Central Nervous System Disease Flashcards
Name the different types of primary headache
- Tension headache
- Migraine
- Cluster headache (and other trigeminal autonomic cephalalgias)
- Primary headaches caused by exertion, cough etc.
What are primary headaches thought to be due to?
Due to a primary malfunction of neurones
What are secondary headaches?
Secondary headaches are thought to be due to an underlying pathology e.g. raised ICP and space occupying lesions.
What % of migraines are with aura and what % are without?
10% with aura; 90% without aura
Describe symptoms of migraine without aura
A bilateral or unilateral headache; characteristically pulsatile over the temporal or frontal area. It is often accompanied by unpleasant GI disturbances such as nausea, vomiting and abdominal pain. May also have photophobia and phonophobia.
What is the most common aura to occur in migraines?
Visual aura
Describe some negative phenomena of visual auras
Hemianopia - loss of half of the visual field
Scotoma - small areas of visual loss
Describe some positive phenomena of visual auras
Fortification spectra e.g. seeing zig zag lines
What is the most common cause of primary headache in children?
Migraine (without aura)
Familial migraine is an uncommon form of migraine linked to…
A calcium channel defect - it is dominantly inherited.
What is a basilar type migraine?
Vomiting with nystagmus and/or cerebellar signs
Periodic syndromes are often precursors of migraines. Name three periodic syndromes
Cyclical vomiting
Abdominal migraine
Benign paroxysmal vertigo of childhood
What are vasomotor symptoms?
Flushing
Name the features that may alert you to raised ICP/space occupying lesion
- Headaches worse on lying down
- Morning vomiting
- Night time waking
- Change in mood/personality/educational performance
- Visual field defects / papilloedema
- Cranial nerve abnormalities
- Abnormal gait / torticollis (tilting of head)
- Growth failure
- Cranial bruits (AVMs - rare)
What acute/resuce treatments should be given to control symptoms of headaches?
- Analgesia: paracetamol & NSAIDs (taken as early as possible when an episode start)
- Anti-emetics: prochlorperazine & metoclopramide
- Serotonin (5HT1) agonists: e.g. sumatriptan (nasal preparation is used in preference to oral triptan in children 12-17 years)
What prophylactic agents can be used in headaches that are frequent and intrusive?
- Sodium channel blockers: e.g. topiramate, valproate
- Beta-blockers: propranolol (NB contraindicated in asthma)
- Pizotifen (5HT2 antagonist)
What must your remember to advise women and girls of childbearing potential before starting topiramate
Topirimate is associated with a risk of fetal malformations and can impair the effectiveness of hormonal contraceptives
Define febrile seizure
A seizure accompanied by fever, in the absence of intracranial infection due to bacterial meningitis or viral encephalitis
At what temperature should you send a baby with fever who is 3 months or less to hospital?
38°
What % of children between the ages of 6 months and 5 years get febrile seizures?
3% of children between the ages of 6 months and 5 years get febrile seizures
Febrile seizures have a genetic predisposition : true or false?
True (10% risk if child has 1st degree relative with febrile seizures)
When do febrile seizures tend to occur?
Early in viral infection when the temperature is rising rapidly
Describe the characteristics of a febrile seizure
Usually brief, and are generalised tonic-clonic seizures
What % of children will go on to have further febrile seizures after their first?
30-40%
What factors increase the likelihood of further seizures
The younger the child
The shorter duration of illness before the seizure
A lower temperature at the time of the seizure
Positive family history
How do febrile seizures affect the risk of developing epilepsy
Simple febrile seizures do not affect risk of developing epilepsy (1-2% risk same as all children)
Complex febrile seizures confer increased risk of 4-12% chance of subsequent epilepsy
Define a complex febrile seziure
Those that are focal, prolonged or repeated in the same illness
What drugs can be given to parents to give to their child in the event of a prolonged febrile seizure?
Rectal diazepam or buccal midazolam
How should body temp be measured in an infant
electronic thermometer in the axilla
How should body temperature be measured in children aged 4 weeks to 5 years?
- electronic thermometer in the axilla
- chemical dot thermometer in the axilla
- infra-red tympanic thermometer
What are the causes of ‘funny turns’ in children?
Breath-holding attacks Reflex anoxic seizures Syncope Migraine Benign paroxysmal vertigo Cardiac arrhythmias
What is Todd’s paresis?
Focal weakness in a part of the body after a seizure. May also effect speech/vision.
