Nervous System

Question 1

What is cerebral palsy?

Answer 1

Abnormality of movement + posture Non-progressive Brain injuries occurring up to the age of 2

Question 2

Causes of CP

Answer 2

Antenatally: vascular occlusion, cortical migration disorders or structural maldevelopment of brain. Genetics or congenital infection HIE during delivery 10% postnatally

Question 3

What are preterm babies at risk of (in relation to CP)

Answer 3

Brain damage from periventricular leucomalacia (PVL) secondary to ischaemia or intravascular haemorrhage

Question 4

Post natal causes of CP

Answer 4

Meningitis, encephalitis, head trauma, hydrocephalus, hyperbilirubinaemia

Question 5

S+S of CP

Answer 5

Abnormal limb/ trunk posture + tone Delayed motor milestones Feeding difficulties Abormal gait Asymmetric hand function before 1 year

Question 6

What are the types of CP?

Answer 6

Spastic Dyskinetic Ataxic

Question 7

What are the characteristics of spastic CP?

Answer 7

Cortical pyramidal abnormality = increased muscle tone, reflexes + clonus Dynamic catch - greater resistance when muscle is stretched further Limb tone may yield in ‘clasp knife’ fashion Presents early

Question 8

What are the types of spastic CP?

Answer 8

Hemiplegia - one arm + leg Quadriplegia - all 4 limbs Diplegia - predominantly legs

Question 9

Levels of CP

Answer 9

1 = walks without limits 2 = walks with limitations 3 = walks using handheld mobility device 4 = self mobility with limitations 5 = transported in manual wheelchair

Question 10

What are the characteristics of dyskinetic CP?

Answer 10

Involuntary movements Chorea = irregular + sudden Athetosis = slow writhing (fanning of fingers distally) Dystonia = simultaneous contraction of muscles giving twisting appearance Present with floppiness + delayed motor development Common cause: HIE at term

Question 11

What are the characteristics of ataxic CP?

Answer 11

Usually genetic Early hypotonia, poor balance, delayed motor development Incoordinate movements, intention tremor, ataxic gait

Question 12

How many children will go on to have a further febrile seizure after 1?

Answer 12

30-40%

Question 13

When is sodium valproate used?

Answer 13

Generalised seizures

Question 14

When is carbamazepine used?

Answer 14

Focal + tonic-clonic seizures

Question 15

When is phenobarbitone used?

Answer 15

Newborns

Question 16

What are infantile spasms?

Answer 16

1-6 months Infant doubles up, flexing at waist + neck + flings arms forward EEG shows disordered picture = hypsarrhthymia Caused by metabolic/ cerebral damage Commonly tuberous sclerosis

Question 17

Characteristics of tension headache

Answer 17

Symmetrical, gradual onset Described as band/ pressure Relates to stress

Question 18

Characteristics of migraines

Answer 18

Pulsatile over temporal or frontal area Accompanied by GI symptoms Can have aura Photophobia/ phonophobia

Question 19

What are the characteristics of an aura?

Answer 19

Negative phenomena eg hemianopia or scotoma Positive phenomena eg fortification spectra (seeing zigzag lines)

Question 20

What are the symptoms of raised ICP/ SOL?

Answer 20

Headache worse when lying down Morning vomiting Night time waking Change in mood + personality Visual field defects Abducens nerve affected = squint, diplopia Abnormal gait Torticollis Growth failure Papilloedema

Question 21

Rescue treatments for headaches

Answer 21

Paracetamol + NSAIDs Anti emetics = prochlorperazine + metoclopramide Serotonin agonists = sumitriptan

Question 22

Prophylactic treatments for headaches + SE

Answer 22

Pizotifen (serotonin antagonist) = weight gain + sleepiness B blockers = contraindicated in asthma Sodium channel blockers = valproate

Question 23

Complications of a head injury

Answer 23

Concussion Impaired consciousness Subdural/ extradural haematoma

Question 24

What is the first line investigation for a head injury?

Answer 24

CT head

Question 25

What are S+S of significant head injury?

Answer 25

Panda eyes CSF leak from ears/ nose Bruising over mastoid (Battle's sign) Raised ICP - low HR, raised BP Slow pupil reactions

Question 26

What is the pathology of hydrocephalus?

Answer 26

Obstruction to outflow of CSF Dilatation of ventricular system Non-communicating = obstruction within ventricular system Communicating = at arachnoid villi (site of absorption of CSF) Accumulating CSF = enlarging head

Question 27

Causes of non-communicating hydrocephalus?

Answer 27

Congenital malformation Aqueduct stenosis Atresia of outflow foramina of 4th ventricle (Dandy-walker malformation) Chiari malformation Posterior fossa neoplasm Intraventricular haemorrhage in preterms

Question 28

Causes of communicating hydrocephalus + pathology

Answer 28

Failure to reabsorb CSF: Subarachnoid haemorrhage Meningitis

Question 29

S+S hydrocephalus

Answer 29

Large head circumference Bulging fontanelles Distended scalp veins Fixed downwards gaze Raised ICP S+S

Question 30

Management of hydrocephalus

Answer 30

Insertion of ventriculoperitoneal shunt

Question 31

What is plagiocephaly?

Answer 31

Skull asymmetry but normal sutures + fontanelles Due to positional moulding Goes away with time

Question 32

What is a tic?

Answer 32

Sudden, quick, coordinated movement Recurs in same part of body - usually face + head Repetitive, involuntary + stereotypic

Question 33

What is Tourette's syndrome?

Answer 33

Multiple motor tics + vocal tics

Question 34

Management of tics

Answer 34

Clonidine or risperidone

Question 35

What is the pathology of Duchenne's?

Answer 35

X linked recessive disorder Deletion on short arm of X chromosome Raised CPK

Question 36

S+S of Duchenne's

Answer 36

Waddling gait Language delay Gower's sign - need to turn prone to rise Pseudohypertrophy of calves Absent knee jerks Lumbar lordosis Progressive muscular atrophy

Question 37

Management of Duchenne's

Answer 37

Exercise Contractures CPAP at night Corticosteroids

Question 38

Features of Becker muscular dystrophy

Answer 38

Progresses more slowly than Duchenne's Average age of onset = 11 Inability to walk by late 20s

Question 39

What are the characteristics of spina bifida?

Answer 39

Neural tube defect - failure of fusion of vertebral arch Meningomyelocele = most severe form = baby born with exposed spinal cord Associated with hydrocephalus Paralysis of legs Neuropathic bladder Faecal incontinence