Neuro Flashcards
What are some causes of gross motor delay?
- Cerebral palsy
- Ataxia
- Myopathy
- Spina bifida
- Visual impairment
What are some causes of fine motor delay?
- Dyspraxia
- Cerebral palsy
- Muscular dystrophy
- Visual impairment
- Congenital ataxia (rare)
What are some causes of global developmental delay?
- Down’s syndrome
- Fragile X syndrome
- Rett syndrome
- Foetal alcohol syndrome
- Metabolic disorders
What are some causes of language delay?
- Specific social circumstances - multiple languages, siblings do all talking
- Hearing impairment
- Learning disability
- Neglect
- Autism
- Cerebral palsy
What is a potential management option for language delay?
SALT, audiology and health visitor; consider referring to safeguarding
What are potential causes of personal and social delay?
- Emotional and social neglect
- Parenting issues
- Autism
What is a febrile convulsion?
Seizure occurring in a child with a high fever
What age children will experience febrile convulsions?
6 months to 5 years of age
What characterizes a simple febrile convulsion?
Generalized, tonic clonic seizure; <15 minutes - only during single febrile illness
What characterizes a complex febrile convulsion?
Partial or focal seizure; >15 minutes, multiple times during same febrile illness
What is the typical presentation of a patient with a febrile convulsion (consider age too)?
~18 months, 2-5 minute tonic-clonic seizure during high fever. Fever caused by underlying viral infection (e.g. tonsillitis)
What are key differentials to consider when a child presents with a possible febrile convulsion?
- Epilepsy
- Meningitis, encephalitis, other neuro issue (e.g. cerebral malaria)
- IC space occupying lesions (e.g. brain tumour, IC haemorrhage)
- Syncopal episode
- Electrolyte abnormalities
- Trauma (consider safeguarding)
What would prompt an ambulance to be called when a child suffers a possible febrile convulsion?
> 5 minutes (1st episode should be trip to hospital anyway)
Which carries higher risk of future epilepsy development: simple/complex febrile convulsions?
Simple slightly higher than gen. population
Complex 10-20% higher (worse prognosis)
What are the clinical feature of generalized tonic-clonic seizure?
- Tonic-clonic
- Tongue biting
- Incontinence
- Groaning
- Irregular breathing
- Post-ictal period
What is the 1st line management for generalized tonic-clonic seizure?
Sodium valproate
What is the 2nd line management for generalized tonic-clonic seizure?
Lamotrigine, carbamazepine
What are the clinical features of focal seizures?
- Temporal lobe; hearing, speech, memory emotions (hallucinations, memory flashback, déjà vu, autopilot)
What is the 1st line management for focal seizures?
Carbamazepine
Lamotrigine
What is the 2nd line management for focal seizures?
Sodium valproate
Levetiracetam
What characterizes a absence seizure?
Blank and staring into space before returning to normal after around 10-20 seconds.
What is the 1st line management for absence seizure?
Sodium valproate or ethosuximide
What characterizes a atonic seizure?
Drop attack, usually <3 minutes
What is the 1st line management for a atonic seizure?
Sodium valproate
What is the 2nd line management for a atonic seizure?
Lamotrigine
What are the clinical features of myoclonic seizure?
Sudden, brief muscle contractions - jumping (often as part of juvenile myoclonic epilepsy)
What is the 1st line for a myoclonic seizure treatment?
Sodium valproate
What is the treatment for infantile spasms?
Often carries poor prognosis
Pred, vigabatrin
What are investigations that are performed for a child who has suffered seizures?
EEG, MRI
ECG, blood electrolytes, blood glucose, blood cultures/urine cultures/LP.
When should an EEG be considered for a patient suffering seizures?
After 2nd simple tonic-clonic seizure
What would lead to an MRI being requested for a patient suffering a seizure?
1st seizure child <1 year old
Focal seizure
No response to 1st line anti-epileptic medication
What should be given should the patient be in status epilepticus and suffering seizures for 10 minutes?
IV Lorazepam
A patient suffering status epilepticus who has become more stable and after lorazepam should be given?
IV phenytoin or phenobarbital (+intubate and ventilate)
What is status epilepticus?
> 5 minute seizure or 2 or more seizures without regaining consciousness
What are side effects of sodium valproate?
- Teratogenic - try to avoid in pregnancy age girls
- Liver damage and hepatitis
- Hair loss
- Tremor
What are the side effects of carbamazepine?
- Agranulocytosis
- Aplastic anaemia
- P450 system induction so beware of many drug interactions
Which system can be stimulated as a side effect of carbamazepine?
P450 system
What are the side effects of phenytoin?
- Folate and vitamin D deficiency
- Megaloblastic anaemia
- Osteomalacia
Which types of anaemia is caused by carbamazepine and phenytoin respectively?
Carbamazepine - aplastic anaemia
Phenytoin - megaloblastic anaemia
What are the side effects of ethosuximide?
Night terrors
Rashes
What are the side effects of Lamotrigine?
- Steven-Johnson syndrome
- DRESS syndrome
- Leukopenia
What is cerebral palsy?
Permanent non progressive condition resulting from damage to the brain around the time of birth
(huge range in symptom severity)
What are antenatal causes of cerebral palsy?
- Maternal infection
- Trauma during pregnancy
What are perinatal causes of cerebral palsy?
- Birth asphyxia
- Pre-term birth
What are postnatal causes of cerebral palsy?
- Meningitis
- Severe neonatal jaundice
- Head injury
Pathophysiology of spastic hypertonia?
Damage to the UMN causing increased tone
What is the pathophysiology of dyskinetic cerebral palsy?
Basal ganglia are damaged - athetoid movements, oro-motor problems; hyper/hypotonia
What is the pathophysiology of ataxic cerebral palsy?
Cerebellum damage - coordinated movement problems
What is the pathophysiology of mixed cerebral palsy?
Spastic, dyskinetic and/or ataxic features mix
Name the patterns of cerebral palsy?
Monoplegia - one limb
Hemiplegia - one side of the body
Diplegia - four limbs mostly legs
Quadriplegia - four limbs affected more severely (seizures, speech disturbance, other impairments).
What is the tale-tale sign of a potential cerebral palsy diagnosis?
Hand preference prior to 18 months
What may be found on neurological examination for a patient with cerebral palsy?
Increased muscle tone and spasticity in legs
Hemiplegic/diplegic gait
UMN signs (muscle bulk preserved, hypertonia, slightly reduced power, brisk reflexes)
Athetoid movements
Cerebellar involvement - coordination may need testing
Who may be involved in the care of a complex cerebral palsy patient?
MDT to include:
- Physio
- OT
- SALT (consider NGT or PEG)
- Dietician
- Orthopaedic surgeon
- Paediatrician (medication control)
- Social worker
- Charity and support group
What medication may be prescribed by a paediatrician for a cerebral palsy patient?
Muscle relaxants - baclofen
Anti-epileptic medication
Glycopyrronium bromide (drooling)
