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Y4 Paeds CCs > 8. Neuro > Flashcards

8. Neuro Flashcards

1
Q

What is cerebral palsy?

A

-Permanent disorder of motor and posture development, caused by insult to a developing brain
-Associated with developmental difficulties and epilepsy
-Lesion / insult occurs at any point between conception and 3 yrs
(after 3 yrs = acquired brain injury)

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2
Q

What can cause cerebral palsy?

A

IN UTERO
-Congenital infections (TORCH)
-Genetic cause
-Stroke
-Periventricular leukomalacia (brain injury)
PERINATAL
-Birth asphyxia
-Prematurity
-Kernicterus
AFTER DELIVERY
-Intraventricular haemorrhage
-Brain injury
-Meningitis
-Encephalitis
-Hypoglycaemia
UNKNOWN = 2/3

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3
Q

How is cerebral palsy classified?

A

MOVEMENT TYPE
-Spastic = muscle spasms
-Dyskinetic = involuntary muscle movement
-Ataxic = poor balance / coordination (rare)
-Athetoid = jerky limbs (basal ganglia involvement)
-Mixed
DISTRIBUTION TYPE
-Hemiplegia = paralysis on one side of the body
-Diplegia = paralysis of corresponding parts on both sides of the body
-Quadriplegia = paralysis of all 4 limbs

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4
Q

How does cerebral palsy present?

A

-Hypotonia
-Poor feeding
-Epileptic fits (neonate)
-Spasticity
-Abnormal gait - toe walking, knee hyperextension
-Early hand preference (should be ambidextrous until 18 months)
-Poor growth, abnormal posture
-Delayed milestones, motor delay
-Recurrent LRTIs (unable to cough)
-Recurrent UTIs and incontinence
-Constipation

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5
Q

How is cerebral palsy diagnosed?

A

-MRI brain

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6
Q

How is cerebral palsy managed?

A

Paediatrics
-Anticonvulsants
-Muscle relaxants eg diazepam, botox
-Dorsal rhizotomy (spinal surgery to reduce spasticity)
-Treat complications
Physio / OT
-Mobility aids
-Ankle foot orthoses
SALT
-Speech + feeding

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7
Q

What complications can arise from cerebral palsy?

A

PHYSICAL - muscle spasms, feeding + nutrition issues
SOCIAL - problems with ADLs, developmental delay, hearing + language impairment
MSK - scoliosis, hip dislocation
NEURO - epilepsy
OTHER - recurrent RTIs + UTIs, GORD, constipation
NB well preserved cognitive function

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8
Q

When do febrile fits normally occur?

A

-Typically occurs between 6 months - 6 yrs
-Self-limiting
-Occur as a result of a rapid increase in temperature, typically early in viral infection

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9
Q

What characteristics do febrile fits have?

A

-Short in duration
-Rhythmic, tonic clonic
-Stiff –> shaking
-Sleepy afterwards
-Unconscious
TYPICAL = <15 mins, generalised, recovery within 1h, no recurrence within 24h
ATYPICAL = 15-30 mins, focal, may have further seizures within 24h
FEBRILE STATUS EPILEPTICUS = >30 mins

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10
Q

How should febrile fits be managed?

A

-Collateral, detailed history needed
-A-E including glucose
-Antipyretics for fever
-Treat cause (UTI, URTI) - must rule out meningitis
-Admit if complex / first episode
–IV lorazepam / buccal midazolam / rectal diazepam

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11
Q

What advice should be given to parents following a febrile fit?

A

(-Regular antipyretics)
-During fit - keep them safe, time fit, do not restrain
-Recurrent - buccal midazolam / rectal diazepam
-If lasts <5 min –> GP
-If lasts >5 min –> ambulance

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12
Q

Who suffers from breath-holding attacks?

A

-Babies and toddlers

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13
Q

What are the 3 main types of breath-holding attacks?

A

TEMPER
-Provoked by frustration
-Holds breath –> goes blue –> goes limp –> rapid spontaneous recovery
REFLEX ANOXIC SEIZURES
-Provoked by pain (eg mild head injury) or fear
-Opens mouth as if going to cry –> goes pale + LOC –> may have tonic-clonic seizure
-Caused by involuntary bradycardia for 5-30s
BLUE BREATH HOLDING ATTACKS
-Child starts to cry –> builds up –> becomes silent –> holds breath on expiration –> unable to inhale –> goes blue + LOC
-Lasts <1 min, involuntary, no brain injury
-Improves with age
-Screen for iron deficiency

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14
Q

Are breath holding attacks a cause for concern?

A

-No - check for anaemia / hypoglycaemia
-If complaining of >1 week of confusion, stiffness / shaking lasting >1 min, see the GP
-Typically occurs with crying
-No association with behavioural problems and no post-ictal phase

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15
Q

What are the causes, diagnosis and prognosis of epilepsy?

A

CAUSE
-Usually idiopathic - paroxysmal involuntary disturbances of brain function
-Can be from cerebral insult or an anatomical lesion
DIAGNOSIS
-Largely clinical, based on description of attacks
-FHx
PROGNOSIS
-Generally good if idiopathic - resolution in >70% of children
-Poor prognosis in cases of infantile spasms

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16
Q

What are the features of generalised tonic-clonic epilepsy?

A

TONIC PHASE
-Sudden LOC
-Limb extension, back arching, teeth clench, tongue may be bitten
-Breathing stops
-Eyes roll back
CLONIC PHASE
-Intermittent, jerking movements
-Irregular breathing
-May urinate / salivate
POST-ICTAL PHASE
-15 mins post-fit where may feel drowsy + tired

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17
Q

What are the features of absence seizures?

A

-Fleeting impairment of consciousness (5-20s)
-Typical onset = 4-8yrs
-Daydreaming, staring spells often several times a day
-No falling / involuntary movements
-Diagnosed on EEG, good prognosis
-Management:
–Sodium valproate or ethosuximide
–NOT carbamazepine

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18
Q

What are the features of West’s syndrome / infantile spasms?

A

-Generalised myoclonic seizure lasting a few seconds
–Can occur in clusters lasting up to half an hour
-Symmetrical flexion spasms
-Typical onset = 4-6months
-Manage with steroids / vigabatrin
-Poor prognosis:
–Developmental delay, loss of skills
–Later epilepsy diagnosis
–Associated with neurodegenerative conditions + tuberous sclerosis

19
Q

How should acute seizures be managed?

A

-Recovery position +/- oxygen + suction
-IV lorazepam 0.1mg/kg OR buccal midazolam 0.5mg/kg
–Max 2 doses of benzos, check BG
-Phenytoin if required or last resort thiopentone

20
Q

How should epilepsy be managed long-term?

A

-Anti-epileptics following 2nd seizure
-Sodium valproate or lamotrigine (teen girls)
-Carbamazepine if focal seizures

21
Q

What can cause fits in children?

A

BENIGN
-Febrile convulsions
-Breath-holding attacks
-Reflex anoxic spell
-Syncope / vasovagal
-Hyperventilation
SERIOUS
-Apnoea + acute life-threatening events eg sepsis, arrhythmia
-Infantile spasms
-Hypoglycaemia
-Epilepsy
-Cardiac arrhythmias

22
Q

What is the most common cause of headache and when do they usually occur?

A

-Most common among adolescents
-Almost always due to non-specific / local infection or tension headache
-More common in girls after puberty

23
Q

What red flag symptoms are there for headaches?

A

-Acute onset of severe pain
-Worse on lying down
-Associated vomiting
-Developmental regression / personality change
-Unilateral pain
-HTN, papilloedema
-Increasing head circumference
-Focal neurological signs
-Reduced consciousness
-Recent head trauma
-Chronic progressive headache

24
Q

How should you manage tension headaches?

A

-Reassure + elucidate stress
-Minimise painkillers
-Encourage distraction techniques

25
How should migraines be managed in children?
-Ibuprofen -Can use triptans in >12s but requires follow up + can only use nasal spray -Pizotifen and propanolol can be used prophylactically
26
What symptoms are associated with raised ICP?
RED FLAGS -Worse in morning and on lying down -Vomiting -Papilloedema -Focal neurological signs eg vision disturbance, difficulty walking, weakness -Severe HTN + bradycardia
27
What are important details to gather from a head injury history?
-Condition of child before + after -Hx of fits? Bleeding disorder? -Condition immediately after fall - cried immediately? LOC? -Confusion? Drowsiness? Vomiting? Dizziness? -Headache now?
28
What indications are there for an immediate CT following head injury?
-Witnessed LOC for >5 mins / Amnesia lasting >5 mins -Abnormal drowsiness ->2 discrete episodes of vomiting -Clinically suspected non-accidental injury -Post-traumatic seizure without Hx of epilepsy -Suspected open / depressed skull injury -?Basal skull fracture - CSF from ear/nose -Focal neurological defecit
29
What is hydrocephalus?
-Build-up of CSF in ventricular system of brain -Imbalance of production / absorption -More common in children with spina bifida
30
What are the main causes of hydrocephalus?
OBSTRUCTIVE / NON-COMMUNICATING -Structural pathology blocking CSF outflow eg tumours NON-OBSTRUCTIVE / COMMUNICATING -Imbalance of CSF absorption / increased production -Meningitis, SAH, IVH
31
How does hydrocephalus present in young vs older children?
BABIES -Delay in development -Head growth concerns OLDER -Headache, N+V -Papilloedema EXAMINATION -Macrocephaly seen in infants -Hyperreflexia -Papilloedema -Spasticity
32
How is hydrocephalus diagnosed?
-CT / MRI - ?enlarged ventricles -LP (but will cause brain herniation in obstructive) -URGENT surgical referral for placement of shunt or external ventricular drain -If obstructive --> treat cause
33
How is a diagnosis of migraine made in children?
-Usually occurs in late childhood / early adolescence -Clinical diagnosis based on: --Episodic occurrences --Impaitment of normal functioning during attack --Full recovery between attacks --Aura (often visual) --Nausea (+ sometimes vomiting) --Throbbing (sometimes unilateral) --FHx --Attacks lasting 1-72h
34
What can be done to manage migraines in children?
-Rest and analgesia during attacks -Migraine diary to identify triggers -Avoid: --Cheese --Chocolate --Citrus fruits --Nuts --Caffeine -If attacks are frequent: --Beta blockers --Pizotifen
35
What is plagiocephaly and how does it present?
-Common asymmetry of the skull - 'flat head' syndrome -Normal head circumference, usually resolves in first few months of life PRESENTATION -Flat spot on the back / one side of the head -Caused by remaining in supine position for too long -Can also be caused by lack of amniotic fluid in the womb -No associated symptoms, no affect on the brain
36
How can plagiocephaly be managed?
-Early recognition -Altering of positions eg tummy time, moving toys, alleviate pressure on head whilst in car seat
37
What is the difference between transient + chronic tic disorders and Tourette's syndrome?
Single or multiple motor and/or phonic tics occurring: -Transient = <1 year, multiple times a day -Chronic = >1 year, most days / intermittently Tourette's = both motor and 1+ phonic tics occur many times a day on most days
38
How can tic disorders be managed?
-Counsel parents - try to ignore + reassure child, do not tell them off / try to make them stop -School - educate other children -Screen for - anger, depression, anxiety, ADHD -If interfering with ADLs consider anti epileptics or alpha-2-adrenergic agonists
39
What causes muscular dystrophy?
-X-linked recessive disorder that causes gradual muscle weakness -Deletion of the gene dystrophin -Occurs in men
40
How does muscular dystrophy present?
-Symptoms appear age 1-6yrs -Progressive proximal muscle weakness -- difficulty walking, clumsiness, abnormal waddling gait, toe walking, difficulty climbing stairs -Incontinence -Delayed motor milestones -In Duchenne's, most have lost ability to walk by 12 -GOWER'S SIGN = use hands + arms to 'walk up' the body to stand up -ABSENT knee jerk
41
How can muscular dystrophy be diagnosed and managed?
DIAGNOSIS -Genetic testing -Elevated serum creatinine phosphokinase -Absent dystrophin on muscle biopsy (Duchenne's) MANAGEMENT -Unable to walk by 12, ventilator support required by 25 -Death usually due to pneumonia at an early age -Physio + OT -Early aggressive corticosteroid use can reduce need for surgery / ventilator
42
What are the different types of spina bifida?
MYELOMENINGOCELE (= most common) -Both spine + meninges exposed -Most severe MENINGOCELE (= least common) -Only meninges exposed SPINA BIFIDA OCCULTA -Minor defects of lumbar vertebrae causing: --Naevus / lipoma / hair tufts --Skin + tissue but no bone over distal cord
43
What clinical features can spina bifida have?
-Paralysis below lesion -Hydrocephalus (obstructive) -Neuropathic bladder --> incontinence -Faecal incontinence
44
How can spina bifida be managed?
-May be detected antenatally by measuring maternal serum alpha-fetoprotein -Conservative management eg OT -Surgery may be considered but is high risk

Y4 Paeds CCs (25 decks)

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