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PHA 581 > Peds: Neurology > Flashcards

Peds: Neurology Flashcards

1
Q

Evolution of Symptoms

A

static
progressive
intermittent
saltatory

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2
Q

Evolution of Symptoms: static

A

seen in first few months
does not change over time

congenital abnormalities/brain injury (CP)

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3
Q

Evolution of Symptoms: progressive

A

degenerative disease/neoplasm

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4
Q

Evolution of Symptoms: intermittent

A

epileptic/migraine syndromes

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5
Q

Evolution of Symptoms: saltatory

A

bursts of sx followed by partial recovery

vascular, demyelinating d/o

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6
Q

Midline defects (tufts of hair, lipomas, dimpling) may indicate…

A

spina bifida

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7
Q

Head Circumference: accelerating pattern

A

possible hydrocephalus

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8
Q

Head Circumference: decelerating pattern

A

possible degenerative neurologic disorder

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9
Q

Head Circumference: abnormal shape

A

craniosynostosis (premature suture closure)

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10
Q

Lower Motor Neuron Lesion

A 
FLACCID PARALYSIS
dec tone
ABSENT DTRs
profound muscle atrophy
FASICULATIONS PRESENT
sensory disturbances

strength: weakness
tone: dec passive tone

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11
Q

Upper Motor Neuron Lesion

A 
SPASTIC PARALYSIS
inc tone
INC DTRs/+ babinski; w/ clonus
minimal muscle atrophy
FASICULATIONS ABSENT
sensory disturbances

strength: stiffness
tone: inc passive tone

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12
Q

Babinski Reflex:

  • neonate response
  • older children response
A

variable

toes down is normal after 18mo

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13
Q

Headaches: MCC

A

URI (strep)

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14
Q

Headache Pattern: acute

A

single episode w/out prior hx

usually due to febrile illness

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15
Q

Headache Pattern: acute recurrent

A

pattern of episodes separated by pain free intervals

migraine, tension HA pattern

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16
Q

Headache Pattern: chronic progressive

A

MOST CONCERNING PATTERN

inc ICP

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17
Q

Headache Pattern: chronic nonprogressive/daily

A

> 4mo or >15/mo

possible psych factors

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18
Q

Headaches: worrisome symptoms

A
  • 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
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19
Q

Headaches: when is imaging indicated

A

abnormal neurologic exam

concern for space occupying lesion

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20
Q

Headaches: if worse when lying flat, think …

A

inc ICP

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21
Q

Migraine:

  • onset of sx
  • what is it
A

begins in childhood

periodic HA w/ vomiting and relieved by rest

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22
Q

Migraine: pediatric symptoms

A

frontal, bitemporal, unilateral pouding/throbbing for 2-72hrs
relieved by sleep
visual aura 15-30min prior
N/V, abd pain, phono/photophobia

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23
Q

Migraine: management

  • step one
  • acute tx
  • prophylaxis
A

eliminate triggers (diet, menses, stress)

inc exercise, adequate sleep

acute tx: NSAIDs, APAP, triptans (>12yo), antiemetics

prophylaxis:
<6: cyproheptadine
>6: propanolol, amitriptyline, topiramate

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24
Q

Pseudotumor Cerebri:

  • aka
  • what is it
  • MC population
A

idiopathic intracranial hypertension

inc ICP WITHOUT space occupying lesion/obstruction

females of child bearing age (peds: adolescents 11+yo)

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25
Pseudotumor Cerebri: presentation
``` HA (worse at night, aggravated by sudden mvmt) blurred vision diplopia vision loss PAPILLEDEMA ``` neck stiffness, tinnitus, dizziness, paresthesias
26
Pseudotumor Cerebri: diagnosis
r/o other causes of inc ICP | MR --> LP
27
Pseudotumor Cerebri: management
LP (may resolve sx) medication (acetazolamide, topiramate) surgery (optic nerve sheath fenestration, CSF shunt) dec salt intake
28
Cerebral Palsy: - what is it - comorbidities
- non progressive clinical syndrome w/ motor and postural dysfunction - results from brain injury/malformation (before, during, after birth) intellectual disability, epilepsy, behavioral d/o, sleep d/o, blindness, deafness, bladder control d/o **higher incidence in preterm infants
29
Cerebral Palsy: 4 major classifications
spastic athetoid/dyskinetic ataxic atonic
30
Cerebral Palsy: spastic
MC | UMN lesion/sx
31
Cerebral Palsy: athetoid/dyskinetic
athetoid: slow, smooth writhing mvmt involving distal muscles dyskinetic: dec spontaneous mvmt hypotonia suppressed primitive reflexes
32
Cerebral Palsy: ataxic
rarest wide based gait intention tremor slow jerking mvmts
33
Cerebral Palsy: atonic
sev hypotonia never stand/walk may have cerebral dysgenesis, microcephaly, profound intellectual disability
34
Cerebral Palsy: - treatment goals - approach
``` Social and emotional development Communication Education Nutrition Mobility Maximal independence in activities of daily living ``` multidisciplinary approach (PT, OT, ST, etc)
35
Spina Bifida: what is it
neural tube disorder associated w/ folic acid defective closure of caudal neural tube in early gestation (wk4)
36
Spina Bifida: Myelomeningocele
meninges and spinal cord exposed total paralysis loss of bowel/bladder control w/ chiari II malformation
37
Spina Bifida: Meningocele
spinal canal and meninges exposed | underlying spinal cord intact
38
Spina Bifida: Spina Bifida Occulta
MC skin intact but underlying defects in bone, spinal canal sinus tract, dimply, tuft of hair neuro deficits
39
Spina Bifida: prevention
folic acid supplementation
40
Spina Bifida: diagnosis
routine screening w/ - AFP (16-18wks) - US (12-14wks, 18-20wks)
41
Spina Bifida: management
surgical closure VP shunt adjunct supportive therapy
42
What is the relationship between Chiari II, Myelomeningocele & Hydrocephalus?
Almost all patients with a myelomeningocele have the Chiari II malformation, and most have associated hydrocephalus
43
Hydrocephalus: - what is it - etiology
slowly evolving accumulation of CSF (wks-mos) congenital or acquired
44
Hydrocephalus: presentation
HA, vomiting, AMS, visual changes, ocular nerve palsies, focal neurologic findings infants: nonspecific vomiting, lethargy, irritability, bulging fontanelle, poor feeding bradycardia HTN altered respiration ``` inc head circumference bulging anterior fontanelle abnormal skull contour CN dysfunction papilledema ```
45
What is a classic sign of hydrocephalus?
looking down (EOM/eyes displaced by pressure)
46
Hydrocephalus: treatment
temp, sx relief: - loop diuretic - acetazolamide surgery (remove obstruction, VP shunt)
47
Spinal Muscular Atrophy: what is it
homozygous deletion of exon 7 of SMN1 (autosomal recessive) progressive degeneration of ant horn cells --> progressive weakness of LMN
48
Spinal Muscular Atrophy: presentation
progressive proximal weakness dec spontaneous mvmt floppiness loss of head control loss of leg mvmt dec facial expression and drooling normal mental, social, language skills sensation preserved
49
Spinal Muscular Atrophy: diagnosis
EMG muscle biopsy DNA testing
50
Spinal Muscular Atrophy: management
no treatment | symptomatic therapy
51
Guillain Barre Syndrome: - aka - what is it
acute idiopathic polyneuritis acute immune mediated polyneuropathy
52
Guillain Barre Syndrome: presentation
acute paralyzing illness provoked by preceding infx ASCENDING SYMMETRIC WEAKNESS sensory sx early loss of DTRs autonomic nerve dysfunction peds: REFUSAL TO WALK, LEG PAIN
53
Guillain Barre Syndrome: etiology
post infectious (resp or GI infx -- MC: campylobacter jejuni)
54
Guillain Barre Syndrome: diagnosis
LP (inc CSF protein w/o inc WBC) | EMG
55
Guillain Barre Syndrome: treatment
IVIG | plasmapheresis
56
Duchenne Muscular Dystrophy: what is it
x linked recessive (boys) | absence of dystrophin protein
57
Duchenne Muscular Dystrophy: presentation
``` onset: 3yo awkward gait slower dev of milestones mild cognitive dev global dev delay ``` calf hypertrophy (toe walking) proximal leg/pelvic weakness GOWER'S SIGN prox --> distal lower --> upper
58
Duchenne Muscular Dystrophy: diagnosis
muscle bx EMG serum CK (elevated) genetic testing
59
Duchenne Muscular Dystrophy: treatment
glucocorticoids supportive close pulm and cardio follow up **risk of cardio pulm failure in 2nd-3rd decade of life
60
Duchenne Muscular Dystrophy: prognosis
wheelchair bound by 12yo loss of UE mvmt by 16yo death by PNA/CHF in early 20s avg lifespan: 25yrs
61
Neurofibromatosis: what is it
genetic disorder in which nerve tissue grows tumors --> nerve/brain damage
62
Neurofibromatosis: types
type 1: chromosome 17 peripheral skin, brain abn ``` type 2: chromosome 22 central spinal cord abn more sev incurable ```
63
Neurofibromatosis Type 1: presentation
CAFE AU LAIT SPOTS neurofibroma (late adolescence) CNS tumors (astrocytomas, meningiomas, schwannomas) cognitive impairment
64
Neurofibromatosis Type 1: treatment
surgical excision of tumors | genetic counseling and screening (50% risk to sibs)
65
Neurofibromatosis Type 1: complications
``` seizures deafness short stature early puberty HTN optic glioma ```
66
Neurofibromatosis Type 2: presentation
B vestibular schwannomas (CNVIII tumors) childhood loss of hearing meningiomas, CN schwannomas, ependymomas
67
Febrile Seizure: what is it
age dependent phenomenon (6mo-5yr) generalized seizure <15min doesn't recur during 24hr period associated w/: viral infx high fever
68
What is the MC neurologic disorder of infants and young children?
febrile seizures
69
Febrile Seizure: - diagnosis - treatment
clinical diagnosis IV benzos/buccal midazolam (if >5min)

PHA 581 (6 decks)

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