Sx of what?
_**Frequently begins in childhood**_
•Periodic headaches w/vomiting and relieved by rest
Frontal, bitemporal or unilateral pounding/throbbing for 2-72h
Sx relieved by sleep
Possible visual aura 15-30 minutes prior
**N/V, abd pain, phono/photophobia**
Migraines
Step 1 in management of migraines
Eliminate triggers: diet, menses, stress
Inc. exercise & sleep
HA diary
Migraines: Acute treatment?
NSAIDs, acetaminophen
triptans (nasal sumatriptan approved >12 y/o)
antiemetics
When would you use prophylaxis for migraines and what is it?
for kids with frequent, prolonged or disabling HAs
<6yo: cyproheptadine
>6yo: propranolol, amitriptyline (TCA), topiramate, others (PAT)
What is the prognosis for migraines?
Good; improve with time, some may continue to have HAs
Etiology of what condition?
Inc. ICP w/o space-occupying lesion or obstruction
Cause unknown (likely multifactorial)
Pseudotumor Cerebri AKA idiopathic intracranial hypertension (IIH)
Clinical Px of which condition?
MC in females of childbearing age; occurs in peds 11+
Inc. ICP sx: HAs, blurred vision, diplopia, vision loss
HA worse at night, aggravated by sudden movement
neck stiffness, tinnitus, dizziness, paresthesias
Pseudotumor Cerebri (IIH)
What is seen on PE of Pseudotumor Cerebri (IIH)?
What is the main complication of this condition?
PE: Papilledema, abnormal visual field testing
Complication: vision loss
Dx of Pseudotumor Cerebri (IIH)
Diagnosis of exclusion: R/O all other causes of inc. ICP
MRI and MR venography r/o venous sinus thrombosis
LP: inc opening pressue & normal composition
_**IMAGING BEFORE LP**_
Why do we need to image before LP?
inc. ICP may cause cerebral herniation when LP is performed if obstructive hydrocephalus or mass
Pseudotumor Cerebri (IIH) Management
Goal: improve sx and preserve vision
Sometimes sx resolve after diagnostic LP
Pseudotumor Cerebri (IIH) Tx (meds)/surgery/lifestyle
Meds: Acetazolamide, Topiramate
Surgery: Optic nerve sheath fenestration, CSF shunt
Lifestyle: dec. Na+ intake
Non-progressive clinical syndrome characterized by motor and postural dysfunction
Results from brain injury or malformation (before birth, during or after delivery)
What condition is this?
Cerebral Palsy
T/F: CP is often accompanied by other disorders of cerebral function.
TRUE
Intellectual disability (50%), epilepsy, behavioral d/o, sleep d/o
Blindness, deafness, bladder control d/o, others
The following are _______ causes of CP
Prematurity
Intrauterine growth restriction
Intrauterine infection
Antepartum hemorrhage
Severe placental pathology
Multiple pregnancy
Hypoxic brain injury
Stroke
Cerebral dysgenesis
prenatal
The following are _____ causes of CP
Stroke
Kernicterus
Trauma
Near-drowning
Toxins
Hypoxic brain injury
postnatal
What are the 4 major classifications that reflect the area of brain injury in CP?
- Spastic (most common type, 70 – 80%)
- Athetoid/Dyskinetic
- Ataxic (most rare form)
- Atonic
Sx of what type of CP?
UMN lesions/sx
spastic CP (most common type)
Sx of what type of CP?
slow, smooth, writhing movements that involve distal muscles
Athetoid CP
Sx of what type of CP?
decreased spontaneous movement, hypotonia, and suppressed primitive reflexes
Dyskinetic
Sx of what type of CP?
Wide-based gait, intention tremor, slow, jerking movements
Ataxic (most rare form)
Sx of what type of CP?
Severe hypotonia, never stand or walk. May have cerebral dysgenesis, microcephaly, profound intellectual disability
Atonic
Cerebral Palsy Tx
Social and emotional development
Communication
Education
Nutrition
Mobility
Maximal independence in activities of daily living
PT/OT/ST
Cerebral Palsy Prognosis
varies based on severity of dz
This is a description of what condition?
Neural tube disorder (NTD) = defective closure of the caudal neural tube early in gestation (about week 4)
Anomalies may vary depending on degree of closure defect
May be just defect of L5 and S1 vertebral arch
Most severe form results in exposure of meninges & spinal cord
Spina bifida
What type of spina bifida?
Meninges and spinal cord exposed; total paralysis, loss of bowel/bladder control, accompanying Chiari II malformation*
spinal cord is enclosed in the cyst
_**Most serious type of spina bifida**_
Myelomeningocele
What type of spina bifida?
Spinal canal and meninges are exposed, underlying spinal cord is intact
_**2nd most serious type**_
Meningocele
What type of spina bifida?
Skin intact but underlying defects in bone and spinal canal present
May see sinus tract, dimple or tuft of hair.
May have neuro deficits
Discovered only on x-rays or scans & most ppl never become aware of their condition
_**least serious**_
Occulta
Spina Bifida Prevention
Folic Acid supplements pre-pregnancy & during pregnancy
Dx of Spina Bifida
Routine screening for AFP level @ 16-18 wks in maternal serum
US @ 12-14 wks & 18-20 wks
Spina Bifida Management
Surgical closure
VP shunt
Adjunct therapies: Cognitive disabilities, self-catheterization
Almost all patients with a myelomeningocele have the _______________, and most have associated ___________.
Almost all patients with a myelomeningocele have the Chiari II malformation**, and most have associated **hydrocephalus.
heterogeneous group of disorders that are defined by anatomic anomalies of the cerebellum, brainstem, and craniocervical junction, with downward displacement of the cerebellum, either alone or together with the lower medulla, into the spinal canal
What condition does this describe?
Chiari Malformation
What type of Chiari?
downward displacement of medulla & cerebellar tonsils
syringomyelia
Chiari 1
What type of Chiari?
Herniation of the cerebellar tonsils
hydrocephalus
kink in medulla
myelomeningocele
syringomyelia
Chiari 2 (Arnold-Chiari Malformation)
What type of Chiari?
Further herniation of the cerebellum below the foramen magnum forming an encephalocele in addition to spina bifida
Chiari 3
What type of chiari?
hypoplasia/aplasia of the cerebellium with spina bifida
Chiari 4
