Peds Rot Neurology
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| Definition of Temperature | rectal temp 38 or above. 100.4 and greater. Teething does not cause a fever >38.4 (101.12)
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| Fevers less than ___ cause no brain damage | <41.7 (107C)
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| Febrile seizures | are harmless and cause no brain damage. More than 90% are generalized and last less than 5 minutes. Occur in 2-3% of children. Acute respiratory illnesses are most commonly associated with fevers. Roseola is a rare but classic cause.
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| Criteria for febrile seizures | 1) age 3 months to 5 years (most occur between ages 6 and 18 months); 2)Fever of >38.8C (101.8); 3)non-CNS infection
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| Recurrence of febrile seizures | 30%; 50% if under 1 yr of age.
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| EEG of febrile seizures | normal interictal EEG. An EEG can be performed in complicated or unusual febrile seizures and should be done at least a week after the seizure to avoid transient changes from the seizure of illness itself.
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| Tx of febrile seizures | treat underlying illness, fever. Diazepam roally or rectall as needed .3-.5mg/kg/tid during illness for prolonged (>5-15min) seizure.
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| In the event of febrile seizure, ___ must be ruled out. | Meningitis. Sx of meningitis: bulging fontanelle, stiff neck, stupor and irritability (these signs may all be absent in a child younger than 18 months).
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| When should a spinal tap be performed in patients with febrile seizures? | if the child is younger than 18 months, if recovery is slow, if no other cause for the fever is found, or if close follow up will not be possible. Occasionally, observation in the emergency department obviates the need for a tap.
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| Causes of febrile seizures | nonneurologic febrile illness, positive family hx, day care, slow development, prolonged neonatal hospitalizations
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| Positive neurologic signs, especially papilledema are found in which type of headache? | traction and inflammatory (increased ICP)
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| These headaches are pulsatile in character, are located unilaterally or bilaterally in the frontal or temporal regions, and may last from 2 to more than 24 hours. | Migraines. A nonspecific prodrome of decreased or increased appetite and change in mood and temperament may precede the HA by hours or days. Auras are uncommon in children
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| If the neurologic exam is abnl, the next step of evaluating Headaches is | MRI. If MRI is nl, a lumbar puncture may be needed to diagnose pseudotumor cerebri
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| Tx of recurring migraines may include | prophylaxis with propanolol, amitriptyline, cyproheptadine, valproate, or calcium channel blockers
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| What is pseudotumor cerebri? | increased ICP in the absence of an identifiable intracranial mass or hydrocephalus (ruled out by MRI). An obese teenage girl or adult is the typical phenotype. Diagnosis of exclusion
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| Sx of pseudotumor cerebri | HA, tinnitus, visual loss. Associated with a variety of inflammatory, metabolic, toxic, and connective tissue disorders.
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| Tx of pseudotumor cerebri | Aim is to correct the identifiable predisposing condition. Furosemide or acetozolamide may be used to decrease volume. These drugs may be used in combo with repeated lumbar punctures to remove CSF. If not successful and worsening sx, a shunt may be used
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| What is cerebral palsy? | It is a chronic, static impairment of muscle tone, strength, coordination or movements. The term implies that the condition is nonprogressive and originated from some type of cerebral insult or injury before birth, during delivery or perinatal period
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| Neurologic deficits that may be seen in patients with cerebral palsy include | blindness, deafness, epilepsy. Depending on the type and severity of motor deficits, neuro deficits such as seizure (in 50%), mild retardation (26%) and severe retardation (27%). Disorders of language, speech, vision, hearing,&sensory perception may exist
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| The most common type of cerebral palsy | 75% of cases involve spasticity of the limbs. Ataxia is the second most common form affecting 15% of children
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| PE findings in pts with cerebral palsy | spasticity, hyperreflexia, ataxia and involuntary movements. Microcephaly is common. Affected limbs may be smaller and shorter than unaffected limbs
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| The most common cause of death in cerebral palsy pts | aspiration, pneumonia, or other intercurrent infections.
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| Cerebral palsy outcomes | may improve with age. Some pts experience resolution of their motor deficits by age 7
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| Causes of Cerebral palsy | Small for gestational age, intrauterine hypoxia is a frequent cause. Intrauterine bleeding, infxns, toxins, congenital malformations, Obstetric complications,neonatal infxns, neonatal hypoglycemia, metablic disorders, and small number of genetic syndromes
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