Peds - Neuro Flashcards
Mechanisms of headache pain (4)
o VASCULAR dilation - migraine, fever
o MUSCULAR contraction - tension
o TRACTION - space-occupying lesion - tumor, hematoma, ICP
o INFLAMMATION - infection
OLD CARTS
Onset Location Duration Characteristics Aggravating Relieving Treatment Severity
Diagnostic testing for headache with fever
when meningitis is suspected
Lumbar puncture –> CSF analysis
CSF findings in meningitis (4)
o cloudy
o WBCs present
o increased protein – bacteria are protein
o decreased glucose – bacteria eat sugar
Differential for headache which is worst in the morning followed by vomiting, usually increasing in frequency.
brain tumor
Caution when considering lumbar puncture.
Do not perform if any suspicion of ICP. May cause brain herniation. :-(
Which type of migraine has an aura?
classic
Which type of migraine has NO aura?
common
Is migraine unilateral or bilateral?
unilateral and localized
What age does classic (w/ aura) migraine usually occur?
> 10 years old
When should prophylactic therapy be used for migraine?
when occurring more than 3-4 times per month or are interfering with work or school
Typical age range for bacterial meningitis?
1 month to 5 years
Typical age range for brain tumor in children?
4 to 11 years
Typical location for brain tumor in children?
infratentorial, brain stem tumors
lots of space to grow undetected
Migraine baseline studies
4 bw + 1 imaging
For exclusion of other causes -- CMP - complete metabolic panel CBC - complete blood count (r/o anemia) VDRL - venereal disease research (r/o syphilis) ESR - erythrocyte sedimentation rate CT - cat scan
Agents used for prophylaxis of migraine (5)
o NSAIDS - chronic low dose o propanalol (Inderal) -- beta blocker o amatriptyline (Elavil) -- antidepressant o imipramine (Tofranil) -- antidepressant o topiramate (Topamax) -- antiepileptic o verapamil (Calan) -- calcium channel blocker
Management of acute migraine
o NSAIDS
o -triptans
These drugs are examples of what class?
Imitrex
Maxalt
Axert
Zomig
TRIPTANS
almotriptan
rizatriptan
sumatriptan
zolmitriptan
Caution for use of triptans?
avoid in children at risk for HEART DISEASE because they can cause heart block
A transient disturbance of cerebral function due to abnormal paroxysmal neuronal discharge in the brain.
Seizure disorder
Which type of seizure occurs in only one hemisphere?
partial seizures
Variant syndromes of migraine in children usually involve what?
The abdomen - nausea, vomiting
Which triptan is limited to those age 12 and up?
almotriptan (Axert)
Which triptan is available as a nasal spray?
zolmitriptan (Zomig)
When should triptans be taken?
At the first sign of headache
What are the two overarching categories of seizures?
Partial
Generalized
What are the two types of partial seizures?
simple partial
complex partial
Which type of partial seizure involves the loss of consciousness?
complex partial
What are the four types of generalized seizures?
Absence
Tonic
Tonic-clonic
Atonic
Which category of seizures involves both hemispheres of the brain?
generalized seizures
What are some potential causes of seizures? (6)
o congenital o metabolic o trauma o tumor o infectious o fever
What are some symptoms of a simple partial seizure?
motor
autonomic
sensory
** NO loss of consciousness **
Which seizure exhibits a sudden increase in muscle tone producing a number of characteristic postures?
Tonic
Is consciousness lost during a TONIC seizure?
It may or may not be
Which seizure is characterized by a sudden loss of consciousness, arrested respirations, and increased muscle tone followed by bilateral rhythmic jerks?
Tonic-clonic
Which type of seizure is characterized by sudden loss of muscle tone, often resulting in head drop or fall to the ground?
Atonic
What drug class is used to stop convulsive seizures?
benzodiazepines
o lorazepam (Ativan) o diazepam (Valium)
Peak incidence of febrile seizure?
1 to 3 years
When is an-illness related seizure more likely due to infection than fever?
> 24 hours after the onset of the fever
A progressive, autosomal dominant, neuro-cutaneous syndrome characterized by numerous cafe au lait spots and nerve tumors
Neurofibromatosis / von recklinghausen disease
Neuro-fibromatosis –
Typical signs and symptoms (6)
o multiple cafe au lait spots o seizures o neurofibromatomas o axillary or inguinal freckling o lisch nodules o distinctive osseous lesions
Medications which may be associated with tics. (3)
o methylphenidate
o pemoline
o amphetamines
Distinction of complex from simple motor tics
complex include VOCAL tics
The most common type of headache with onset in adolescence is:
tension
