Week 4 - Neuro Flashcards
Diagnostic criteria for migraine
More than 5 attacks with a 2–72-hour duration
At least two of the following:
- Bilateral/unilateral
- Pulsating
- Moderate to severe – worse with activity
- n/v or photo/phonophobia
- not attributed to another disorder
Physical exam for possible migraine
- Blood pressure, height and weight, and head circumference (all ages)
- Vision screen
- Eyes: Palpate for tenderness; check for papilledema, movements
- Ears: Patency of canals, normal tympanic membranes
- Neck: Palpate muscles; check range of motion for nuchal rigidity
- Sinuses (frontal and maxillary)
- Teeth and temporomandibular joints (mouth and jaw): Palpate and check range of motion
- Thyroid gland
- Bones and muscles of skull: Palpate for tenderness; listen for cranial bruits; check range of motion of cervical spine
- Extremities: Tandem gait
- Nerves: Palpate supraorbital, trochlear, occipital nerves; assess CN IX to CN XII
- Reflexes: Pronator drift test (Romberg)
Diagnostics for migraine
MRI within 2-4 weeks
Hemoglobin/iron and vitamin D for persistent headaches
Treatment for migraine in children
- NSAIDS
- Zofran
- Abortive medications - sumatriptan and zolmitriptan (only two tested for children)
- Avoid using medication more than 3 times per week to avoid overuse headaches
- Prophylactic therapy for children having 3-4 migraines per week
a. β-blockers (propranolol), antidepressants (amitryptilene), anticonvulsants (divalproex sodium), or calcium channel blockers
Migraine education for patients
- Headache plan
- Headache diary
- Identify triggers
- Nutrition and not skipping meals
- Hydration
- Sleep
- Exercise
- School
- Limit electronic use
- Stress
Red flags for secondary/pathological headaches
- Headache upon awakening from sleep that then fades; increases in frequency and severity over a period of only a few weeks; is persistent and unilateral
- First or worst headache
- Pain that awakens the child from sleep
- Vomiting but not nauseated that may relieve the headache, or intractable vomiting
- Visual disturbances, diplopia, edema of the optic disc (papilledema)
- Increased pain with straining, sneezing, coughing, defecation, or changes in position
- Occipital region and neck pain
- Educational, mental, personality, or behavioral alterations; irritability
- New onset seizures or facial or extremity numbness
- Unsteadiness or dramatic changes in balance, gait abnormalities
- Fever with or without nuchal rigidity
- Family history of neurologic disorders (e.g., brain tumors, neurofibromatosis, vascular malformations)
- Child has a history of a ventriculoperitoneal shunt, meningitis, hydrocephalus, tumor, or prior history of a malignancy.
Concussion
iMild traumatic brain injury is an alteration in mental state that results from injury to the head. Brain collides with the skull during traumatic injury or when it bounces back. Injury caused to the neurons which causes symptoms
Concussion symptoms
- Vacant stares
- Disorientation
- Inability to focus
- Memory impairment
- Slurred speech
- Stumbling
- May or may not involve loss of consciousness
Treatment for concussion
Symptoms typically resolve on their own in a few months
- Refrain from exercise, reading, TV, video games
- Gradual return to school
- Avoid sports until symptoms resolve
Concussion MNM
- Concussions can cause serious brain injury. The following symptoms warrant immediate treatment including:
- neck pain or tenderness
- double vision
- numbness, tingling, weakness in extremities
- severe or worsening headache
- seizure
- loss of or deteriorating consciousness
- vomiting
- agitation, confusion, or combativeness
Cerebral palsy
Group of neurological disorders that affect body movement and coordination
Cause is unknown – may be caused by genetic mutations, lack of oxygen or trauma during fetal development causing neuron damage and lesions.
Symptoms of cerebral palsy
- Spastic muscles, permanent muscle shortening, muscle spasms, paralysis. Speech, cognition and sense perception may also be affected.
- Damaged white matter around the ventricles
Hydrocephalus
A neurological disorder caused by an abnormal buildup of cerebrospinal fluid in the ventricles (cavities) deep within the brain
Causes of hydrocephalus
- congenital
- hemorrhage, cerebral trauma, infection or mass, idiopathic
Clinical features of cerebral palsy
- altered level of consciousness,
- headaches,
- Nausea
- vomiting, which is worse in the morning
- new onset estropia, diplopia
- gait disturbance
