Central Nervous System Disease

Question 1

Name the different types of primary headache

Answer 1

• Tension headache
• Migraine
• Cluster headache (and other trigeminal autonomic cephalalgias)
• Primary headaches caused by exertion, cough etc.

Question 2

What are primary headaches thought to be due to?

Answer 2

Due to a primary malfunction of neurones

Question 3

What are secondary headaches?

Answer 3

Secondary headaches are thought to be due to an underlying pathology e.g. raised ICP and space occupying lesions.

Question 4

What % of migraines are with aura and what % are without?

Answer 4

10% with aura; 90% without aura

Question 5

Describe symptoms of migraine without aura

Answer 5

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.

Question 6

What is the most common aura to occur in migraines?

Answer 6

Visual aura

Question 7

Describe some negative phenomena of visual auras

Answer 7

Hemianopia - loss of half of the visual field

Scotoma - small areas of visual loss

Question 8

Describe some positive phenomena of visual auras

Answer 8

Fortification spectra e.g. seeing zig zag lines

Question 9

What is the most common cause of primary headache in children?

Answer 9

Migraine (without aura)

Question 10

Familial migraine is an uncommon form of migraine linked to…

Answer 10

A calcium channel defect - it is dominantly inherited.

Question 11

What is a basilar type migraine?

Answer 11

Vomiting with nystagmus and/or cerebellar signs

Question 12

Periodic syndromes are often precursors of migraines. Name three periodic syndromes

Answer 12

Cyclical vomiting
Abdominal migraine
Benign paroxysmal vertigo of childhood

Question 13

What are vasomotor symptoms?

Answer 13

Flushing

Question 14

Name the features that may alert you to raised ICP/space occupying lesion

Answer 14

• 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)

Question 15

What acute/resuce treatments should be given to control symptoms of headaches?

Answer 15

• 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)

Question 16

What prophylactic agents can be used in headaches that are frequent and intrusive?

Answer 16

• Sodium channel blockers: e.g. topiramate, valproate
• Beta-blockers: propranolol (NB contraindicated in asthma)
• Pizotifen (5HT2 antagonist)

Question 17

What must your remember to advise women and girls of childbearing potential before starting topiramate

Answer 17

Topirimate is associated with a risk of fetal malformations and can impair the effectiveness of hormonal contraceptives

Question 18

Define febrile seizure

Answer 18

A seizure accompanied by fever, in the absence of intracranial infection due to bacterial meningitis or viral encephalitis

Question 19

At what temperature should you send a baby with fever who is 3 months or less to hospital?

Answer 19

38°

Question 20

What % of children between the ages of 6 months and 5 years get febrile seizures?

Answer 20

3% of children between the ages of 6 months and 5 years get febrile seizures

Question 21

Febrile seizures have a genetic predisposition : true or false?

Answer 21

True (10% risk if child has 1st degree relative with febrile seizures)

Question 22

When do febrile seizures tend to occur?

Answer 22

Early in viral infection when the temperature is rising rapidly

Question 23

Describe the characteristics of a febrile seizure

Answer 23

Usually brief, and are generalised tonic-clonic seizures

Question 24

What % of children will go on to have further febrile seizures after their first?

Answer 24

30-40%

Question 25

What factors increase the likelihood of further seizures

Answer 25

The younger the child
The shorter duration of illness before the seizure
A lower temperature at the time of the seizure
Positive family history

Question 26

How do febrile seizures affect the risk of developing epilepsy

Answer 26

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

Question 27

Define a complex febrile seziure

Answer 27

Those that are focal, prolonged or repeated in the same illness

Question 28

What drugs can be given to parents to give to their child in the event of a prolonged febrile seizure?

Answer 28

Rectal diazepam or buccal midazolam

Question 29

How should body temp be measured in an infant

Answer 29

electronic thermometer in the axilla

Question 30

How should body temperature be measured in children aged 4 weeks to 5 years?

Answer 30

• electronic thermometer in the axilla
• chemical dot thermometer in the axilla
• infra-red tympanic thermometer

Question 31

What are the causes of ‘funny turns’ in children?

Answer 31

Breath-holding attacks
Reflex anoxic seizures 
Syncope
Migraine
Benign paroxysmal vertigo
Cardiac arrhythmias

Question 32

What is Todd’s paresis?

Answer 32

Focal weakness in a part of the body after a seizure. May also effect speech/vision.