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CD II - PEDs - Neuro
Terms in this set (68)
macrocephaly/microcephaly dx on growth curve
2 SDs above or below normal (98 and 2nd percentile)
accelerating head size may be related to?
premature closure of cranial sutures
table showing how to test cranial nerves in PEDs
examples of primitive reflexes
disappearance of most primitive reflexes in normal maturation occurs by when?
asymmetry of primitive reflexes may indicate
focal brain or PNS lesions
UMN or LMN?
•Originate in motor region of cerebral cortex or brainstem and terminate at brainstem and spinal cord
UMN or LMN?
•Profound muscle atrophy
•May have sensory disturbances
UMN lesion highlights
increased DTRs and passive tone
when do toes curl down with the babinski reflex?
common causes of HA in PEDs
URI, fever, strep throat, sinusitis, migraine, tension, cluster
life threatening causes of HA in PEDs includes?
•Meningitis, encephalitis, cerebral abscess
which is the most concerning headache pattern in PEDs?
ddx of chronic progressive HA, knowing that this is usually due to increased ICP? how may this present?
Pseudotumor cerebri, brain tumor, hydrocephalus, chronic meningitis, abscess
worse HA when lying flat with ^ ICP
•Frequently begins in childhood
•Periodic headaches accompanied by vomiting and relieved by rest may be migraines
step one in migraine management?
acute tx of migraines
NSAIDs, acetaminophen, triptans (ODT and nasal spray available), antiemetics
which of the following medications may be used for a 4 year old patient with frequent migraines?
propranolol, amitriptyline, topiramate are all meds used for what regarding PEDs HA?
prophylaxis of frequent/disabling migraines in kids older than 6 y/o
PE of pt with pseudotumor cerebri
usually normal except for bilateral papilledema and abnormal visual field testing
sx of pseudotumor cerebri
•Headaches, blurred vision, diplopia, vision loss
•HA are worse at night, aggravated by sudden movement
•May also have neck stiffness, tinnitus, dizziness, paresthesias
dx of pseudotumor cerebri
•Imaging (MRI and MR venography to rule out venous sinus thrombosis)
•Increased opening pressure but normal composition of CSF (cell count, protein, glucose)
•Imaging BEFORE lumbar puncture
medications used to tx pseudotumor cerebri
•Non-progressive clinical syndrome characterized by motor and postural dysfunction
•Results from brain injury or malformation (before birth, during or after delivery)
Higher incidence in preterm infants
postnatal causes of CP include which of the following?
•Intrauterine growth restriction
•Kernicterus (due to hyperbilirubinemia)
(the rest are prenatal)
what are the 4 classifications of cerebral palsy?
MC type of cerebral palsy?
what is the MC neural tube defect?
spina bifida subtypes
most serious type of spina bifida? accompanying malformation?
myelomeningocele; chiari II malformation
prevention of spina bifida
folic acid supplementation
dx of spina bifida
Routine screening w/ maternal serum alpha-fetoprotein (AFP) level (16-18 weeks) and ultrasound (12-14 weeks and 18-20 weeks)
Fetal MRI confirms
part of cerebellum herniates down through foramen magnum
chiari malformation type chart
which type of chiari malformation is associated with myelomeningocele?
what may happen as a complication of surgical correction of myelomengocele?
tethered cord syndrome (TCS)
dx of TCS
urodynamic testing for evaluation of bladder dysfx
examples of causes of acquired hydrocephalus?
possible vitals of PEDs patient with hydrocephalus?
•Vitals - bradycardia, HTN, altered respiration (think brainstem)
what may be seen on PE of PEDs patient with hydrocephalus?
•Increased head circumference, bulging anterior fontanelle, abnormal skull contour, CN dysfunction, papilledema
a mother with diabetes delivers a premature infant presents with lethargy, bulging fontanelle and poor feeding, what medication may provide temporary relief?
hydrocephalus -- loop diuretic or acetazolamide for symptomatic relief
___ is characterized by a progressive degeneration of the anterior horn cells in the spinal cord leading to progressive weakness of lower motor neurons
Spinal Muscular Atrophy (SMA)
dx of spinal muscular atrophy
a 12mo old child presents with progressive "floppiness" with decreased facial expression and drooling with EMG and muscle biopsy performed. which of the following treatments is indicated?
acute idiopathic polyneuritis AKA
guillain barre syndrome (GBS)
causes of GBS
•Post-infectious (respiratory or GI infections)
cytomegalovirus, Epstein-Barr virus, and Mycoplasma pneumonia infections, MCV4/influenza vaccine
MCC infectious precipitant of GBS
clinical presentation of GBS
•Ascending weakness (symmetric; distal to proximal)
•Loss of DTRs early
•+/- sensory symptoms
•May have autonomic nerve dysfunction
•Children - refusal to walk and leg pain are most common presenting symptoms
LP with elevated CSF protein without increased WBC and EMG is involved in the diagnosis of __?
tx of GBS
__% of children have excellent recovery from GBS
DMD big 4 highlights
X linked recessive
absence of dystrophin protein
proximal to distal
which neuro condition is the opposite of GBS in terms of muscle weakness?
DMD (proximal to distal, lower then upper)
3 year old male presents with awkward/waddling gait and calf hypertrophy, what lab value may be elevated?
DMD-- serum creatine kinase
•may prolong or extend independent ambulation by 2.5yrs if started between ages 4-8
•Eteplirsen, deflazacort are newer approved treatments
•Management is largely supportive
important follow up in those with DMD
cardiopulm follow up due to cardiopulm failure in 2nd/3rd decade
MCC of death due to DMD?
pneumonia or CHF
type I neurofibromatosis chromosomal change? More or less common/severe than type II?
MC but less severe (peripheral)
CAFE SPOT mnemonic for __
neurofibromatosis type I
C: café-au-lait spots (greater than six seen during one year)
A: axillary or inguinal freckling
F: fibromas (neurofibroma (two or more) or plexiform neurofibroma (one))
E: eye hamartomas (Lisch nodules)
S: skeletal abnormalities, e.g. sphenoid wing dysplasia, leg bowing
P: positive family history
OT: optic tumor (optic nerve glioma)
when do neurofibromas form in neurofibromatosis type I?
there is a greater incidence of CNS tumors in what neuro condition?
neurofibromatosis type I/II (spinal cord too in II)
complications of NF I
From benign learning disability to MR; may also be associated with seizures, macrocephaly, neuropathy
highlights of neurofibromatosis type II
•Dominantly inherited neoplasia syndrome- rare autosomal dominant disease
•Manifests as bilateral vestibular schwannomas (VIII nerve tumors)
•Vestibular schwannomas virtually never occur in NF type 1
•May appear in childhood w/ loss of hearing
•Café-au-lait spots are NOT part of NF type 2
febrile seizures occur MC in what age group?
peak = 12-18mo
14mo patient with a generalized sz lasting less than 15 minutes, what viral infection may be present?
when should a LP be performed in pt with febrile sz?
fever, nuchal rigidity, AMS
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