Acute neuro presentations in children

Question 1

Childrens GCS eye categories

Answer 1

4 = spontaneously
3 = to speech
2 = to pain
1 = none

Question 2

Childrens GCS verbal categories

Answer 2

5 = alert, babbles, coos words to usual ability
4 = less than usual words, spontaneous irritable cry
3 = cries only to pain
2 = moans to pain (incomprehensible words)
1 = none

Question 3

Childrens GCS motor categories

Answer 3

6 = spontaneous/obeys verbal commands
5 = localise to pain
4 = withdraws from pain
3 = abnormal flexion
2 = abnormal extension
1 = none

Question 4

Causes of decreased consciousness in children

Answer 4

hypoxia
infection
intoxication
trauma
metabolic
seizure
raised ICP

Question 5

Define status epilepticus

Answer 5

recurrent or continuous seizure activity lasting >30mins in which the patient does not regain baseline mental status

or 2 or more convulsive seizures in 30mins without gaining consciousness between them

Question 6

Simple febrile convulsions features

Answer 6

6 months to 6 years
<10mins
complete recovery within 1h
no recurrence within 24h

Question 7

Complex febrile seizures features

Answer 7

focal onset
>15mins
seizure recurrent within 24h or the same illness
incomplete recovery after 1h

Question 8

Risk factors for further febrile seizures

Answer 8

early age of onset
FH of febrile seizures
lower temperature (<40)

Question 9

Risk factors for patients who have had a febrile seizure developing epilepsy

Answer 9

previous abnormal neurology
FH of afebrile seizures
complex febrile seizures

Question 10

Which children with seizures get scanned?

Answer 10

new focal onset seizures
new onset, persistent focal neurology
signs of meningism
trauma
NAI concerns

Question 11

Triggers that exacerbate chronic dystonia

Answer 11

pain from any source
GI
dental (ulcers, caries)
orthopaedic - dislocated hip, casting, fractures
intercurrent illness/infection
weaning or addition or some drugs
surgical procedures and anaesthetics

Question 12

Medical complications of status dystonicus

Answer 12

elevated body temperature
pain
exhaustion from sleep deprivation and exertion
rhabdomyolysis
dehydration with electrolyte disturbance
acute renal failure
bulbar dysfunction
resp insufficiency
death

Question 13

Status dystonicus treatment

Answer 13

hydration
pain relief
anticholinergic
Benzodiazepines, baclofen
dopaminergic - L-dopa

Question 14

Red flags for headaches in children

Answer 14

persistent and recurrent headaches
balance/coordination/gait abnormalities
persistent/recurrent vomiting
abnormal eye movements
blurred or double vision
behaviour change
seizures
abnormal head position
delayed puberty

Question 15

What causes cerebral palsy?

Answer 15

insult to a developing brain