12. Neurology Flashcards
What is key to note about a child’s brain?
As it continues to develop lesions may not become apparent for many years.
What sort of neurological pathologies may a child get
Congenital abnormalities
Neurogenetic diseases and syndromes
Nuerometabolic diseases and syndromes
Acquired disease: infection, trauma, tumour, ischeamia
What are you looking to find out in a developmental history?
Motor milestones:gross and fine motor Speech and language development Early cognitive development Play esp symbolic play and social behaviour Self help skills Vision and hearing assessment
What is involved in a neurological assessment of a child?
Opportunistic approach and observation skills Appearance Gait Head size Skin findings Real world examination
What are the different types of headaches a child might have?
Finding out the type of headache is very important:
Isolated acute- worrying Recurrent acute Chronic progressive- worrying Chronic non progressive New onset daily persistent headache
What other information is good in a headache history?
Any warning? Location Severity? Duration? Frequency?
What are your two differrent types of headaches?
Primary
Secondary- caused by a structural abnormality
What are red flags for examination?
Growth parameters slowing (OFC, FB)-cranial pharyngoma
Sinuses, teeth, visual acuity defects- optic chiasm disruption
Cranial Bruit
Focal neurological signs (specific deficits in an area of the body)
Cognitive and emotional status
How does a migraine present in children
Associated abdominal pain, nausea, vomiting
Focal symptoms (parenthesis, weakness)
Aura
Aggravated by bright light/noise
Helped by sleep
Family history
Pain on one side
How do tension type headaches present?
No aura, nausea, vomiting
Tight band around head
Constant headache
No localised point of pain
What indicated a raised intracranial pressure headache?
Aggravated by activities that raise ICP e.g. coughing, straining at stools bending
Woken from sleep with headache/ vomiting
How does analgesic overuse headache present?
Headache is back before they are allowed another dose
Paracetamol/NSAIDS
Particular problem with compound analgesics e.g. co-codamol
When would you send for a scan?
Features of cerebellar dysfunction
Features of raised ICP
New focal neurological deficit e.g. new squint
Seizures esp. focal
Personality change
Unexplained deterioration in school work
How do you treat a migraine?
Acute attack- pain relief, triptans (somatriptin, vasotriptin)
Preventative (more than one migraine a week) propranolol, amitriptyline, valproate
How do you treat a tension type headache?
Reassurance MDT approach Attention to underlying chronic physical, psychological or emotional problems Acute attacks- simple analgesia Prevention- amitriptyline Discourage analgesics in chronic TTH
What is a seizure?
And sudden attacks from whatever cause
What is syncope?
A faint
What is convulsion?
Seizure with prominent motor activity
What is an epileptic seizure?
Abnormal hyper synchronised discharge from a group of cortical neurons
It may or may not have clinical manifestations
Paroxysmal change in motor sensory or cognitive function
Depends on site of seizure and neurological spread
Epilepsy refers to recurrent episodes of seizures
What can mimic epileptic seizures?
Hypoglycaemic seizure Infection, traumatic seizure Reflex anoxic seizure- vagally mediated seizure- common in stressed toddlers Syncope Parasomnias- nightmare Behavioural stereotypes
What is a febrile convulsion?
Very common in childhood, usually between 3 months and 5 years of age
Associated with fever but without evidence of intracranial infection or defined cause for the seizure
Commonest cause of acute symptomatic seizure in childhood
What are the different types of epileptic seizures?
Jerk/shake- clinic, myoclonic spasms
Stiff- usually a tonic seizure
Fall- atonic/tonic/myoclonic
Vacant attack: abscence, complex partial seizure
Tonic clonic- two stages, kid goes tonic (seizes up) then clonic (ryhymthic jerking of both sides)
What is the physiology behind epilepsy?
Chemically triggered by decreased inhibition (GABA)
Excessive excitation (glutamates and aspartate)
Excessive influx of Na and Ca
What are the two different types of seizures?
Partial- starts in one area of the brain
Generalised- involves all areas of the brain, both hemispheres
How do you conform epilepsy?
History Video ECG in convulsive seizures EEG MRI brain to look for abnormalities genetics metabolic tests- esp if associated with regression
What is the role of an EEG?
Interictal EEG has limited value Sensitivity is around 30-60% Problematic false positives as well Useful for seizure types Seizure syndromes and aetiology
How do you treat epilepsy in children?
What should you consider with treatment?
Anti epileptic drugs in diagnosis is clear
Used to control seizures not cure epilepsy
Start with one drug and titrations up
Watch out for side effects ( drowsiness, effect on learning ad cognition)
Consider age, gender, type of seizures
What drugs are used for epilepsy?
Sodium valporate (first line)- not in girls,
Levetiracetam- first line for general epilepsies
Carbamazepine- first line for focal epilepsies
