Class notes
PHYA 418 Pediatric Neurology Notes
- Course
- PHYA 418
- Institution
- Duquesne University
This is a comprehensive and detailed note on pediatric neurology for PHYA 418. *Essential Study Material!!
[Show more]
Content preview
Pediatric NeurologyH&P:
● History
○ Timing
○ Symptoms: preceding, during and after
○ Other body systems
○ Birth History
○ Family history
○ Social History
● PE
○ Growth parameters
○ Developmental assessment
○ Reflexes
○ Hallmark of neurologic diagnosis is localization
○ Play!
Diagnostics:
● EEG
● Evoked Potentials
● EMG
● LP
● US
● CT
○ High sensitivity, low specificity
● MRI/MRA
○ Best, but usually requires sedation
Epilepsy:
● Intermittent derangement of the nervous system due presumably to a sudden,
excessive, disorderly discharge of cerebral neurons.
● Two or more generalized seizures is characterized as epilepsy
● Idiopathic epilepsy: NO source is found
Seizure Hx:
● What was the patient doing at the time of the seizure?
● Any prodromal symptoms such as strange smells, odd feelings of
depersonalization?
● Any ingestion of drugs, alcohol etc.?
● How long did it last?
● Was there urinary incontinence?
, ● Any witnesses who can describe it?
● Last thing patient remembers before seizure or during it?
● First thing recalled after seizure?
Generalized Seizures:
● Non motor
○ Absence (Petit Mal)
■ Loss of awareness < 15 sec
■ Often starts in childhood
● Motor
○ Tonic Clonic (Grand Mal)
■ Stiffening of the body and loss of consciousness
■ Short rhythmic bursts of movement in all 4 limbs
■ Post-ictal state
● “Sleepiness”
○ Myoclonic
○ Atonic
Focal Seizures:
● Arise from one region of cortex
● Types:
○ Focal Onset Aware Seizures
■ AKA Simple Partial Seizure
■ No loss of consciousness
○ Focal Onset Impaired Awareness
■ AKA Complex Partial Seizure
■ Loss of consciousness
● Partial seizures can progress into a generalized seizure
Seizures- Dx and Tx:
● Work-up
○ Labs
○ Imaging
■ EEG
■ MRI/CT
● Diagnosis of epilepsy is made best by history*
● Treatment
○ ABCs and protect the patient
○ Anticonvulsant therapy
■ Phenobarbital
■ Valproic acid
, ■ Carbamazepine
■ Phenytoin
Status Epilepticus:
● Recurrent generalized seizures
● Occurring at a rate that does not permit consciousness to be regained in the
intervals between seizures
● Medical emergency
○ Can lead to:
■ Death, hyperthermia, acidosis, renal failure and circulatory collapse
● Tx:
○ ABCs
○ Start glucose-containing IV (unless patient is on ketogenic diet); evaluate
serum glucose, electrolytes, HCO3–, CBC, BUN, anticonvulsant levels.
■ Consider arterial blood gases, pH.
■ Give 50% glucose if serum glucose is low (1–2 mL/kg).
○ Begin IV drug therapy; goal is to control status epilepticus in 20–60 min.
■ Diazepam, 0.3–0.5 mg/kg over 1–5 min (20 mg max); may repeat in
5–20 min; or lorazepam, 0.05–0.2 mg/kg (less effective with
repeated doses, longer-acting than diazepam); or midazolam: IV,
0.1–0.2 mg/kg; intranasally, 0.2 mg/kg.
■ Phenytoin, 10–20 mg/kg IV (not IM) over 5–20 min; (1000 mg
maximum); monitor with blood pressure and ECG. Fosphenytoin
may be given more rapidly in the same dosage and can be given
IM; order 10–20 mg/kg of “phenytoin equivalent” (PE).
■ Phenobarbital, 5–20 mg/kg (sometimes higher in newborns or
refractory status in intubated patients).
○ Correct metabolic perturbations (eg, low-sodium, acidosis).
○ Administer fluids judiciously.
■ Other drug approaches in refractory status:
■ Repeat phenytoin, phenobarbital (10 mg/kg). Monitor blood levels.
Support respiration, blood pressure as necessary.
■ Other medications: valproate sodium, available as 100 mg/mL for
IV use; give 15–30 mg/kg over 5–20 min.
■ Levetiracetam may be helpful (20–40 mg/kg/dose IV).
■ For patients who fail initial intervention consider: midazolam drip:
1–5 mcg/kg/min (even to 20 kg/min); pentobarbital coma; propofol
and general anesthetic.
○ Consider underlying causes:
■ Structural disorders or trauma: MRI or CT scan.
■ Infection: lumbar puncture, blood culture, antibiotics.
The benefits of buying summaries with Stuvia:
Guaranteed quality through customer reviews
Stuvia customers have reviewed more than 700,000 summaries. This how you know that you are buying the best documents.
Quick and easy check-out
You can quickly pay through credit card or Stuvia-credit for the summaries. There is no membership needed.
Focus on what matters
Your fellow students write the study notes themselves, which is why the documents are always reliable and up-to-date. This ensures you quickly get to the core!
Frequently asked questions
What do I get when I buy this document?
You get a PDF, available immediately after your purchase. The purchased document is accessible anytime, anywhere and indefinitely through your profile.
Satisfaction guarantee: how does it work?
Our satisfaction guarantee ensures that you always find a study document that suits you well. You fill out a form, and our customer service team takes care of the rest.
Who am I buying these notes from?
Stuvia is a marketplace, so you are not buying this document from us, but from seller anyiamgeorge19. Stuvia facilitates payment to the seller.
Will I be stuck with a subscription?
No, you only buy these notes for $9.99. You're not tied to anything after your purchase.
Can Stuvia be trusted?
4.6 stars on Google & Trustpilot (+1000 reviews)
75632 documents were sold in the last 30 days
Founded in 2010, the go-to place to buy study notes for 14 years now