Nervous System Flashcards
What is cerebral palsy?
Abnormality of movement + posture Non-progressive Brain injuries occurring up to the age of 2
Causes of CP
Antenatally: vascular occlusion, cortical migration disorders or structural maldevelopment of brain. Genetics or congenital infection HIE during delivery 10% postnatally
What are preterm babies at risk of (in relation to CP)
Brain damage from periventricular leucomalacia (PVL) secondary to ischaemia or intravascular haemorrhage
Post natal causes of CP
Meningitis, encephalitis, head trauma, hydrocephalus, hyperbilirubinaemia
S+S of CP
Abnormal limb/ trunk posture + tone Delayed motor milestones Feeding difficulties Abormal gait Asymmetric hand function before 1 year
What are the types of CP?
Spastic Dyskinetic Ataxic
What are the characteristics of spastic CP?
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
What are the types of spastic CP?
Hemiplegia - one arm + leg Quadriplegia - all 4 limbs Diplegia - predominantly legs
Levels of CP
1 = walks without limits 2 = walks with limitations 3 = walks using handheld mobility device 4 = self mobility with limitations 5 = transported in manual wheelchair
What are the characteristics of dyskinetic CP?
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
What are the characteristics of ataxic CP?
Usually genetic Early hypotonia, poor balance, delayed motor development Incoordinate movements, intention tremor, ataxic gait
How many children will go on to have a further febrile seizure after 1?
30-40%
When is sodium valproate used?
Generalised seizures
When is carbamazepine used?
Focal + tonic-clonic seizures
When is phenobarbitone used?
Newborns
What are infantile spasms?
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
Characteristics of tension headache
Symmetrical, gradual onset Described as band/ pressure Relates to stress
Characteristics of migraines
Pulsatile over temporal or frontal area Accompanied by GI symptoms Can have aura Photophobia/ phonophobia
What are the characteristics of an aura?
Negative phenomena eg hemianopia or scotoma Positive phenomena eg fortification spectra (seeing zigzag lines)
What are the symptoms of raised ICP/ SOL?
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
Rescue treatments for headaches
Paracetamol + NSAIDs Anti emetics = prochlorperazine + metoclopramide Serotonin agonists = sumitriptan
Prophylactic treatments for headaches + SE
Pizotifen (serotonin antagonist) = weight gain + sleepiness B blockers = contraindicated in asthma Sodium channel blockers = valproate
Complications of a head injury
Concussion Impaired consciousness Subdural/ extradural haematoma
What is the first line investigation for a head injury?
CT head
What are S+S of significant head injury?
Panda eyes CSF leak from ears/ nose Bruising over mastoid (Battle’s sign) Raised ICP - low HR, raised BP Slow pupil reactions
What is the pathology of hydrocephalus?
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
Causes of non-communicating hydrocephalus?
Congenital malformation Aqueduct stenosis Atresia of outflow foramina of 4th ventricle (Dandy-walker malformation) Chiari malformation Posterior fossa neoplasm Intraventricular haemorrhage in preterms
Causes of communicating hydrocephalus + pathology
Failure to reabsorb CSF: Subarachnoid haemorrhage Meningitis
S+S hydrocephalus
Large head circumference Bulging fontanelles Distended scalp veins Fixed downwards gaze Raised ICP S+S
Management of hydrocephalus
Insertion of ventriculoperitoneal shunt
What is plagiocephaly?
Skull asymmetry but normal sutures + fontanelles Due to positional moulding Goes away with time
What is a tic?
Sudden, quick, coordinated movement Recurs in same part of body - usually face + head Repetitive, involuntary + stereotypic
What is Tourette’s syndrome?
Multiple motor tics + vocal tics
Management of tics
Clonidine or risperidone
What is the pathology of Duchenne’s?
X linked recessive disorder Deletion on short arm of X chromosome Raised CPK
S+S of Duchenne’s
Waddling gait Language delay Gower’s sign - need to turn prone to rise Pseudohypertrophy of calves Absent knee jerks Lumbar lordosis Progressive muscular atrophy
Management of Duchenne’s
Exercise Contractures CPAP at night Corticosteroids
Features of Becker muscular dystrophy
Progresses more slowly than Duchenne’s Average age of onset = 11 Inability to walk by late 20s
What are the characteristics of spina bifida?
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
