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44 Cards in this Set
- Front
- Back
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pediatric neuro exam- history
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1. birth hx: prolonged delivery, preg issues, illnesses
2. developmental hx: nml milestones, special ed classes? 3. FH 4. immunizations 5. PMH 6. allergies 7. Recent travel, illnesses |
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general exam
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-look at them, play with them
-facies? -syndromic appearance? -dysmorphic features? -skin- neurocutaneous lesions |
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Brushfield spots
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- in downs syndrome
-whitish or light grey or brown spots in the eyes |
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Angelman Syndrome
"happy puppet" |
-maxillary hypoplasia
-large mouth -prognathism -mental retardation -autistic features: poor eye contact, speech delay -inappropriate outbursts of laughter -flickering tongue -ataxia gait -15q11-q13 deletion on maternal chromosome |
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Fragil X
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-long, wide protruding ears
-elongated face -flattened nasal bridge -large testes -CGG triplicate repeat -developmental delay -predominately male |
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General congenital malformations
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-possible neural tube defects
-inspection of the spine and lumbo-sacral region of back...look for... 1. sinus tracts/dimples 2. hair tufts 3. raised skin covered bumps 4. Meningocele/ Myelomeningocele/ Encephalocele |
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neural tube defects
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most severe: no brain formation (anencephaly)- do not survive
less severe: partial failure of anterior closure - encephalocele less severe- partial failure of post closure- meningocele, spina bifida -prevention most impt tx! -folate taken before preg! |
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Skin- Sturge-Weber Syndrome
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-neurocutaneous syndrome
-skin can be a reflection of the brain -Facial hemangioma-most freq in V1 and V2 distribution (may be little) -seizures -contralateral hemiplegia -mental retardation (50%) -need MRI |
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Cafe Au lait spots neurofibromatosis type 1
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-large freckles
- in place where "sun doesnt shine"-axillay -deeper color than skin -6+ spots, grow with age |
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neurofibromatosis type 1
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2+ signs:
-cafe-au-lait spots -2 neurofibromas -intertrigonal freckling -sphenoid wing dysplasia or congenital long bone bowing -B/L optic gliomas! (tumors on optic nerve, will lose vision) -2 lisch nodules-pigments in iris, benign -1st degree relative w/NF -epilepsy, learning d/o, hydrocephalus -need MRI or CT |
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Developmental exam
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-Denver developmental screen
-more like playing -remember to correct age of premature babies for testing -There are age defined expected milestones in areas of social, gross motor, fine motor and language |
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M-CHAT (Modified Checklist for Autism in Toddlers)
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-to screen kids for further testing for autism
1. Social interactions: doesn't look at you, has no peer relationships, lack of emotion 2. Communication: lack of expression, lack of imaginative play, cannot make needs known 3. Stereotypies: inflexibility, repetitive movements, restricted interests, preoccupation w/parts of objects |
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Pervasive Developmental Disorders Autism Spectrum Disorders
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-cannot be attributed ot another disorder
-delays or abnml social skills before age 3 -6+ more features for 3 major areas: social impairment, communications impairment, restricted repetitive and stereotyped behaviors |
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Head circumference
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-avg at birth: 35 cm
-inc by 2cm/mo for 0-3 months -inc by 1cm/mo for 3-6 months -premees grow faster |
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Mental status
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1. altertness
2. attentiveness 3. language 4. behavior- interaction with you, parents, siblings 5. enviornment 6. age appropriateness 7. follows commands? |
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Cranial nerves
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1. Eyes-gaze, nystagmus, acuity, visual fields, tracking, fundoscopic
2. olfactory- s/p head trauma 3. CN VII- facial nerve- bells palsy 4. CN III, IV, VI- EOM 5. stick out tongue 6. open-say "aahh" 7. infant- put a gloved finger in the mouth, how well do they suck? |
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Pseudopapilledema
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-pt with farsightedness
-difficulty seeing up close -blurred distance vision -eye fatigue when reading -eye strain -crossed eyes in kids |
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Facial motor pathway
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-upper face muscle have bilateral control
-lower face muscles have only ipsilateral control -worse looking if peripheral lesions (True Bells Palsy) |
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Facial weakness
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-cannot close L eye
-L peripheral CN VII lesion -on LI r/o lyme disease -LP recommended -CT scan first |
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plantar reflex
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-babies will fan out until about 1 yr old
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Guillain-Barre syndrome
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-ascending weakness, no reflexes
-almost always preceding viral illness (EBV, CMV, Herpes, Mumps) or post vaccine (varicella) -monitor for respiratory compromise -miller-fischer variant: descending weakness w/triad of areflexia, ataxia and opthalmoplegia) -tx: TVIG |
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newborn reflexes
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-slides!
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Charcot-Marie-tooth
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-hereditary motor sensory neuropathy
-decreased proprioception and pallesthesia -areflexia -foot drop -flat feet -stork legs -problem with myelination, IB more severe than IA |
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Infant motor and tone
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-look at baby- frog legs, not moving much
-try to lift - arms should flex if nml - they should provide some resistance -head drops back - cant support or lift it |
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-Consider Landau Response
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-(2-3 mo) sustained straightening of head and trunk. Baby can inhibit by 12 months
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Hypertonia
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1. rigidity: resistance to externally imposed movement throughout the range of motion at any speed
2. Spasticity: resistance to externally imposed movement increases with increasing speed of stretch or beyond threshold joint angle 3. Dystonia: Involuntary sustained or intermittent muscle contractions causing twisting and/or abnormal postures. Painful. |
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Wilsons disease
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-liver failure
-hemolytic anemia -low ceruloplasmin -rigidity, dystonia, tremor or tics -kayser-fleischer rings |
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Tic disorder
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-boys>girls
-start as a physiologic act that becomes habituated -most outgrow by adolescence -r/o wilsons, iron-def, thyroid, chronic strep -tx: ignore it |
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Duchenne muscular dystrophy
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-onset 2-4 yrs
-elevated CPK -calf hypertrophy -X-linked recessive -dystrophin content <3% of nml, death ~20 |
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Becker muscular dystrophy
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-onset late childhood
-elevated CPK -calf hypertrophy -x-linked recessive -dystrophin content <20% of nml -less malignant |
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dysmetria
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-poor finger to nose
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station and gait
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Sensory ataxia: stepping gait
Cerebellar ataxia: wide-based Steppage gait: foot drop Spastic hemiparesis: circumduction Spastic paraparesis: scissor gait Dystrophic gat: lordotic w/lateral hip movement (waddle) |
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Headaches
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-episodic, chronic
-when to act quickly: new onset, occipital, wakes me out of sleep, neuro signs |
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Migraines in kids
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-not usually unilateral,hemiplegic
1. photophobia 2. phnophobia 3. N/V 4. dizzines, fatigue 5. vision changes 6. osmophobia- sensitivty to smells 7. FH, missing school, sleep disturbances |
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Migraine txs
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-good sleep, good fluid intake, no caffeine, vitamins, Ca, Mg
-prophylactic tx: antiepileptics, beta blockers, tricyclic antidepressants, Ca channel blockers (>10/mo) -motrin for acute H/A in kids |
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Attention problems
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-consider developmental delay and psychiatric disorders
-dx: connor's or vanderbilt screening tests, neuropsyc eval -classroom interventions first -meds if needed (hyperactivity, impulsivity) -omega 3 supplement |
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Generalized tonic-clonic seizure
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1. Tonic phase: eyes open & roll up, pupils dilate, elbows flex, arms pronate, incontinence
2. clonic phase: generalized movements, frequency slowly decreases, tongue bitting 3. Post-ictal phase: drowsy, confused, lethargic, HA, muscle sorness |
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Tonic seizures
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-flexed/extended, no shaking
-brief |
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Clonic seizured
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-Similar to generalized tonic-clonic seizures in nature
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Absence eplilepsy
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-nml kids
-brief, but can happen many times/day -abrupt recovery -sometimes eyelid flutering |
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infantile spasms
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-serious
-look like flexing or extending body repeatedly -occur in clusters when just waking up -nml and abnml kids -usually before 1 yr old -EEG: hypersarrhythmia- chaotic, high voltage discharges -tx: ACTH, Vigabatrin |
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Simple partial seizure
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-no loss of consciouness
-can be motor seizures, automatisms -can be sensory -flashbacks -abd discomfort, bradycardia, drooling, hair on end -gelastic- bursts of laughter |
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Complex partial
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-loss of consciousness
-temporal > frontal > parietal/occipital -can start as simple partial -automatisms (lip-smacking, gum chewing, nose wiping, buttoning) -can occur with absence -side opposite of focus -may evolve into generalized |
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Febrile seizures
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-6mo - 6 yrs old
-generalized tonic-clonic but may be focal -occur with febrile illness -determine cause for fever and tx if needed |
