Neuro Flashcards
What are gross motor skills
Truncal and major limb muscles which help mobility
What are fine motor skills
Fine movements- using hands mainly
Also encompasses vision
If patient has speech problems what is important to check first
Check auditory system
Which develops first hearing or expressive development
Hearing
What are primitive reflexes
Reflexes we are born with but we lose at 3 months
What are the primitive reflexes
Sucking and rooting
Palmar grasp
Stepping
Asymmetric tonic reflex (ATNR)
mORO
Babinski
Which is worse neonatally hypothermia, hypoglycaemia or hypoxia
Hypoglycaemia is the worst
Then hypoxia and hypothermia
What is the sucking and rooting reflex
If tickle side of mouth, baby will try to suck it
Evolutionary purpose of sucking and rooting
First evolved as means can not go hypoglycaemic
What is the palmar grasp
If stimulate the palm then baby will try to grab it
Disappears by 1 year
What is the stepping reflex
If hold baby up will lift foot up as if taking step
What is the asymmetic tonic neck reflex
If turn babies neck then will get extension on that side of the body
What is the moro reflex
If move baby or hears loud noise will extend arms upwards then move them back to body
Why is babinskis reflex significant in babies
Myelin not formed properly by age of 1 so get positive babinskis
What are the protective reflexes
Head righting and parachute
Need to develop these before can attain motor development
What is head righting
If baby is sat and move the baby it will move neck to make sure its neck remains perpendicular
When should babies develop head righting
4-6 months
What is the parachute reflex
If when try to stand outstretch arms to protect the head
When should develop parachute reflex
7-9 MONTHS
What happens to grip in development in first year of life
Initially develop full hand grip then move to mature pincer but lose full hand grip a bit
Principles of learning development milestones
6wks
6months
12months
18months
24months
36months
When do children normally stand by
10 months
Gross motor development milestones
6wks- head control
6mths- no head lag, sitting
12mths- pulls to stand, walking, cruising
18mths- walks well, run
24mths- climbs stairs (1 step), kicks ball
36mths- standing on one leg, climbs stairs
Fine motor and vision
6wks- fixes and follows
6mths- full hand grip, hand to hand transfer
12 mths- mature pincer, pointing
18mths- build tower of 3 blocks, hand preferance, scribbles
24 mths- build tower of 7 blocks, circular scribbles
36mths- draw circle, imitates bridge
What is cruising
When hold on to furniture
Language and hearing development milestones
6wks- stills to sound
6mths- turn to sound, babbles
12mths- first word, respond to name
18mths- 6-12 words, follow simple instruction
24 mths- 2 words sentence
36mths- speaks in sentences
Socail skill and self care development milestones
6wks- smiles
6 mth- laughs and squeals
12mths- waves and peek-a-boo, drink from cup
18mths- spoon feeding, symbolic play
24mths- start toilet training, remove clothes
36mths- parallel play, interacting play and sharing
When do you get nystagmus
If struggling to focus
What does clenched fist suggest with regard to fine motor
Unable to form pincer grip
What is criteria for global developmental delay
Lack of development in 2 or more fields
Long term management of child with meningitis
Review in 4-6 weeks after discharge
- audiological assessment
- neuro/development assessment
Immediate management of meningitis in a child
Resus
Abx
- If under 3 months IV amoxicillin/ampicillin and cefotaxime
- Over 3 months IV ceftriaxone/cefotaxime
Steroids (dexamethasone)
- if over 3 months
- prurulent CSF
- WCC over 1000
- raised CSF WCC and protein over 1g/L
- bacteria on gram stain
- over 1 month and Hinfluenzae
- non meningococcal
Fluids
What is used to treat contacts of meningitis
Ciprofloxacin
Order of investigations for meningitis
LP first unless contraindicated (not meningococcal!)
Blood culture
FBC, U&Es, CRP and glucose
Coagulation profile
Contraindications for initial LP in meningitis
Meningococcal
Focal neuro
Papilloedema
Bulging of fontanelle
DIC
Signs of cerebral herniation
Most common viruses causing meningitis
Cocksackie B
Echovirus
How to treat viral meningitis
Discharge home after tests to rule out bacterial
Supportive therapy- fluids etc
What is purpura fulminans
Haemorrhagic skin necrosis from DIC
How does purpura fulminans present
Blood spots
Mass discolouration of the skin
Treatment for purprua fulminans
FFP and surgical debridement
What are reflex anoxic seizures
Seizure in response to pain or emotional stimuli. Caused by neurally mediated transient asystole in those with very sensitive vagal cardiac reflexes
Typical features of reflex anoxic seizures
Child goes very pale
Falls to floor- can have seizure
Rapid recovery
Occurs in children aged between 6mths-3 years
DDx for micropcephaly
Normal variation
Familial
Congenital infection - CMV etc
Perinatal brain injury liek HIE
Fetal alcohol syndrome
Patau
Craniosynostosis
What is defined as microcephaly
An occipital-frontal circumfrence under the 2nd centile
How is retinoblastoma inherited
Autosomal dominant
Pathophysiology of retinoblastoma
Loss of function in retinoblastoma tumour suppressor gene chr 13
Causes tumour of retinal cells
Most common presenting symptom of retinoblastoma
Absence of red reflex giving white pupil
What is leukocoria
White pupil
How can retinoblastoma present
Leukocoria
Strabismum- eyes dont line up
Visual problems-
Normally around 18months
How can retinoblastoma occur categorically
Unilateral
Bilateral- ALL hereditary
Treatment of retinoblastoma
Depends on how bad the tumour is, options include;
- enucleation (remove eye but not the muscles)
- other options include external beam, radiation, chemo
Most common type of seizure in febrile convulsion
Tonic-clonic
How are febrile convulsions classified
Simple
Complex
Febrile status epilipticus
What causes febrile convulsion
Temperature rising rapidly early in response to a viral infection
Differences between simple and complex febrile convulsions
Simple
- under 15 mins
- generalised seizure
- does not recur
Complex
- 15-30 mins
- focal seizure
- may repeat in 24 hours
What advice should be given about febrile convulsions if happesn again
Time it
Protect from head injury
If lasts more than 5 mins call ambulacne or is possibility to use emergency benzos if specialist has advised them.
If given anti-epileptics then wait another 5 mins and see if the seizure has not stopped/unconscious give again and call an ambulance
OPtions for emergency benzos in febrile convulsion
Buccal midazolam
Rectal diazepam
Only advised if recurrent seizures
When should febrile seizures be referred for specialist care
1st one
Less than 18mths
Diagnostic uncertainty
Focal neuro deficit
Taken recent antibiotics as can mask CNS infection
Most common cause of headache in children
Migraine without aura
Then tension
What is criteria for diagnosing migraine
At least 5 headaches with 2 of the following
Headache attack lasting 4-72 hours
2 of the following features
- bilateral or unilateral (frontal/temporal) location
- pulsating quality
- moderate to severe intensity
- aggravated by routine physical activity
Is accompanied by 1 of following
- nausea
- photo/phonophobia
What are infatile spasms (WEST syndrome) and how do they present
A type of childhood epilepsy with characteristic salaam attacks- head, trunk and arms flex followed by extension of the arms
Typically 4-8 months
What causes west syndrome
Typically is an underlying condition
- tuberous sclerosis
- HIE
- downs syndrome
- SOL
Investigations for WEST syndrome
EEG- hysparrythmia
CT- underlying condition
Management of WEST syndrome
Refer for tertiary centre assessment within 24 hours
Combination therapy with vigabatrin and prednisolone
Presentation of encephalitis
LOC
Focal neurology
Ataxia
Fever
Seizure
Investigations for encephalitis
CT then LP for viral PCR
Management of encephalitis
IV ceftriaxone and aciclovir
What is arm in waiters tip position diagnosis
Erb palsy