Neuro Flashcards
What are the 4 domains assessed in Child Development
Gross Motor
Fine Motor and Vision
Speech, Language and Hearing
Social Interaction and Self Care Skills
What is a hallmark of UMN abnormality
- Persistence of Primitive reflexes
- Lack of development of postural reflexes
What are gross motor development skills
Newborn: Flexed arm and legs 3 month: Lifts Head when on their Tummy 6 months: lift chest with arm support, rolls and sit unsupportive 9 months: Pulls to stand 1 year: walking
What are fine, motor and vision skills
4 months: grasp object using both hands 8 months: take a cube in each hand 12 months: pincer grip 18 months: build a tower - 2 cubes 3 years build tower of 8 cubes
What are the speech, language and hearing skills
3 months: laughs and squeals 9 months: two syllable babble 'mama' 'dada' 12 months: 1 word 2 years: 2 word sentences 3 years: speech mainly understandable
What are the social/ self care skills
6 weeks: smiles spontaneously 6 months: finger feeds 9 months: waves bye-bye 12 months: uses spoon/fork 2 years: helps with dressing and plays with friend
What is the healthy child programme snd what does it involve
Promotes healthy child development as well as eating and physical activity
ALSO
screens children for disease and disability
Involves growth and development checks:-
- Neonatal exam
- New Baby review (14 days)
- Baby’s 6-8 week examination
- Check at 1 year
- Check between 2- 2 1/2 years
What are red flags gross motor
Not sitting by a year
Not walking by 18 months
What are red flags fine motor
No hand preference by 18 months
What are speech and language red flags
No clear words by 18 months
What are social development red flags
Not smiling by 3 months
No response to carer interaction by 8 months
No interest in playing with peers by 3 yrs
What are other red flags in child development
- Regression
- Poor health/growth
- Significant FHx
- Safeguarding indicators
- Findings on Examination e.g microcephaly
What are causes of delayed talking
- Familial
- Hearing Impairment
- Environmental - deprivation/abuse
- Neuropsychological - Autism
Causes of Childhood Development Delay
- Genetics: Chromosomal Disorders e.g Downs, Chromosomal disorders/deletions, single gene disorders e.g Duchennes
- Factors in Pregnancy: congenital infections, exposure to drugs/alcohol, MCA infarct e.g cerebral palsy
- Factors in Birth: prematurity, birth asphyxia
- Factors in Childhood: infections, chronic ill health, metabolic conditions, acquired brain injury, hearing/vision impairment
- Environmental Factors e.g abuse/neglect
What are the Ix for Development Delay
- Developmental Exam and Hx
- Creatine Kinase - boy’s not walking by 18mths - Duchenne Muscular Dystrophy
- Focal Neurological Signs - MRI
- Dysmorphic Features
- Unwell Child - metabolic Ix
What is impairment
An abnormality or loss of function
What is disability
Someone who has a physical/mental impairment that results in marked limitation of activity
Disability is determined by there function, activity and ability to participate
What sort of impairments are there
- Physical e.g Cerebral Palsy, brain injury, neuromuscular disorders
- Sensory Impairment e.g hearing/visual
- Learning e.g low IQ
- Neurodevelopmental Disorders e.g ADHD?Autism
Emotional/Behavioural e.g depression conduct disorder, attachment disorder
What is a generic disability/ heath assessment
WHODAS
What 6 domains of functioning does WHODAS cover
Cognition Mobility Self- Care Social Life Activiites Participation
What is Williams Syndrome
Global Development Impairment Disorder:
Chromesome 7
Presentation: Mental Retardation Hyper sociability and Comfort with strangers Dysmorphic Features - Elfin Facies Visual Impairment Poor Growth Supravalvular Stenosis
How is Williams Syndrome managed
MDT: Physiotherapy SALT Dieticians Doctors Housing Support
What is Cerebral Palsy
Chronic Disorder of movement and posture due to a non progressive insult/lesion to the developing brain
How does cerebral palsy present
Delayed motor Development
Evolving CNS signs
Learning Disability and Epilepsy
What are the causes for Cerebral Palsy
Antenatal: TORCH infections, and cerebral malformation
Perinatal: Birth Asphyxia or Trauma, Prematurity
Postnatal: Intraventricular haemorrhage, meningitis, head trauma, neonatal Seizures
What are the signs of Cerebral Palsy
Weakness or Paralysis
Delayed motor milestones
Abnormal Gait
Other non-motor signs: Seizures (35-50%) Intellectual Disability (50%) Language/Speech and Feeding Problems Joint Contractures
What are the 3 main types of cerebral palsy
Spastic cerebral palsy - hemiplegic, diplegia and quadraplegia spasticity
- Dyskinetic - unwanted actions
- Ataxia - tremor, lack of coordination
How is Cerebral Palsy treated
MDT: Physio and Occupational Therapists Orthopedic Surgery Continence, Sleep and Feeding Callipers may help patent stand and walk Conductive education Botulinum Toxin or Diazapam- Helps Spasticity
How does hearing impatient present and how is it managed
Presentation: Delayed Speech
Management: Hearing aids, consideration for cochlear implant, SALT, alternative forms of communication e.g Sign Language, Social care
What can cause neonatal seizures
- Hypoglycaemia
- Infection/ Meningitis
- Head Trauma: Intracranial Infarction/ Haemorrhage
- Pyridoxine Dependency - give IV B6!!!
- Asphyxia
- Benign Neonatal Seizures (5th day)
- Neonatal withdrawal from maternal drugs/substance abuse
How can neonatal seizures present
12-48 hrs after brith
- generalised
- focal
- can be tonic, clonic, cyclonic
- may present as lip making, eye deviation, apnoea
- EEG can confirm
How are neonatal seizures managed
ABC Rule out reversible causes Start Abx Insert IV and take bloods radiological Ix Treat Cause Prolonged or Repeated Seizure consider Phenobarbital
What is Epilepsy
A tendency to intermittent unprovoked abnormal electrical activity in the brain
What are the two broad categories of Seizures due to their location
Generalised
Focal
What are the two broad categories of seizures dependent on consciousness
Simple - Conscious/Aware
Complex - Reduced Consciousness/Unaware
What are the types of generalised seizures
Tonic/Clonic - limb stiffness then jerking
Absence - Brief pauses, eyes may role up
Infantile Spasms/West Syndrome - Clusters of head nodding and arm jerks
Myoclonic Seizure: Thrown suddenly to ground
What is infantile spasms/ West Syndrome how is it managed
Brief spasms beginning in first 4-6 months of life
Cause: Hypoxic ischaemic injury, perinatal infection
Presentation:
1. Clusters of symmetrical jerking flexion or extension of neck, torso and limbs
lasting 1-2 seconds and occurring up to 50 times
2. Progressive mental handicap
3. EEG: Hypsarrhythmia
4. Poor Prognosis
Treatment: Prednisolone
What are complex focal seizures
Reduced Consciousness
Automatisms - Lip smacking, rubbing face, running
Fits of Pure pleasure
What causes epilepsy
Often none found
FHx of Epilepsy
Complex febrile seizure
Neurodevelopmental Disorder e.g ASD, CP
What are differentials for epilepsy
Arrhythmias e.g prolonged QT Migraine Narcolepsy Night Terrors Fainting
Wha texts should be performed for epilepsy
EEG
MRI
Lab Tests to rule out metabolic disturbance, Toxicology
What is a simple febrile seizure
- Usually occur early on in viral infection due to rapid rise in temperature
- A single generalised tonic clonic seizure
- lasting < 15 mins
- complete recovery within an hour
- do not recur in 24 hrs
Occur in absence of CNS infection, metabolic abnormalities or Hx of afebrile seizures
What is a complex febrile seizure
Usually starts as focal, lasts longer than 15 mins and occurs more than once in 24hrs
How are Febrile Seizures managed
Following seizure
- Admit to hospital if first febrile seizure or a complex febrile seizure
- Investigate Cause e.g exclude meningitis
- Recurrent seizures if fit lasting more than 5 mins call ambulance and give IV Lorazepam or PR Diazepam
How do you manage an active seizure or status epilepticus
- Call for help - ABC
- Most resolve within 5 - 10 mins
- If fit lasts 5 mins or longer give IV Lorazepam
Status Epilepticus
- 2nd line Phenytonin
- General Anesthesia
What drugs are used to treat Epilepsy
Carbamazepine
Sodium Valproate
Lamotrigine
What are the primitive reflexes
Stepping Reflex Asymmetrical Tonic Neck Reflex Plantar Grasp Palmer grasp Mono Reflex Rooting Reflex Sucking Reflex Babinski Sign
What is the stepping reflex and when does it stop
Stepping Motion - 2 months
What is asymmetrical tonic neck reflex
Infants head turned to one side - 3 - 4 months
What is plantar grasp reflex
Plantar Flexion - Curling in - 3 months
What is palmer grasp reflex
Closure of its palm - 3-6 months
What is moro reflex
Abduction and Extension of arms when head is suddenly allowed to fall out - 3-6 months
What is the rooting reflex
Cheek stroked and head turns to ipsilateral side and opens it mouth - 4 months
What is the sucking reflex
infant starts to suck the finger - 4 months
What is the Babinski reflex
Dorsiflexion of foot and fanning of the toes - 12 months
