PEDS Neuro

Question 1

Management of Simple Febrile Seizures

Answer 1

Education - seizure precautions

Reassurance

Evaluate cause of fever

No role for MRI, CT imaging, LP or EEG

Question 2

NEXUS Criteria for evaluation of cervical spine injury

Answer 2

1. Neurological deficits
2. Spinal tenderness (midline)
3. Altered mental status
4. Intoxication
5. Distracting injury - injury in other part of body that is severe enough to distract from potential neck pain

**if any of the above are present, should get C-spine XR; if none of above are present, imaging can be deferred

Question 3

Erb-Duchenne Palsy vs Klumpke paralysis

Answer 3

• injury at the level of C5-C6
• pt holds the affected arm internally rotated and adducted with pronation of the forearm but usually with preserved hand grasp and forearm extension. All of these patients will have an asymmetrical Moro reflex
• KLUMPKE Paralysis - C7-C8 and T1; in addition to above, you can have hand paralysis and ipsilateral ptosis & miosis (Horner syndrome) –> worse prognosis

Question 4

Neuropraxia

Axonotmesis

Neurotmesis

Avulsion

Answer 4

Neuropraxia = damage to the nerve sheath; best chance of complete recovery.

Axonotmesis = axonal rupture with intact sheath

Neurotmesis = in which both the axon and the sheath are disrupted.

The worst prognosis occurs with avulsion of the nerve from the spinal cord, sometimes with damage to the spinal cord itself.

Question 5

Good prognostic factors in Brachial plexus injury

Answer 5

• the presence of hand grasp
• recovery of antigravity movement in the biceps, triceps, and deltoid by 3 months of age
• the presence of Horner syndrome predicts a worse outcome.

** critical period - if no improvement or recovery occurs by age 3 - 9 months, may require surgical intervention

Question 6

Chemotherapy-induced neuropathy

Answer 6

• usually peripheral neuropathy
  
  • reduced distal vibratory sensation
• can affect dorsal column
• motor neuropathy
  
  • distal weakness
  • loss of muscle bulk

Similar findings can be seen with: autoimmune diseases, heavy metals and other toxins, chemotherapeutic and other medications, vitamin deficiencies (B1, B6, B12, E), and endocrine disorders

Question 7

Tx. acute dystonic reaction

Answer 7

• IV anticholinergic medication, ex. benadryl for acute
• for chronic dystonia, can use anticholinergic benztropine

Question 8

Characteristics: Juvenile Myoclonic epilepsy

Answer 8

• Adolescent-onset, generalized tonic-clonic seizures occurring in the morning and with sleep deprivation

Question 9

Furrowing of the tongue associated with facial weakness

Answer 9

Melkerson-Rosenthal syndrome

• recurring/alternating hemifacial weakness/paralysis
• swelling of the face and lips (upper lip)
• development of folds and furrows in the tongue

** onset in childhood/early adolescence