neuro

Question 1

what are febrile convulsions?

Answer 1

seizures provoked by fever in otherwise normal children

Question 2

when do febrile convulsions typically occur?

Answer 2

between ages of 6 months and 5 years; seen in 3% of children

Question 3

what are the clinical features of febrile convulsions?

Answer 3

1. usually occur early in a viral infection as temperature rises rapidly
2. seizures are usually brief, lasting <5 mins
3. most commonly tonic-clonic

Question 4

what are the types of febrile convulsions?

Answer 4

1. simple
2. complex
3. febrile status epilepticus

Question 5

what are the features of simple febrile convulsions?

Answer 5

• <15 mins
• generalised seizure
• typically no recurrence within 24 h
• usually complete recovery within an hour

Question 6

what are the features of complex febrile convulsions?

Answer 6

• 15-30 mins
• focal seizure
• may have repeat seizures within 24 h

Question 7

what is the feature of febrile status epilepticus?

Answer 7

> 30 mins

Question 8

what is the management following a seizure?

Answer 8

children who have had a first seizure OR any features of a complex seizure should be admitted to paeds

Question 9

what increases the risk of further febrile convulsion?

Answer 9

overall risk is 1 in 3

• age of onset < 18 months
• fever 39^oC
• shorter duration of fever before seizure
• family hx of febrile convulsions

Question 10

how to manage recurrent febrile convulsion?

Answer 10

• teach parents how to use rectal diazepam or buccal midazolam
• advise parents to phone for an ambulance is seizure lasts > 5 minutes
• regular antipyretics have not been show to reduce chance of a febrile seizure occurring

Question 11

what is the link between febrile convulsions and epilepsy?

Answer 11

• risk factors: family hx epilepsy, having complex febrile seizures and a background of neurodevelopmental disorder
• children with no risk factors have 2.5% risk of developing epilepsy
• if children have all 3 features, risk of developing epilepsy is much higher (e.g. 50%)

Question 12

Migraine without aura is the most common cause of primary headache in children.

What are the criteria for peadiatric migraine?

Answer 12

A: >= 5 attacks fulfilling features B to D

B: Headache attack lasting 4-72 hours

C: Headache has at least two of the following four features:

• bilateral or unilateral (frontal/temporal) location
• pulsating quality
• moderate to severe intensity
• aggravated by routine physical activity

D: At least one of the following accompanies headache:

• nausea and/or vomiting
• photophobia and phonophobia (may be inferred from behaviour)

Question 13

what is the 1st line Rx for paediatric migraines?

Answer 13

ibuprofen or paracetamol

if above fails, nasal triptans can be used but ONLY in >12 year olds

oral triptans should NOT be used <18 years old

Question 14

Tension-type headache is the second most common cause of headache in children.

What is the diagnostic criteria for TTH in children?

Answer 14

A: At least 10 previous headache episodes fulfilling features B to D

B: Headache lasting from 30 minutes to 7 days

C: At least two of the following pain characteristics:

• pressing/tightening (non/pulsating) quality
• mild or moderate intensity (may inhibit but does not prohibit activity)
• bilateral location
• no aggravation by routine physical activity

D: Both of the following:

• no nausea or vomiting
• photophobia and phonophobia, or one, but not the other is present

Question 15

what are infantile spasms (West syndrome) clasically characterised by?

Answer 15

repeated flexion of head/arms/trunk followed by extension of arms

“salaam” attacks

EEG: hypsarrythmia in 2/3 of infants

Question 16

what is cerebral palsy?

Answer 16

a disorder of movement and posture

due to a non-progressive lesion of the motor pathways in the developing brain

Question 17

how common is cerebral palsy?

Answer 17

affects 2 in 1000 live births

the most common cause of major motor impairment

Question 18

what are the causes of cerebral palsy: antenatal?

Answer 18

most common (80%)

• cerebral malformation
• congenital infection (rubella, toxoplasmosis, CMV)

Question 19

what are the causes of cerebral palsy: intrapartum?

Answer 19

birth asphyxia / trauma

Question 20

what are the causes of cerebral palsy: postnatal?

Answer 20

• intraventricular haemorrhage
• meningitis
• head trauma

Question 21

how does cerebral palsy manifest?

Answer 21

• abnormal tone early infancy
• delayed motor milestones
• abnormal gait
• feeding difficulties

Question 22

children with cerebral palsy often have associated non-motor problems. what are they?

Answer 22

• learning difficulties (60%)
• epilepsy (30%)
• squints (30%)
• hearing impairment (20%)

Question 23

how is cerebral palsy classified?

Answer 23

1. spastic (70%): hemiplegia / diplegia / quadriplegia
2. dyskinetic
3. ataxic
4. mixed

Question 24

how is cerebral palsy managed?

Answer 24

• multidisciplinary approach
• treatments for spasticity
  
  • ^{oral diazepam}
  • ^{oral / intrathecal baclofen}
  • ^{botulinum toxin type A}
  • ^{orthopaedic surgery}
  • ^{selective dorsal rhizotomy}
• anticonvulsants, analgesia as required

Question 25

what are the criteria for immediate request for CT scan of the head in children?

Answer 25

• witnessed LOC >5 mins
• amnesia >5mins
• abnormal drowsiness
• ≥3x vomiting
• clinical suspicion of NAI
• post-traumatic seizure but no hx epilepsy
• GCS<14 (GCS<15 for baby) on assessment at A+E
• suspicion of open/depressed skull injury/tense fontanelle
• basal skull # signs
• focal neurological deficit
• <1 year old: bruise, swelling or laceration >5cm on head
• dangerous MOI (high speed RTA, fall from height >3m, high speed injury from a projectile or an object)

Question 27

what are reflex anoxic seizures?

Answer 27

a syncopal (or presyncopal) episode that occurs in response to pain or emotional stimuli

Question 28

what are reflex anoxic seizures thought to be caused by?

Answer 28

neurally-mediated transient asystole in children with very sensitive vagal cardiac reflexes

Question 29

in what ages does reflex anoxic seizures occur?

Answer 29

6 months to 3 years

Question 30

what are the typical features of reflex anoxic seizures?

Answer 30

• child goes very pale
• falls to floor
• 2˚ anoxic seizures common
• rapid recovery

Question 31

what is the rx for reflex anoxic seizures?

Answer 31

no rx, px excellent