Neuro

Question 1

What is cerebral palsy?

Answer 1

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

Question 2

What are some prenatal and postnatal causes of CP?

Answer 2

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

Question 3

How does CP manifest?

Answer 3

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

Question 4

What are some complications associated with CP?

Answer 4

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

Question 5

How is CP managed?

Answer 5

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

Question 6

What are the medical managements for CP?

Answer 6

muscle relaxants - baclofen
anti-epileptics
glycopyrronium bromide - drooling

Question 7

What is the pathophysiology of epilepsy?

Answer 7

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

Question 8

How might a seizure present?

Answer 8

• 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

Question 9

What type of seizures are there?

Answer 9

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

Question 10

How would you manage status epilepticus?

Answer 10

• 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

Question 11

How is epilepsy investigated?

Answer 11

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

Question 12

How do you manage seizure?

Answer 12

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

Question 13

What is extradural haemorrhage?

Answer 13

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

Question 14

How extradural haemorrhage present?

Answer 14

• 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

Question 15

how does a migraine present?

Answer 15

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

Question 16

What is an aura in association to migraines?

Answer 16

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

Question 17

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

Answer 17

• 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

Question 18

How are migraines managed?

Answer 18

• 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)

Question 19

What is Duchennes MD?

Answer 19

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

Question 20

How might MD present?

Answer 20

• 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

Question 21

What are the complications for MD?

Answer 21

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

Question 22

How is MD managed?

Answer 22

• 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

Question 23

What could cause a raised ICP?

Answer 23

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

Question 24

How might you identify a paeds raised ICP?

Answer 24

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

Question 25

What examination findings would you look for in raised ICP?

Answer 25

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

Question 26

What initial investigations might you do in suspected raised ICP?

Answer 26

- 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

Question 27

What is the management of raised ICP?

Answer 27

- 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

Question 28

What is spinal muscle atrophy?

Answer 28

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

Question 29

What are the symptoms of spinal atrophy?

Answer 29

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

Question 30

What examination findings would you look for in spinal atrophy?

Answer 30

- fasciculations - reduced muscle bulk - reduced tone - reduced power - reduced or absent reflexes

Question 31

How might you manage spinal atrophy?

Answer 31

- 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

Question 32

What are ways of spinal cord injury?

Answer 32

*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

Question 33

How might spinal cord injury present?

Answer 33

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

Question 34

What are some investigations carried out in spinal cord injury?

Answer 34

- blood tests - infection - XR - visualise injury - CT - MRI - Somatosensory evoked potential (SSEP)

Question 35

What is the immediate management of spinal cord injuries?

Answer 35

- 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

Question 36

What could cause subarachnoid haemorrhage in children?

Answer 36

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

Question 37

How is an SAH managed?

Answer 37

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

Question 38

what could cause tension headache in children?

Answer 38

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

Question 39

What is a febrile seizure?

Answer 39

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

Question 40

How would you manage a febrile seizure?

Answer 40

- 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