Nervous System Spinal/Cord Injuries
Headaches Migraines
Head injury
Encephalitis
Seizures and epilepsy
Hydrocephalus
Gliomas
Medulloblastoma
Neuroblastoma
100
Name the 2 components of the nervous system
Central (brain and spinal cord)
Peripheral (nerves outside the brain and spinal cord)
100
What is the difference between a headache and a migraine?
Headaches
-are often mild-moderate; described as pressure, tightness or squeezing.
-often both sides of the head
-no aura
-normal activities can be continued
Migraines
-Often moderate/severe; described as throbbing/pulsating
-Often ones side of the head; can be both
-Aura's common
-light/sound sensitive
-activities are often limited
100
What are 3 types of head injuries?
Concussion
Contusion/Laceration
Hematoma
100
What is encephalitis?
Inflammation of brain tissue caused by infection or autoimmune condition
100
What are febrile seizures?
Seizures caused by sudden rise in body temperature
Not about the degree of the fever but how suddenly the temperature rises
Last less than 2 minutes typically
100
What is hydrocephalus?
Enlarged ventricles in the brain due to CSF buildup
100
What are gliomas?
Tumors that result from abnormal GLIAL cell growth
Most common form of solid cancer in children
Can occur ANYwhere in the CNS (brain or spinal cord)
Can be low grade or high grade
Diffuse midline (DIPG)
100
What is medulloblastoma?
Embryonal brain tumor, fast growing
Usually arises from the cerebellum
100
What is neuroblastoma?
Abnormal growth of neural/sympathetic nervous system cells
*actually typically found on the adrenal glands
200
At what age gestation does the nervous system begin to develop?
3 weeks gestation
200
Types of PRIMARY headaches
Types of SECONDARY headaches
Primary: Migraines
Tension headaches
Cluster headaches
Secondary:
Serious: trauma
Non-serious: Colds, sinuses, TMJ dysfunction
200
What are 2 ways to screen for head injuries (not imaging)?
Pupillometry (uses a pupillometer to measure the pupils and their reaction to light)
Glasgow Coma Scale
200
What are 3 possible causes of encephalitis?
Infections: Bacterial or viral including enterovirus and herpes (especially HSV)
Insect-borne virus (mosquitos like West Nile)
Autoimmune diseases (the immune system mistakenly attacks the brain).
200
What are the risk factors for febrile seizures?
Ages 6mo-5yr, temperature >100.4, family
history or previous febrile seizures
200
What are the types of hydrocephalus?
Acquired-happens later due to hemorrhage, infection, tumor, trauma etc...
Congenital-present at birth
Communicating (CSF fluid can flow between the ventricles)
Obstructive/non communicating: aqueduct stenosis, brain tumors, cysts, congenital malformations
Normal pressure hydrocephalus: Usually in older adults
Hydrocephalus ex vacuo: occurs because of loss of brain tissue (CF, stroke, neurodegenerative disease)
200
Expected clinical presentation of patients with gliomas?
Hydrocephalus, headaches, seizures, balance issues
weakness, vision changes
200
Expected clinical presentations for medulioblastoma?
Clumsiness, difficulty walking, hydrocephalus (blocks flow of CSF)
200
Expected findings of neuroblastoma
Abdominal mass
Abdominal distention
Bone pain
Weight loss
Periorbital ecchymosis (raccoon eyes) due to mets to the skull/orbit
300
How many pairs of spinal nerves are there?
31 pairs
300
What are migraine auras and examples?
A temporary neurologic symptom that can occur before or during a migraine
Develop gradually and last about 5-60 minutes
Examples:
Visual (most common-flashing lights, blind spots)
Sensory (tingling, numbness)
Speech (slurred speech, difficulty finding words)
Motor (less common-weakness in arm or leg)
300
What are red flags of head injuries?
Declining level of consciousness
Repeated vomiting
Seizures
Severe/worsening headaches
Increased confusion or abnormal behavior
300
Clinical manifestations of encephalitis
Rapidly worsen, have neurological and
systematic manifestation
300
How do we treat febrile seizures?
Lower the temperature
300
How is hydrocephalus diagnosed?
Neuro imaging like CT, ultrasound, MRI
300
Risk factors for gliomas?
Not really a definitive cause
Can be seen in Neurofibromatosis (NF 1) -optic nerve
Can be seen in syndromes (Li-Fraumeni syndrome, Tuberous sclerosis, Turcot syndrome)
300
What are the risk factors for medulloblastoma?
Genetic distorders: Gorlin, Turcot, and Li-Fraumeni syndromes
300
What age is most commonly affected by neuroblastoma?
Infants and young children under 5
400
What are the 4 regions of the spinal cord?
Cervical (C1-C7)
Thoracic (T1-T12)
Lumbar (L1-L5)
Sacral (S1-S5)
400
Common triggers for migraines:
Poor sleep
dehydration
stress
caffeine
heat
bright lights
hormonal changes
400
What are common causes of head injuries?
Concussions: Contact sports
Trauma: Shaken Baby/Non accidental trauma
400
What is the treatment for encephalitis?
Neuroimaging, lumber puncture
Infections: antibiotics or antiviral
Autoimmune: corticosteroids, IVIG400
Tonic clonic seizures
A generalized seizure that causes loss of consciousness followed by stiffening and rhythmic jerking of the muscles
Used to be called Grand Mal Seizures
Tonic: Tight
Clonic: Contractions
400
How do we treat hydrocephalus?
VP shunt is often needed
400
How do we diagnose gliomas?
MRI of brain with and without contrast
CT scan (good for looking for bleeds and detecting hydrocephalus)
Biopsy
CSF testing
400
How do we diagnose medulloblastoma?
MRI of brain (with contrast)
MRI of entire spine (look for metastatic disease)
Biopsy
Lumbar puncture
400
How do we diagnose neuroblastoma?
Ultrasound of abdomen (often first test)
CT or MRI-looks at things like location, size, involvement of other, nearby structures
MIBG: Most neuroblastoma cells take up MIBG (radioactive substance). It helps to look for metastasis and primary source
Biopsy
Bone marrow (neuroblastoma often spreads to bone marrow)
500
What are spinal cord injuries?
A disrupting signal transmission that can be temporary or permanent, affecting sensation, movement, and strength
500
What are tension headaches?
Feels like bilateral tightness and pressure
More common in school-age children and older
Can be episodic or sporadic
500
What is the treatment for head injuries?
Rest, NSAIDs (mild)
Manage intracranial pressure (severe)
External bleeding control (severe)
Hematoma- surg drain (moderate to severe)
500
What is rabies?
Fatal inflammation of the neurological system caused by a virus after an animal bite
Most commonly seen in Dogs
No human-to-human cases reported
500
What would you expect to see in a patient with absence seizures?
Loss of consciousness
500
What eduction should we provide to families/patients with VP shunts?
Signs of VP shunt malfunction
-headaches
-vomiting
500
Treatment for Gliomas
Will depend on stage and location
Surgery is the main treatment option
Chemo
Radiation (used selectively in children)
500
Treatment for medulloblastoma
Typically multimodal because of the tendency to spread (CNS involvement)
Surgery to remove as much as possible
Radiation if older child
Chemotherapy for high risk disease
Proton therapy is a special form of radiation that is used in children. Can control better where it is going and often does not involve other tissues surrounding it.
500
How do we treat neuroblastoma?
Will depend on the age of the child, tumor stage and location
Typically surgery to remove if safe (may have to do partial resection only if it involves nerves or blood vessels)
Chemotherapy-if high risk, large, metastatic or difficult to remove
Radiation-used if high risk disease as radiation is not used often in children
Stem cell transplant
600
What are the 4 types of spinal cord injuries? (also known as Spinal Cord Injury Syndromes/SCIs)
Incomplete SCI (Some motor and/or sensory function remains below the injury)
Complete SCI (No motor function or sensory function below the level of injury)
Paraplegia (Paralysis primarily affecting the lower body/legs. Usually thoracic, lumbar or sacral)
Tetraplegia (Affects arms and legs, from cervical spinal cord injury)
600
What are cluster headaches?
Characterized by extremely severe, one-sided pain; usually around the eye
Can occur multiple times per day, often predictable times
Occur in clusters over weeks to months
600
What is the current treatment recommendations for concussions?
Brain rest
-no video games
-no contact sports
Gradual return to regular activities
Management of headaches
600
What is the clinical presentation seen with rabies?
Hyperactivity, hallucination, hydrophobia, lack of
coordination, muscle paralysis
Testing is usually done post mortem
600
When can antiepilepsy medications be stopped?
Once the patient has remained seizure free for 2 years.
600
What are the 4 types of gliomas?
Astrocytoma
Ependymoma (eh-PEN-dih-MOH-muh)
Oligodendroglioma (OL-ih-go-DEN-droh-gly-OH-muh)
Glioblastoma
*Type will depend on what cells are affected
700
Causes of spinal cord injuries?
Blunt trauma, vehicle accidents, falls, sports injuries
700
What is the recommended treatment for headaches?
Prevent with consistent sleep patterns,
adequate hydration, decreased stress,
and well-balanced meals
• When a headache occurs, reduce
triggers and administer medication ASAP
• Encourage rest in a dark area until you
recover from a headache
• If chronic headaches, develop a prevention plan
700
What is meningitis?
How do we prevent the spread of this
Treatment
Diagnosis
Meningitis is an inflammation of the meninges, the protective membrane surrounding the brain
Can be caused by bacteria, viruses, fungus
Prevent the spread: Isolating children with this known infection
Treat: antibiotics immediately , steroids in some cases
DX: Lumbar puncture for CSF evaluation
700
What would we teach parents regarding what to do when the child is seizing?
Remain calm
Lay child on the side with head tilted back
Do not restrain a child or put anything in the child's mouth
800
Treatments of spinal cord injuries
Initial stabilization, immobilization, possible surgery
800
What is cyclical vomiting syndrome (CVS)
A disorder where a person has repeated, predictable episodes of intense vomiting followed by periods where they feel completely normal
-prodrome phase (nausea, abdominal pain, sweating)
-vomiting phase (repeated, severe vomiting many times over several hours
-recovery phase (vomiting stops, fatigue common)
-well phase (normal periods of time)
Can often be caused by migraines
800
What might we see in patients with meningitis?
Fever
Irritability (especially in infants)
Poor feeding (especially in infants)
Lethargy
High pitched cry (infants)
Severe headache
Nucal rigidity (stiff neck-usually not in infants)
Photophobia
N/V
Altered mental status
800
What is the difference between seizures and epilepsy?
A seizure is a single episode of abnormal, excessive brain activity
-can happen due to a temporary trigger like fever, hypoglycemia, electrolyte imbalance or infection
Epilepsy is a neurological disorder characterized recurrent, unprovoked seizures
-often occur randomly without a trigger
-can have a predisposition like genetics