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Paediatrics > Fits, faints and funny turns > Flashcards

Fits, faints and funny turns Flashcards

1
Q

What is a seizure? What is a convulsion?

A

Seizure / Fit: any attack from whatever cause

Convulsion: Seizure with prominent motor activity

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2
Q

What is syncope due to?

A

Fainting - due to neuro-cardiogenic mechanism

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3
Q

What is an epileptic seizure?

A

An abnormal excessive hyper synchronous discharge from a group of cortical neurons

Can have many clinical manifestations (motor, sensory, cognitive)

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4
Q

What are some important non-epileptic seiuzure causes in children?

A
  • Acute symptomatic seizures (caused by acute insult to brain - hypoxia, hypoglycaemia, infection)
  • Reflex anoxic seizures: common in toddlers, caused by vagal overstimulation. Always provoked (eg. fright)
  • Parasomnias
  • Psychogenic non-epileptic seizures
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5
Q

What is a febrile convulsion? Who does it occur to?

A

Seizure that is associated with a fever but there is no evidence of intracranial infection or precipitating factor
- Commonest cause of acute symptomatic seizure

Occurs to children aged 3 months to 5 years

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6
Q

What are some signs of an absence seizure occuring?

A
  • Upwards rolling of eyeballs
  • Eyelid blinking
  • Brief duration
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7
Q

What are some signs of a myoclonic seizure?

A

Brief duration attack with muscle spasms

  • Often patient will drop things
  • Might fall down
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8
Q

What are some signs of an atonic seizure?

A
  • Sudden and abrupt loss of tone (patient just flops)

- Potential for significant injury

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9
Q

What happens in a tonic clonic seizure?

A

Tonic phase - patients muscles go stiff and they fall / drop things

Clonic phase - rhythmic jerking seen

Eyes of the patient usually open

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10
Q

What triggers the discharges that cause seizures?

A

An imbalance between excitatory and inhibitory neurotransmitters

Main inhibitor neurotransmitter: GABA (decreased in seizure)

Main excitatory: glutamate, aspartate (increases in seizure)

Causes an excessive influx of Ca and Na, depolarization results in seizure symptoms

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11
Q

What are the main types of epileptic seizures?

A

Focal / partial - the seizure focus is restricted to one hemisphere or part of one hemisphere

Generalized - Neurons are recruited from both hemispheres of the brain

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12
Q

What types of seizure is more common in children?

A

More common to have generalized seizures

Most are idiopathic in origin

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13
Q

What are some of the limitations of the EEG in diagnosing and classifying epilepsy?

A
  • The EEG done in the interictal (between seizures) period cannot always pick-up epileptic activity (sensitivity of 30-60%)
  • High chance of false positive as many non-epileptic paroxysmal attacks may be seen on EEG (30% FP)
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14
Q

What are some of the advantages of an EEG when investigating seizures?

A
  • Useful at determining seizure type (focal / generalized)

- Useful in classifying seizure syndromes

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15
Q

If a child presents with convulsive seizures what is an important test to do first off? Why?

A

ECG

Because there are arrhythmias that may cause convulsive seizures and if they are not identified they may be classified as epilepsy and treated incorrectly - with bad consequence

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16
Q

If epilepsy is suspected in a child, what tests should be done?

A

ECG

EEG (interictal or ideally ictal)

MRI brain (cause - eg. structural abnormality)

Metabolic testing (if associated with growth regression etc)

Genetic testing

17
Q

What are some of the important steps in managing a childs epilepsy?

A
  1. MAKE SURE IT’S EPILEPSY
  2. Anti-epileptic drugs (AED): choose one and perform slow upwards titration (symptomatic improvements?)
  3. Monitor side effects of the drug (can be detrimental - drowsiness / effects on cognition)
18
Q

What are the first line AEDs for children?

A

Generalized epilepsies:
Boys - sodium valproate
Girls - Levetiracetam

Focal epilepsy:
- Carbamazepine

19
Q

If the patient has tried 2 AED’s and is still having seizures what are they termed as? Management from there?

A

Drug refractory epilepsy

  • Offer other AEDs
  • Other therapies: immunomodulation with steroids, ketogenic diets, surgery
20
Q

What is VNS surgery? Who is given it?

A

Vagal nerve stimulator: electrical signal generator inserted below clavicle and wrapped around the left vagus nerve, functions to inhibit seizure activity

Parents / carers can use a hand held magnet to set it off during seizure

Palliative care, given to those with drug refractory epilepsy

21
Q

What term is used to describe a baby with a big head? Small head?

A

Macrocephaly

Microcephaly

22
Q

What is the major difference between a babies skull and an adults skull?

A

The presence of fontanelles

Anterior & posterior fontanelles

23
Q

When do each of the fontanelles on a babies skull tend to close?

A

Posterior fontanelle - 2-3 months after birth

Anterior fontanelle - between 1-3 years of age

24
Q

What is measured in regards to head size?

A

Occipito-frontal circumference

(front of tape measure above eyebrows, posteriorly the tape measure should go over the most prominent part of the occiput)

25
Q

How is microcephaly categorized?

A

If the occipitofrontal circumference is less than 2 standard deviations below average - mild microcephaly

Less than 3 SD - moderate to severe

26
Q

How big does a childs head have to be to be considered macrocephalic?

A

More than 2 standard deviations bigger than average

27
Q

What is plagiocephaly? Brachycephaly? Scaphocephaly?

A

Palgiocephaly - flat head

Brachycephaly - Short head or flat at the back

Scaphocephaly - boat shaped skull

28
Q

What is craniosynostosis?

A

Fusion of one or more of the sutures of the babies skull excessively quickly

Caused deformed head shape that may result in raised ICP and may be reflected in facial features

29
Q

What is Gower’s sign?

A

Sign of muscle weakness, particularly around the pelvic girdle

Demonstrated by having child lie flat on their back and ask them to get up as quick as possible, sign is positive if they have to roll onto their front and then push themselves up onto their feet

30
Q

Who is affected by Duchenne Muscular Dystrophy? What are the signs / symptoms?

A

Boys - present in childhood

Delayed motor skills, late walking, symmetrical proximal weakness (waddling gait), Gower’s sign positive

31
Q

What is myotonia? What is it a sign of?

A

Inability of muscles to relax after sustained period of contraction

Neuromuscular disease

32
Q

What are some important signs that may indicate myopathy instead of neuropathy?

A

Proximal muscle weakness more common in myopathies

Usually pure motor (no sensory) signs in myopathies

Fasciculations usually only present in neuropathies

Contractures only develop in myopathies

Myocardial dysfunction common in myopathies

Paediatrics (33 decks)

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