neuro Flashcards
what are periodic syndromes
precursors of migraine
cyclical vomiting, abdominal migraine, benign paroxysmal vertigo of childhood
mx of headaches
assess impact of life
timing, frequency, triggers
headache diary for 8 weeks
1 - simple analgesia (consider aspirin if >16 - worry about reye’s
2 - nasal sumatriptan (can’t give oral triptans in <18)
3- combination therapy w/ triptan and NSAID
porphlyaxis - topiramate or propanolol - expert referral
red flags for SOL
worse when lying down morning vomiting change in mood and academic performance abnormal gait torcicollis
what is the hallmark of a febrile seizure
seizure early in viral illness, tonic-clonic seizure usually
what factors make dx of febrile seizure more likely
young child
seize early in illness
seizure at lower temperature
FHx
Which febrile seizures increase risk of epilepsy
simple don’t
complex (more than once in illness, prolonged, focal) increase risk
mx of febrile seizure
protect: cushion head, remove harmful objects
airway: once seizure stops put in recovery position
if seizure lasts >5 mins
rectal diazepam or buccal midazolam (can repeat after 10 min if seizure hasn’t stopped)
call ambulance if:
after 10 mins still seizing, still twitching, another seizure is starting without consciousness returns
Mx after seizure
Admit if: first seizure <18 months seizure last >15 mins diagnostic uncertainty about cause focal features seizure occurred during same illness incomplete recovery after 1 hour if child has no apparent site of infection
if managed at home:
information:
risk of epilepsy only slightly than usual
not harmful
1/3 of these children will have another seizure
advice:
protect, don’t restrain
check airway
seek medical advice if < 5mins, call ambulance >5mins
managing fever:
reducing fever doens’t prevent reccurrence
What are the two types of seizues
generalised - from both hemisphere
focal - from 1 part of hemisphere
how do seizures present in different hemispheres
frontal - motor symptoms (jacksonian march)
temporal - aura, automatisms, deja-vu, consciousness can be impaired
occipital - visual hallucinations
parietal - contralateral dyasthesia (altered sensation)
Different types of seizures
absence - LOC myoclonic - 1 jerk tonic - stiffness atonic - 1 jerk then limp tonic-clonic - jerking
mx epilepsy
not all epileptics require AED
not checked regularly (only to check adherence)
generalised:
tonic clonic - valproate
absence - ethosuximide/valproate
myoclonic - valproate
Focal:
carbamazepine, lamotrigine
S//E of AED
valproate - weight gain, hair loss
carbamazepine - rash, neutropenia, liver enzyme induction, exacerbates absence seizures
lamotrigine - rash, exacerbates myoclonic
ethosuximide - nausea and vomiting
can only drive after 1 year of no seizures
signs of peripheral motor disease
waddling gait
distal wasting and weakness
fatiguability throughout day
Diagnosis of peripheral motor disease
myopathy - plasma ck, muscle bipsy
neuropathy - EMG, nerve conduction studies
What happens in charcot-marie-tooth disease
slow, symmetrical muscle wasting
present with ankle drop + no reflex which progresses to loss of knee reflexes
pes cavus may be present
