Neuro Flashcards
Absence seizures
Females
Periods of absence/ stop what they are doing but they remain conscious Can be misdiagnosed as - ADHD - Behavioural problems - Hearing problems - NAI
EEG - 3Hz spike and wave
Hearing test
ADHD assessment
Management
Valproate
Ethosux
Not carbemazapine
Prognosis
- can –> JME in later life
- Can –> tonic clonic
prognosis of absence
10% –> JME
can also –> tonic clonic
JME
Presentation
Throwing their cornflakes - jerky movements
Teens - females
can be absence seizure in childhood then –> JME
can also have absence + TC
EEG - polyspike and wave
Management
Valproate
Not associated with other conditions later in life but need to be on lifelong Rx
West syndrome
Salaam attacks - can be up to 50 times
lasts 1-2 seconds per jerk
INFANTILE SPASMS - 4-6 months
EEG - hypsarrythmia
Management
Vigabatrin
Prognosis - poor
progressive mental handicap
Febrile seizure
when there is a RAPID RISE in temp
eg remember roseola infantum
Give paracetamol to bring temp down
partial = 1-2% risk of developing epilepsy
Complex = 2-4% risk of developing epilepsy
Future febrile seizure risk 1/3
Tonic clonic risk in later life
Management
buccal midaz
rectal diazepam
When to worry >1hr to recover Partial seizure 1st seizure >1 in 24hrs >15m
Lennox gestau
Ketogenic diet
ADHD
Presentation
epidemiology
4-7%
Males
1) Inattention
2) Hyperactivity
3) Impulsivity
Investigations
- School nurse reports, school reports, home report
Management - watch and monitor for 10 weeks - ADHD parenting program - Pharmacological methylphenidate (trial for 6w) Lisdexamphetamine
Monitor weight as can cause reduced appetite and weight loss, stunted growth
Cardiotoxic - do ECG
Autism
Triad
1) Global language +communication impairment
2) Impaired social skills
3) Repetitive, ritualistic
Investigations
Management
timetables
parenting therapy
Applied behavioural analysis
Complications
- Learning difficulties
- Seizures
Congenital cataracts
associated with rubella
Loss of light reflex
done
Squints
Aetiology
- 60% hereditary
Types
Concomitant - imbalance of extra-ocular muscles - usually convergent
Paraplegic - paralysis of one or more extra ocular muscles (rarer) - sinister - can be due to SOL
Investigations
- Cover test
- Corneal light reflex - should reflect back symmetrically
- visual acuity test
- MRI if suspect sinister lesion
Management - prevent amblyopia Patch Glasses Prism Surgery - to cut the muscles
Cerebral palsy
Types + presentation
Types 1) Spastic Damage to the motor cortex - UMN - cerebral malformation eg maternal infection Symptoms - ^tone, ^ reflexes, upping plantars, clasp knife Types - Hemiplregic - tip toe walk - Diplegic - PVL - knock knee - Quadraplegic - extensor posturing
2) Dyskinetic Problem in the basal ganglia + extrapyramidal tracts - associated with HIE - Chorea - Athetosis - writhing movement - Dystonia
3) Ataxic - lesion in the Cerebellum
- Broad gait
- Hypotonia
- Poor balance
4) Mixed (in the name babes)
Cerebral palsy
definition
early presentation
Non progressive disorder of movement and posture that occurs in the developing CNS
Early presentation
1) Poor feeding
2) Delayed motor miles stones
3) Asymmetrical hand use <1
4) Hypotonia
5) Abnormal gait
6) Persistent primitive reflexes
Cerebral palsy aetiology
Antenatal 80% - Infection - Genetics - Vascular occlusion Birth - Cord compression - Uterine rupture - (HIE) Post birth - trauma - meningitis - PVL - BPD - Kernicterus