lmcc review: pediatric neurology
DESCRIPTION
LMCC Review: Pediatric Neurology. Asif Doja, MD, FRCP(C) April 3 rd , 2008. Outline. Seizures Febrile Seizures Status Epilepticus Hypotonia in the Newborn and Cerebral Palsy. Seizures. Question 1. Someone can be diagnosed with epilepsy if they have: A. More than one febrile seizure - PowerPoint PPT PresentationTRANSCRIPT
![Page 1: LMCC Review: Pediatric Neurology](https://reader036.vdocument.in/reader036/viewer/2022081511/56813419550346895d9b062d/html5/thumbnails/1.jpg)
LMCC Review:Pediatric Neurology
Asif Doja, MD, FRCP(C)
April 3rd, 2008
![Page 2: LMCC Review: Pediatric Neurology](https://reader036.vdocument.in/reader036/viewer/2022081511/56813419550346895d9b062d/html5/thumbnails/2.jpg)
Outline
• Seizures
• Febrile Seizures
• Status Epilepticus
• Hypotonia in the Newborn and Cerebral Palsy
![Page 3: LMCC Review: Pediatric Neurology](https://reader036.vdocument.in/reader036/viewer/2022081511/56813419550346895d9b062d/html5/thumbnails/3.jpg)
Seizures
![Page 4: LMCC Review: Pediatric Neurology](https://reader036.vdocument.in/reader036/viewer/2022081511/56813419550346895d9b062d/html5/thumbnails/4.jpg)
Question 1
Someone can be diagnosed with epilepsy if they have:
A. More than one febrile seizure
B. More than one afebrile seizure
C. Seizures in the context of hypoglycemia
D. One seizure and a history of brain injury
![Page 5: LMCC Review: Pediatric Neurology](https://reader036.vdocument.in/reader036/viewer/2022081511/56813419550346895d9b062d/html5/thumbnails/5.jpg)
Question 2
All of the following seizure types are classified as “generalized” seizures EXCEPT:
A. Complex partial seizuresB. Absence seizuresC. Tonic-clonic seizuresD. Atonic seizures
![Page 6: LMCC Review: Pediatric Neurology](https://reader036.vdocument.in/reader036/viewer/2022081511/56813419550346895d9b062d/html5/thumbnails/6.jpg)
Question 3
All of the following are features of Absence seizures EXCEPT:
A. Lack of an aura or warning
B. Impairment in consciousness
C. Post-ictal drowsiness/lethargy
D. 3 Hz spike and wave on EEG
![Page 7: LMCC Review: Pediatric Neurology](https://reader036.vdocument.in/reader036/viewer/2022081511/56813419550346895d9b062d/html5/thumbnails/7.jpg)
Question 4
Which of the following is an appropriate first line treatment for an 8 year old child with epilepsy?
A. Bromide therapyB. Ketogenic DietC. CarbemazepineD. Phenobarbital
![Page 8: LMCC Review: Pediatric Neurology](https://reader036.vdocument.in/reader036/viewer/2022081511/56813419550346895d9b062d/html5/thumbnails/8.jpg)
Question 5
A 9 year old child presents with recurrent episodes of waking in the morning with facial twitching, dysarthria and normal level of consciousness. The most likely diagnosis is:
A. Transient Ischemic AttacksB. Benign Epilepsy of Childhood with Rolandic
SpikesC. Juvenile Myoclonic EpilepsyD. Facial tics
![Page 9: LMCC Review: Pediatric Neurology](https://reader036.vdocument.in/reader036/viewer/2022081511/56813419550346895d9b062d/html5/thumbnails/9.jpg)
Definitions
• Seizure: Paroxysmal discharge of neurons resulting in behaviour change, motor or sensory dysfunction
• Epilepsy: > 1 unprovoked seizure
![Page 10: LMCC Review: Pediatric Neurology](https://reader036.vdocument.in/reader036/viewer/2022081511/56813419550346895d9b062d/html5/thumbnails/10.jpg)
Was it a Seizure?
• Differential Diagnosis– Syncope– Breath Holding– Night Terrors– Tics– GERD– etc
![Page 11: LMCC Review: Pediatric Neurology](https://reader036.vdocument.in/reader036/viewer/2022081511/56813419550346895d9b062d/html5/thumbnails/11.jpg)
Syncope vs Seizure
• Vasovagal reflex
• Usually happens when standing up
• Lightheaded feeling
• Pale, cold, clammy
• Loss of consciousness and fall
• Tremble but no tonic-clonic movements
• No post-ictal lethargy
![Page 12: LMCC Review: Pediatric Neurology](https://reader036.vdocument.in/reader036/viewer/2022081511/56813419550346895d9b062d/html5/thumbnails/12.jpg)
Focal vs. Generalized Seizures
Focal• Simple Partial• Complex Partial• Partial Seizure with 2O
Generalization
Generalized• Generalized Tonic-
Clonic• Tonic• Clonic• Absence• Atonic• Myoclonic
![Page 13: LMCC Review: Pediatric Neurology](https://reader036.vdocument.in/reader036/viewer/2022081511/56813419550346895d9b062d/html5/thumbnails/13.jpg)
How to differentiate “Staring Spells”
Complex Partial• Aura• ~ 30 sec or more• Decr LOC• Automatisms• Post-ictal period• EEG: focal epileptiform
abnormality• Hyperventialtion has no
effect
Absence• No aura• Lasts few seconds• Decr LOC• May have automatisms• No post-ictal period• EEG: 3 HZ spike and
wave• Provoked by
hyperventialtion
![Page 14: LMCC Review: Pediatric Neurology](https://reader036.vdocument.in/reader036/viewer/2022081511/56813419550346895d9b062d/html5/thumbnails/14.jpg)
Investigations and Treatment
• Neuroimaging if focal findings present• May do EEG after first seizure• Treatment if patient has 2 or more seizures
– Commonly used: Carbemazepine, Valproic Acid, Phenobarbital
– Many other newer anticonvulsants ie Topiramate, Levotiracetam
– (For refractory patients: Ketogenic Diet, Epilepsy surgery)
![Page 15: LMCC Review: Pediatric Neurology](https://reader036.vdocument.in/reader036/viewer/2022081511/56813419550346895d9b062d/html5/thumbnails/15.jpg)
Epilepsy Syndromes
West Syndrome• Infantile Spasms• Onset in 1st year• Symmetrical
contractions of trunk/extremities
• EEG: hypsarrythmia• Poor prognosis
Lennox Gastault• Onset age 3-5• Multiple seizure types• Developmental delay• EEG: slow spike and
wave• Many have history of
infantile spasms
![Page 16: LMCC Review: Pediatric Neurology](https://reader036.vdocument.in/reader036/viewer/2022081511/56813419550346895d9b062d/html5/thumbnails/16.jpg)
Epilepsy Syndromes
Benign Epilepsy of Childhood with Rolandic Spikes
(BECRS)• 5-10 years• Simple partial seizures
involving face• Remits spontaneously,
no treatment
Juvenile Myoclonic Epilepsy
• 12-16 years• Myoclonus and GTC
seizures• Good prognosis, but
requires lifelong treatment with Valproic Acid
![Page 17: LMCC Review: Pediatric Neurology](https://reader036.vdocument.in/reader036/viewer/2022081511/56813419550346895d9b062d/html5/thumbnails/17.jpg)
Question 1
Someone can be diagnosed with epilepsy if they have:
A. More than one febrile seizure
B. More than one afebrile seizure
C. Seizures in the context of hypoglycemia
D. One seizure and a history of brain injury
![Page 18: LMCC Review: Pediatric Neurology](https://reader036.vdocument.in/reader036/viewer/2022081511/56813419550346895d9b062d/html5/thumbnails/18.jpg)
Question 2
All of the following seizure types are classified as “generalized” seizures EXCEPT:
A. Complex partial seizuresB. Absence seizuresC. Tonic-clonic seizuresD. Atonic seizures
![Page 19: LMCC Review: Pediatric Neurology](https://reader036.vdocument.in/reader036/viewer/2022081511/56813419550346895d9b062d/html5/thumbnails/19.jpg)
Question 3
All of the following are features of Absence seizures EXCEPT:
A. Lack of an aura or warning
B. Impairment in consciousness
C. Post-ictal drowsiness/lethargy
D. 3 Hz spike and wave on EEG
![Page 20: LMCC Review: Pediatric Neurology](https://reader036.vdocument.in/reader036/viewer/2022081511/56813419550346895d9b062d/html5/thumbnails/20.jpg)
Question 4
Which of the following is an appropriate first line treatment for an 8 year old child with epilepsy?
A. Bromide therapyB. Ketogenic DietC. CarbemazepineD. Phenobarbital
![Page 21: LMCC Review: Pediatric Neurology](https://reader036.vdocument.in/reader036/viewer/2022081511/56813419550346895d9b062d/html5/thumbnails/21.jpg)
Question 5
A 9 year old child presents with recurrent episodes of waking in the morning with facial twitching, dysarthria and normal level of consciousness. The most likely diagnosis is:
A. Transient Ischemic AttacksB. Benign Epilepsy of Childhood with Rolandic
SpikesC. Juvenile Myoclonic EpilepsyD. Facial tics
![Page 22: LMCC Review: Pediatric Neurology](https://reader036.vdocument.in/reader036/viewer/2022081511/56813419550346895d9b062d/html5/thumbnails/22.jpg)
Febrile Seizures
![Page 23: LMCC Review: Pediatric Neurology](https://reader036.vdocument.in/reader036/viewer/2022081511/56813419550346895d9b062d/html5/thumbnails/23.jpg)
Question 1
Which of the following is NOT a feature of a typical febrile seizure?
A. Onset between ages 6 months – 6 yearsB. Duration of < 15 minutesC. Only one seizure in 24 hour spanD. Patients usually have pre-existing
developmental delay
![Page 24: LMCC Review: Pediatric Neurology](https://reader036.vdocument.in/reader036/viewer/2022081511/56813419550346895d9b062d/html5/thumbnails/24.jpg)
Question 2
Which of the following is FALSE regarding atypical febrile seizures?
A. They may show clonic jerking on only one side of the body
B. The patient is at no increased risk for further febrile seizures.
C. The patient can present in status epilepticusD. The patient can show focal abnormalities on
neurologic exam.
![Page 25: LMCC Review: Pediatric Neurology](https://reader036.vdocument.in/reader036/viewer/2022081511/56813419550346895d9b062d/html5/thumbnails/25.jpg)
Question 3
A 8 month old female has one typical febrile seizure, then 2 months later has another. With respect to anticonvulsants, you would prescribe:
A. Phenobarbital
B. Carbemazepine
C. Valproic Acid
D. None, as the patient does not require treatment
![Page 26: LMCC Review: Pediatric Neurology](https://reader036.vdocument.in/reader036/viewer/2022081511/56813419550346895d9b062d/html5/thumbnails/26.jpg)
Question 4
A 7 month old male has a typical febrile seizure. With respect to doing a lumbar puncture, the AAP guidelines state that you should:
A. Not do an LP
B. Do an LP if the temperature is > 39 degrees
C. Do an LP only if there are meningeal signs
D. Do an LP irregardless of the physical exam findings
![Page 27: LMCC Review: Pediatric Neurology](https://reader036.vdocument.in/reader036/viewer/2022081511/56813419550346895d9b062d/html5/thumbnails/27.jpg)
Question 5
What is the risk of developing epilepsy in a child with a typical febrile seizure?
A. 1%, the same as the general population
B. 2-3%
C. 10-15%
D. 33%
![Page 28: LMCC Review: Pediatric Neurology](https://reader036.vdocument.in/reader036/viewer/2022081511/56813419550346895d9b062d/html5/thumbnails/28.jpg)
Febrile Seizures
• 3-5% of all children
• Ages 6 months to 6 years
• Usually GTC
![Page 29: LMCC Review: Pediatric Neurology](https://reader036.vdocument.in/reader036/viewer/2022081511/56813419550346895d9b062d/html5/thumbnails/29.jpg)
Typical vs Atypical Febrile Seizures
Typical• Duration < 15 min• No focality• Does not recur in 24-
hour period• No hx of
developmental delay
Atypical• Duration > 15 min• Focal findings during
seizure or after exam• > 1 in 24 hours• Previous History of
Developmental Delay
![Page 30: LMCC Review: Pediatric Neurology](https://reader036.vdocument.in/reader036/viewer/2022081511/56813419550346895d9b062d/html5/thumbnails/30.jpg)
Risk of Recurrence
• 33% chance of recurrence (75% occur within 1 year)
• Risk Factors:– Family history of feb. con. or epilepsy– Short duration of fever prior to seizure– Developmental / Neurological problems– Atypical febrile seizure
![Page 31: LMCC Review: Pediatric Neurology](https://reader036.vdocument.in/reader036/viewer/2022081511/56813419550346895d9b062d/html5/thumbnails/31.jpg)
Investigations
• History and Physical – determine source of fever
• EEG and Neuroimaging only needed in atypical cases
• LP:– If < 12 months: Do LP– If 12-18 months: Consider LP– If > 18 months: Only if meningeal signs present
![Page 32: LMCC Review: Pediatric Neurology](https://reader036.vdocument.in/reader036/viewer/2022081511/56813419550346895d9b062d/html5/thumbnails/32.jpg)
Management
• Reassurance
• Risk of developing epilepsy is 2-3% (1% in general population)
• Antipyretics and fluids for comfort (neither prevent seizures)
• No need for anticonvulsants
![Page 33: LMCC Review: Pediatric Neurology](https://reader036.vdocument.in/reader036/viewer/2022081511/56813419550346895d9b062d/html5/thumbnails/33.jpg)
Question 1
Which of the following is NOT a feature of a typical febrile seizure?
A. Onset between ages 6 months – 6 yearsB. Duration of < 15 minutesC. Only one seizure in 24 hour spanD. Patients usually have pre-existing
developmental delay
![Page 34: LMCC Review: Pediatric Neurology](https://reader036.vdocument.in/reader036/viewer/2022081511/56813419550346895d9b062d/html5/thumbnails/34.jpg)
Question 2
Which of the following is FALSE regarding atypical febrile seizures?
A. They may show clonic jerking on only one side of the body
B. The patient is at no increased risk for further febrile seizures.
C. The patient can present in status epilepticusD. The patient can show focal abnormalities on
neurologic exam.
![Page 35: LMCC Review: Pediatric Neurology](https://reader036.vdocument.in/reader036/viewer/2022081511/56813419550346895d9b062d/html5/thumbnails/35.jpg)
Question 3
• A 8 month old female has one typical febrile seizure, then 2 months later has another. With respect to anticonvulsants, you would prescribe:
• A. Phenobarbital• B. Carbemazepine• C. Valproic Acid• D. None, as the patient does not require treatment
![Page 36: LMCC Review: Pediatric Neurology](https://reader036.vdocument.in/reader036/viewer/2022081511/56813419550346895d9b062d/html5/thumbnails/36.jpg)
Question 4
A 7 month old male has a typical febrile seizure. With respect to doing a lumbar puncture, the AAP guidelines state that you should:
A. Not do an LP
B. Do an LP if the temperature is > 39 degrees
C. Do an LP only if there are meningeal signs
D. Do an LP irregardless of the physical exam findings
![Page 37: LMCC Review: Pediatric Neurology](https://reader036.vdocument.in/reader036/viewer/2022081511/56813419550346895d9b062d/html5/thumbnails/37.jpg)
Question 5
What is the risk of developing epilepsy in a child with a typical febrile seizure?
A. 1%, the same as the general population
B. 2-3%
C. 10-15%
D. 33%
![Page 38: LMCC Review: Pediatric Neurology](https://reader036.vdocument.in/reader036/viewer/2022081511/56813419550346895d9b062d/html5/thumbnails/38.jpg)
Status Epilepticus
![Page 39: LMCC Review: Pediatric Neurology](https://reader036.vdocument.in/reader036/viewer/2022081511/56813419550346895d9b062d/html5/thumbnails/39.jpg)
Question 1
Status Epilepticus is defined as:
A. 30 minutes or > of continuous seizure activity
B. Recurrent seizures with no intervening normal level of consciousness for > 30 min
C. A and BD. None of the above
![Page 40: LMCC Review: Pediatric Neurology](https://reader036.vdocument.in/reader036/viewer/2022081511/56813419550346895d9b062d/html5/thumbnails/40.jpg)
Question 2
A 5 year old boy presents to the ER with a 45 minute GTC seizure. What is your initial management?
A. ABC’sB. Stat CT headC. Lorazepam 0.1mg IV pushD. Tox screen
![Page 41: LMCC Review: Pediatric Neurology](https://reader036.vdocument.in/reader036/viewer/2022081511/56813419550346895d9b062d/html5/thumbnails/41.jpg)
Question 3
Which of the following metabolic disturbances is MOST likely to cause seizures?
A. High Potassium
B. High Chloride
C. Low urea
D. Low glucose
![Page 42: LMCC Review: Pediatric Neurology](https://reader036.vdocument.in/reader036/viewer/2022081511/56813419550346895d9b062d/html5/thumbnails/42.jpg)
Question 4
First line anticonvulsant treatment in status epilepticus should be:
A. Lorazepam
B. Phenytoin
C. Phenobarbital
D. Thiopentol coma
![Page 43: LMCC Review: Pediatric Neurology](https://reader036.vdocument.in/reader036/viewer/2022081511/56813419550346895d9b062d/html5/thumbnails/43.jpg)
Status Epilepticus
• 30 minutes or > of continuous seizure activity
• Recurrent seizures with no intervening normal level of consciousness for > 30 min
![Page 44: LMCC Review: Pediatric Neurology](https://reader036.vdocument.in/reader036/viewer/2022081511/56813419550346895d9b062d/html5/thumbnails/44.jpg)
Status Epilepticus
• ABC’s– Oxygen / pulse oximetry– Bag-valve support or intubation if req’d– IV access
• Check blood sugar -- give dextrose if low (2-4 ml/kg of 25% solution)
![Page 45: LMCC Review: Pediatric Neurology](https://reader036.vdocument.in/reader036/viewer/2022081511/56813419550346895d9b062d/html5/thumbnails/45.jpg)
Status Epilepticus
• Anticonvulsants:– Benzodiazepines ie Lorazepam (0.1 mg/kg IV),
can repeat X1– If fails, Phenytoin 20mg/kg (no faster than 1
mg/min)– If fails, Phenobarbital 20 mg/kg (no faster than
1 mg/min)– If fails, will need to go to ICU for barbituate
coma (ie thipentol) or midazolam infusion
![Page 46: LMCC Review: Pediatric Neurology](https://reader036.vdocument.in/reader036/viewer/2022081511/56813419550346895d9b062d/html5/thumbnails/46.jpg)
Question 1
Status Epilepticus is defined as:
A. 30 minutes or > of continuous seizure activity
B. Recurrent seizures with no intervening normal level of consciousness for > 30 min
C. A and BD. None of the above
![Page 47: LMCC Review: Pediatric Neurology](https://reader036.vdocument.in/reader036/viewer/2022081511/56813419550346895d9b062d/html5/thumbnails/47.jpg)
Question 2
A 5 year old boy presents to the ER with a 45 minute GTC seizure. What is your initial management?
A. ABC’sB. Stat CT headC. Lorazepam 0.1mg IV pushD. Tox screen
![Page 48: LMCC Review: Pediatric Neurology](https://reader036.vdocument.in/reader036/viewer/2022081511/56813419550346895d9b062d/html5/thumbnails/48.jpg)
Question 3
Which of the following metabolic disturbances is MOST likely to cause seizures?
A. High Potassium
B. High Chloride
C. Low urea
D. Low glucose
![Page 49: LMCC Review: Pediatric Neurology](https://reader036.vdocument.in/reader036/viewer/2022081511/56813419550346895d9b062d/html5/thumbnails/49.jpg)
Question 4
First line anticonvulsant treatment in status epilepticus should be:
A. Lorazepam
B. Phenytoin
C. phenobarbital
D. Thiopentol coma
![Page 50: LMCC Review: Pediatric Neurology](https://reader036.vdocument.in/reader036/viewer/2022081511/56813419550346895d9b062d/html5/thumbnails/50.jpg)
Hypotonia and Cerebral Palsy
![Page 51: LMCC Review: Pediatric Neurology](https://reader036.vdocument.in/reader036/viewer/2022081511/56813419550346895d9b062d/html5/thumbnails/51.jpg)
Question 1
![Page 52: LMCC Review: Pediatric Neurology](https://reader036.vdocument.in/reader036/viewer/2022081511/56813419550346895d9b062d/html5/thumbnails/52.jpg)
![Page 53: LMCC Review: Pediatric Neurology](https://reader036.vdocument.in/reader036/viewer/2022081511/56813419550346895d9b062d/html5/thumbnails/53.jpg)
The child in the preceding picture is alert, has little spontaneous movement and no reflexes. He most likely has:
A. Central HypotoniaB. Peripheral HypotoniaC. Mixed Central and Peripheral HypotoniaD. None of the above
![Page 54: LMCC Review: Pediatric Neurology](https://reader036.vdocument.in/reader036/viewer/2022081511/56813419550346895d9b062d/html5/thumbnails/54.jpg)
Question 2
Which of the following on obstetrical history is NOT usually associated with hypotonia in the newborn?
A. Decreased fetal movement
B. Breech presentation
C. Jitteriness immediately after birth
D. Polyhydramnios
![Page 55: LMCC Review: Pediatric Neurology](https://reader036.vdocument.in/reader036/viewer/2022081511/56813419550346895d9b062d/html5/thumbnails/55.jpg)
Question 3
The following would all be considered causes of peripheral hypotonia EXCEPT:
A. Spinal Muscular Atrophy
B. Neonatal Myasthenia Gravis
C. Myotonic Dystrophy
D. Trisomy 21
![Page 56: LMCC Review: Pediatric Neurology](https://reader036.vdocument.in/reader036/viewer/2022081511/56813419550346895d9b062d/html5/thumbnails/56.jpg)
Question 4
With respect to Cerebral Palsy, which of the following statements is NOT correct?
A. 66% of cases are due to intrapartum asphyxia
B. Prematurity is a leading cause of the spastic diplegic form
C. in 1/3 of cases there is no etiology
D. A majority of patients have spasticity
![Page 57: LMCC Review: Pediatric Neurology](https://reader036.vdocument.in/reader036/viewer/2022081511/56813419550346895d9b062d/html5/thumbnails/57.jpg)
Question 5
Which of the following is the most common form of cerebral palsy?
A. Spastic
B. Athetoid/Dystonic
C. Ataxic
D. Mixed
![Page 58: LMCC Review: Pediatric Neurology](https://reader036.vdocument.in/reader036/viewer/2022081511/56813419550346895d9b062d/html5/thumbnails/58.jpg)
Hypotonia
• Decreased resistance to movement• “floppy baby”• Obstetrical/Perinatal History
Fetal movement– Breech presentation– Polyhydramnios– History of miscarriage– Resuscitation at birth
![Page 59: LMCC Review: Pediatric Neurology](https://reader036.vdocument.in/reader036/viewer/2022081511/56813419550346895d9b062d/html5/thumbnails/59.jpg)
Hypotonia
• Check for resting posture “frog legged position” (indicates peripheral)
• Check infant’s postural tone– Traction response – pull to sit– Vertical (axillary) suspension– Horizontal (ventral) suspension
![Page 60: LMCC Review: Pediatric Neurology](https://reader036.vdocument.in/reader036/viewer/2022081511/56813419550346895d9b062d/html5/thumbnails/60.jpg)
Hypotonia
Central
-“Floppy and Strong”
- preserved reflexes
-May not be alert
Peripheral
-“Floppy and Weak”
- absent reflexes
-alert
![Page 61: LMCC Review: Pediatric Neurology](https://reader036.vdocument.in/reader036/viewer/2022081511/56813419550346895d9b062d/html5/thumbnails/61.jpg)
Hypotonia - Central
• Genetic– Trisomy 21, Prader-Willi
• Perinatal Problems– Perinatal asphyxia
• Infections – TORCH
![Page 62: LMCC Review: Pediatric Neurology](https://reader036.vdocument.in/reader036/viewer/2022081511/56813419550346895d9b062d/html5/thumbnails/62.jpg)
Hypotonia - Peripheral
• Motor Neuron– Spinal Muscular Atrophy (SMA)
• Peripheral Nerve• Neuromuscular junction
– Neonatal mysathenia gravis
• Muscle– Congenital muscular dystrophy, myotonic
dystrophy
![Page 63: LMCC Review: Pediatric Neurology](https://reader036.vdocument.in/reader036/viewer/2022081511/56813419550346895d9b062d/html5/thumbnails/63.jpg)
Cerebral Palsy
• Nonprogressive impairment of central motor function, caused by insult or anomaly of the immature CNS
• Only 10% due to intrapartum asphyxia• No etiology in 1/3 of cases• Can present with low tone initially then with
spastic tone– Velocity dependent increase in resistance to movement
![Page 64: LMCC Review: Pediatric Neurology](https://reader036.vdocument.in/reader036/viewer/2022081511/56813419550346895d9b062d/html5/thumbnails/64.jpg)
Cerebral Palsy- Types
• Spastic– 70-80%– Can be spastic diplegia in prems (from
periventricular leukomalacia)– Quadriplegia with hypoxic-ischemic
encephalopathy (asphyxia)
![Page 65: LMCC Review: Pediatric Neurology](https://reader036.vdocument.in/reader036/viewer/2022081511/56813419550346895d9b062d/html5/thumbnails/65.jpg)
Cerebral Palsy- Types
• Athetoid/Dystonic– 10-15%– Due to damage to basal ganglia
• Ataxic– <5%– Damage to cerebellum or thalamus
• Mixed– 10-15%
![Page 66: LMCC Review: Pediatric Neurology](https://reader036.vdocument.in/reader036/viewer/2022081511/56813419550346895d9b062d/html5/thumbnails/66.jpg)
Question 1
![Page 67: LMCC Review: Pediatric Neurology](https://reader036.vdocument.in/reader036/viewer/2022081511/56813419550346895d9b062d/html5/thumbnails/67.jpg)
![Page 68: LMCC Review: Pediatric Neurology](https://reader036.vdocument.in/reader036/viewer/2022081511/56813419550346895d9b062d/html5/thumbnails/68.jpg)
The child in the preceding picture is alert, has little spontaneous movement and no reflexes. He most likely has:
A. Central HypotoniaB. Peripheral HtypotoniaC. Mixed Central and Peripheral HypotoniaD. None of the above
![Page 69: LMCC Review: Pediatric Neurology](https://reader036.vdocument.in/reader036/viewer/2022081511/56813419550346895d9b062d/html5/thumbnails/69.jpg)
Question 2
Which of the following on obstetrical history is NOT usually associated with hypotonia in the newborn?
A. Decreased fetal movement
B. Breech presentation
C. Jitteriness immediately after birth
D. Polyhydramnios
![Page 70: LMCC Review: Pediatric Neurology](https://reader036.vdocument.in/reader036/viewer/2022081511/56813419550346895d9b062d/html5/thumbnails/70.jpg)
Question 3
The following would all be considered causes of peripheral hypotonia EXCEPT:
A. Spinal Muscular Atrophy
B. Neonatal Myasthenia Gravis
C. Myotonic Dystrophy
D. Trisomy 21
![Page 71: LMCC Review: Pediatric Neurology](https://reader036.vdocument.in/reader036/viewer/2022081511/56813419550346895d9b062d/html5/thumbnails/71.jpg)
Question 4
With respect to Cerebral Palsy, which of the following statements is NOT correct?
A. 66% of cases are due to intrapartum asphyxia
B. Prematurity is a leading cause of the spastic diplegic form
C. in 1/3 of cases there is no etiology
D. A majority of patients have spasticity
![Page 72: LMCC Review: Pediatric Neurology](https://reader036.vdocument.in/reader036/viewer/2022081511/56813419550346895d9b062d/html5/thumbnails/72.jpg)
Question 5
Which of the following is the most common form of cerebral palsy?
A. Spastic
B. Athetoid/Dystonic
C. Ataxic
D. Mixed
![Page 73: LMCC Review: Pediatric Neurology](https://reader036.vdocument.in/reader036/viewer/2022081511/56813419550346895d9b062d/html5/thumbnails/73.jpg)
Questions?