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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
Q

How should migraines be managed in children?

A

-Ibuprofen
-Can use triptans in >12s but requires follow up + can only use nasal spray
-Pizotifen and propanolol can be used prophylactically

26
Q

What symptoms are associated with raised ICP?

A

RED FLAGS
-Worse in morning and on lying down
-Vomiting
-Papilloedema
-Focal neurological signs eg vision disturbance, difficulty walking, weakness
-Severe HTN + bradycardia

27
Q

What are important details to gather from a head injury history?

A

-Condition of child before + after
-Hx of fits? Bleeding disorder?
-Condition immediately after fall - cried immediately? LOC?
-Confusion? Drowsiness? Vomiting? Dizziness?
-Headache now?

28
Q

What indications are there for an immediate CT following head injury?

A

-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
Q

What is hydrocephalus?

A

-Build-up of CSF in ventricular system of brain
-Imbalance of production / absorption
-More common in children with spina bifida

30
Q

What are the main causes of hydrocephalus?

A

OBSTRUCTIVE / NON-COMMUNICATING
-Structural pathology blocking CSF outflow eg tumours
NON-OBSTRUCTIVE / COMMUNICATING
-Imbalance of CSF absorption / increased production
-Meningitis, SAH, IVH

31
Q

How does hydrocephalus present in young vs older children?

A

BABIES
-Delay in development
-Head growth concerns
OLDER
-Headache, N+V
-Papilloedema
EXAMINATION
-Macrocephaly seen in infants
-Hyperreflexia
-Papilloedema
-Spasticity

32
Q

How is hydrocephalus diagnosed?

A

-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
Q

How is a diagnosis of migraine made in children?

A

-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
Q

What can be done to manage migraines in children?

A

-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
Q

What is plagiocephaly and how does it present?

A

-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
Q

How can plagiocephaly be managed?

A

-Early recognition
-Altering of positions eg tummy time, moving toys, alleviate pressure on head whilst in car seat

37
Q

What is the difference between transient + chronic tic disorders and Tourette’s syndrome?

A

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
Q

How can tic disorders be managed?

A

-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
Q

What causes muscular dystrophy?

A

-X-linked recessive disorder that causes gradual muscle weakness
-Deletion of the gene dystrophin
-Occurs in men

40
Q

How does muscular dystrophy present?

A

-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
Q

How can muscular dystrophy be diagnosed and managed?

A

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
Q

What are the different types of spina bifida?

A

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
Q

What clinical features can spina bifida have?

A

-Paralysis below lesion
-Hydrocephalus (obstructive)
-Neuropathic bladder –> incontinence
-Faecal incontinence

44
Q

How can spina bifida be managed?

A

-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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