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Y4 Paediatrics > Neuro > Flashcards

Neuro Flashcards

1
Q

What is cerebral palsy?

A

disorder of movement and posture due to a non-progressive lesion of the motor pathways in the developing brain, due to CNS insult sustained before 2 years

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2
Q

What are some prenatal and postnatal causes of CP?

A

prenatal - APH, alcohol, rubella, HIV, placental abruption, cord prolapse, maternal shock
postnatal - birth trauma and hypoxia with cord around neck, HIE, severe neonatal jaundice

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3
Q

How does CP manifest?

A

weakness, paralysis, increased tone, coordination
premature handedness, delayed milestones
UMN signs
high steppage, waddling gait

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4
Q

What are some complications associated with CP?

A

learning disability, epilepsy, kyphoscoliosis, muscle contractures, hearing and visual impairments, GORD

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5
Q

How is CP managed?

A

MDT - physio for muscles, OT for ADL, SALT for swallow, ortho for contractures
paeds - optimise medications
social workers and charities

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6
Q

What are the medical managements for CP?

A

muscle relaxants - baclofen
anti-epileptics
glycopyrronium bromide - drooling

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7
Q

What is the pathophysiology of epilepsy?

A
  • seizures which are transient episodes of abnormal electrical activity in the brain
  • disrupted balance between excitatory glutamate and inhibitory GABA
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8
Q

How might a seizure present?

A
  • a general strange feelingthat’s hard to describe
  • a “rising” feeling inyourtummy–like the sensation in your stomach when on a fairground ride
  • a feeling that events have happened before (déjà vu)
  • unusual smells or tastes
  • tinglingin your arms and legs
  • an intense feeling of fear or joy
  • stiffness or twitching in part ofyour body, such as an arm or hand
  • witnessed general jerking of the whole body
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9
Q

What type of seizures are there?

A

tonic clonic - LOC
focal - focal signs
absence - stare blankly
atonic - muscle tones lapses briefly
myoclonic - brief contractions
infantile spasms

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10
Q

How would you manage status epilepticus?

A
  • Secure the airway
  • Give high-concentration oxygen
  • Assess cardiac and respiratory function
  • Check blood glucose levels
  • Gain intravenous access (insert a cannula)
  • IVlorazepam, repeated after 10 minutes if the seizure continues
  • then infusion of IV phenobarbital or phenytoin
  • ITU
  • community
    • Buccal midazolam
    • Rectal diazepam
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11
Q

How is epilepsy investigated?

A

EEG
MRI brain
ECG
electrolytes
glucose
blood cultures, urine cultures, LP

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12
Q

How do you manage seizure?

A

safety precautions for when seizures happen
medications
managing seizures
ketogenic diet, vagal nerve stimulation, epilepsy surgery

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13
Q

What is extradural haemorrhage?

A
  • tearing of middle meningeal artery as it passes through foramen spinosum of sphenoid
  • space between the dura and the overlying calvarium
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14
Q

How extradural haemorrhage present?

A
  • lucid interval until consciousness deteriorates
  • seizures secondary to increasing haematoma
  • initial presentation - anaemia and shock
  • dilation of ipsilateral pupil
  • paresis of contralateral limbs
  • false localising uL or bL 6th nerve paresis
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15
Q

how does a migraine present?

A

unilateral, throbbing, may take up to 48h to resolve and may present with visual aura, photophobia and phonophobia, N+V, abdominal pain

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16
Q

What is an aura in association to migraines?

A

aura - commonly visual disturbances like hemianopia, scotoma or fortification spectra (zig zag)

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17
Q

What are some red flags to be aware of in regards to migraines?

A
  • headache worse when lying down, coughing or straining, wakes child up from sleep (not in morning when waking up - migraines)
  • associated confusion, morning or persistent N+V
  • recent personality changes, behaviour or educational performance
18
Q

How are migraines managed?

A
  • acute - rest, fluids, low stimulus environment, paracetamol, ibuprofen, sumatriptan, antiemetics like domperidone
  • Prophylaxis - if impacting school and high frequency and severity, propranolol (not for asthma), pizotifen (drowsy), topiramate (teratogenic)
19
Q

What is Duchennes MD?

A
  • X linked recessive disorder of defective gene for dystrophin on X chromosome
    • dystrophin heps hold muscles together at cellular level
20
Q

How might MD present?

A
  • 3-5 year old with weakness in muscles around pelvis
  • progressive weakness
  • Frequent falls
  • Difficulty rising from a lying or sitting position
  • Trouble running and jumping
  • Gower’s signs
21
Q

What are the complications for MD?

A
  • breathing difficulties requiring CPAP etc
  • coughing difficulties due to weakness
  • swallowing difficulties and aspirations
  • heart disease - cardiomyopathy and CHF
  • scoliosis
  • osteoporosis
22
Q

How is MD managed?

A
  • no curative
  • aim for highest quality of life for longest time possible
  • occupational therapy, physio, medical appliances like wheelchairs and braces
  • complication management for spinal scoliosis and heart failure
  • DMD - oral steroids may slow progression of weakness by 2 years, creatine supplementation slight improvement for strength, genetic trials ongoing
23
Q

What could cause a raised ICP?

A
  • traumatic brain injury
  • hydrocephalus, brain tumors
  • intracranial infections
  • hepatic encephalopathy
  • impaired central nervous system venous outflow
24
Q

How might you identify a paeds raised ICP?

A
  • extremely irritable
  • increased sleepiness
  • high pitched cry
  • vomiting
  • headache
  • loss of consciousness
25
Q

What examination findings would you look for in raised ICP?

A
  • drowsy
  • seizures
  • papilloedema
  • pupil changes - ipsilateral dilation
  • abnormal posturing - decorticate or decerebrate
  • cushings triad - bradycardia, raised BP, irregular breathing
26
Q

What initial investigations might you do in suspected raised ICP?

A
  • Cardiovascular monitoring
  • Pulse oximetry
  • Laboratory investigations (to include U&Es, FBC, blood and urine cultures)
  • CT scan urgently once vital signs stabilised
  • Contra-indication to LP
27
Q

What is the management of raised ICP?

A
  • A-E and maintaining cerebral perfusion pressure vital
  • manage in ICU with intubation and ventilation
  • help venous drainage by keeping head in midline elevated at 30 degrees
  • reduce metabolic demand - normothermia (36-37c), oxygenation, muscle relax, prevent seizures and hypoglycaemia
  • optimise CPP - normal pCO2, high - normal BP
  • hypertonic saline or mannitol
  • fluid restriction and diuresis, avoid hypovolaemia
  • emergent neurosurgical transfer if intervention possible
  • steroids maybe useful - dexamethasone
  • no LP
28
Q

What is spinal muscle atrophy?

A

autosomal recessive condition causing progressive loss of motor neurones, leading to progressive muscular weakness
affects lower motor neurones in spinal cord

29
Q

What are the symptoms of spinal atrophy?

A
  • floppy or weak arms and legs
  • movement problems– such as difficulty sitting up, crawling or walking
  • twitching orshaking muscles- tremors
  • bone and joint problems– such as an unusually curved spine- scoliosis
  • swallowing problems
  • breathing difficulties
30
Q

What examination findings would you look for in spinal atrophy?

A
  • fasciculations
  • reduced muscle bulk
  • reduced tone
  • reduced power
  • reduced or absent reflexes
31
Q

How might you manage spinal atrophy?

A
  • no cure
  • MDT
  • physiotherapy - maximise strength, retain resp function
    • splints, braces, wheelchair
  • resp - non-invasive ventilation to prevent hypo and failure
    • type 1 - tracheostomy, mechanical ventilation
  • PEG feeding as weak swallow
32
Q

What are ways of spinal cord injury?

A

*where neck bent or squeezed
- during delivery
- falls
- RTA
- driving accidents
- sporting injuries
- trampoline incidents
- gunshot or stab
- infecction forming an abscess on spinal cord
- injury blocking circulation to spinal cord

33
Q

How might spinal cord injury present?

A

spinal shock
complete - no movement or feeling
incomplete - some
muscle weakness
loss of voluntary movement
breathing problems, bladder and bowel and autonomic regulation issues

34
Q

What are some investigations carried out in spinal cord injury?

A
  • blood tests - infection
  • XR - visualise injury
  • CT
  • MRI
  • Somatosensory evoked potential (SSEP)
35
Q

What is the immediate management of spinal cord injuries?

A
  • Close watch in the intensive care unit
  • Medicines such as corticosteroids to help decrease the swelling in the spinal cord
  • mechanical ventilator or respirator
  • catheter to drain urine into a bag
  • NGT to give nutrition
  • Surgery to check the cord, treat broken backbones, release pressure from the injured area, or to manage other injuries
  • longterm rehab and follow up as required with MDT care
36
Q

What could cause subarachnoid haemorrhage in children?

A

aneurysm or arteriovenous malformation, trauma, non accidental injury, infections causing vessel weakening, coagulation disorders

37
Q

How is an SAH managed?

A

stabilise pt
diagnostic imaging
treat underlying cause
medical - control HTN, prevent vasospasm, manage seizures, pain management
neuro monitor
rehab
long term follow up

38
Q

what could cause tension headache in children?

A

stress and anxiety
muscle strain
eye strain
dehydration and poor nutrition
underlying condition
poor sleep

39
Q

What is a febrile seizure?

A

seizure accompanied by a fever in the absence of intracranial infection occuring in children 6m-6y

40
Q

How would you manage a febrile seizure?

A
  • reassurance and information for parents
  • antipyretics but not shown to prevent seizures
  • first aid management of seizures
  • rescue therapy if history of prolonged seizures - buccal midozolam
  • oral prophylactic antiepileptics not used as not shown to reduce recurrence rate and have relative high risk side effects

*call ambulance if longer than 5 min

Y4 Paediatrics (16 decks)

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