Neuro Flashcards
What are the RF/causes for Cerebral Palsy?
80% antenatal cause e.g. cerebral ischaemia/ hameorrhage, cortical migration disorder, or structural maldevelopment in utero - some are caused by genetic deletions, genetic syndromes, in utero infections TORCH, chorioamnionitis, maternal illness- thyroid disease. Prematurity, teratogen exposure- alcohol, XR.
10% hypoxic insult during/ before delivery
10% postnatal e.g. meningitis, encephalitis, encephalopathy, head trauma, symptomatic hypoglycaemia, hydrocephalus, resp distress, hyperbilirubinaemia.
Preterm causes: periventricular leukomalacia second to ischaemia, severe intraventricular haemorrhage, venous infarction.
low income associated 2x risk
What is CP and what are the types of Cerebral Palsy?
permanent disorder of movement due to a non-progressive abnormality in the developing brain. clinical manifestations emerge over time despite the abnormality not progressing. spastic dyskinetic ataxic others
what are the common causes of Ataxia?
Ataxia Telengectasia (Autosomal Recessive cond.) Friedrich's Ataxia (Autosomal Recessive)
What are the red flag features of brain tumours?
Persistent Headaches: worse in AM/ wake from sleep, worse over time, worse on coughing/leaning forward, recurrent headaches in <4 years old, altered consciousness
Persistent vomiting
Balance issues, Abnormal gait, coordination,
Visual changes: double vision, blurred vision, abnormal eye movements
Behaviour change
Delayed puberty
Seizures
Abnormal head position, increasing head size
Systemic symptoms- weight loss
what are the features of raised ICP?
Persistent Headaches: worse in AM/ wakes from sleep, worse over time, worse on coughing/leaning forward, recurrent headaches in <4 years old
Persistent vomiting
Balance issues, Abnormal gait, coordination,
Visual changes: double vision, blurred vision, abnormal eye movements
Behaviour change
Seizures
Abnormal head position, increasing head size
Systemic symptoms- weight loss
what is epilepsy?
group of disorders in which there is a sudden attack of motor, sensory, autonomic and cognitive function resulting from transient dysfunction of cerebral cortical neuronal electrical activity which is hypersynchronous + excessive.
what can an EEG and MRI Show and not show with regard to Epilepsy?
EEG: type and severity of epilepsy
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what is a febrile seizure/ convulsion? What are the investigations?
a seizure associated with fever caused by infection or inflammation OUTSIDE the central nervous system in a young child who is otherwise neurologically normal. occurs in children aged 6 months- 5 years.
Often associated with viral infection such as HHV or Influenza, URTI, otitis media, tonsillitis.
Common association with fhx, usually had before age 3. peak age 1-2 years old. 1/3 will have a further episode. does NOT cause brain damage. only slightly increased chance of epilepsy in the future.
not routinely investigated HOWEVER, LP is indicated if:
bulging fontanelle, rigid neck, photophobia, petechial rash (non-blanching), kernig’s sign- hip is flexed, and attempt to straighten the knee while keeping the hip flexed. In a meningitis, this movement is greatly limited by spasm of hamstrings - which in turn causes pain - due to inflammatory exudates around the roots of the lumbar theca, decreased consciousness, focal neurol signs.
[Encephalitis + Meningitis]
how should febrile seizures be managed by parents?
protect them from injury
do not restrain them
if stopped seizing, check the airway and place in recovery position
if after 5 mins continuing, give rectal diazepam or buccal midazolam (repeat after another 5 if continuing)
call ambulance if still seizing after 10 mins, child is having another seizure, twitching has not stopped.
use paracetamol or ibuprofen if temp > 38 degrees. start para and change to brufen if not working, Never use both at once.
dress child appropriate to their conditions, prevent overheat/ shivering. no sponging req.
how is status epilepticus managed?
Airway and Breasthing are the top priorities:
maintain airway
100% O2
Assist in ventilating
Stop the seizure
Circulation:
IV access
check Glucose
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what are early features of CP?
abnormal posture + tone, delayed motor development
feeding diff oromotor dysfunction - gagging, vomitting, slow feed
abnormal gait once walking achieved
asymmetric hand function before 1 year old.
what is spastic CP?
characterised by increased tone (spasticity) in limbs due to damage to corticospinal/ pyramidal tracts. Brisk reflexes, extensor plantar responses. Spasticity means that the more the stretch, the greater the resistance (velocity dependent)- dynamic catch, “clasp knife”.
Unilateral affects one side (hemiplegia) and the arm more than leg with the face spared. fisted hand, flexed arm, pronated, tip toe gait (toe-heel pattern), if severe hemianopia of eye on affected side. Affected limb may first be hypotonic + flaccid + then become spastic. causes by antenatal MCA infarct. risk LD/ seizures.
Bilateral (quadriplegic) - 4 limbs + trunk, low central tone, extensor positioning, scissoring legs (over adduction) often assoc LD, speech, hearing, vision impairment, seizures, microcephaly. powered mobility often req, dependent others for ADLs. assoc Hypoxic-ischaemic encephalopathy.
bilateral (diplegia) - 4 limbs but legs more than arms, scissoring legs (over adduction), crouch/ tiptoe gait (Vicky) abnormal gait with fine motor/ pronation diff in arms. good cognition, feeding + communication unaffected. assoc preterm birth.
what is dyskinetic CP?
Dyskinesia: involuntary, uncontrolled movements, sometimes stereotyped. primitive reflexes intact.
may have chorea- sudden irreg brief movements, athetosis- slow writhing movements of distal e.g. fingers, dystonia- sim contract agonist + antagonist of proximal limbs/ trunk - twisted appearance e.g. Internal rotation + extension of arms. Often cognition unaffected but req support for ADLs.
Aeti- perinatal asphyxia (Basal Gang affected), kernicterus (rare cause now).
what is ataxic CP?
Loss of muscular coordination with abnormal force and rhythm, and impaired accuracy. Presents with gait and trunk ataxia, poor balance, past pointing, terminal intention tremor, scanning speech, nystagmus and other abnormal eye movements, and hypotonia. Due to cerebellar dysfunction/ injury, affected on side of lesion in brain. This type is often genetically determined.
