Neuro and development Flashcards
Paediatric autoimmune neuropsychiatric disorders associated with strep infections (PANDAS)
Child with Tourettes, tics, OCD, anorexia plus infection.
ABx plus risperidone.
3 core areas affected in ADHD
Inattention
Hyperactivity
Impulsivity
ADHD definition
Attention deficit and hyperactivity disorder.
Persistent behaviours (longer than 6months) and inferring with social, academic or occupational performance.
Start before 12yrs.
Occurs in 2 or more environments.
Manifestations of Inattention
Disorganised
Difficulty following instructions
Disorganised and loosing items.
Easily distracted
Manifestations of hyperactivity
Fidgeting
Tapping
Talkative
Climbs over things
Manifestations of impulsivity
Poor road safety
Interrupting speech
Answers before complete questions asked.
Unable to take turns or share.
Some environmental factors in the aetiology of ADHD
Maternal smoking or alcohol consumption during pregnancy. Parental co-morbidity. Low birth weight. Preterm delivery. Psychosocial adversity.
Common ADHD patient
MALE
Differentials for ADHD patients
Autism spectrum disorder.
Personality disorder.
Fetal alcohol syndrome.
Auditory or visual impairment.
Investigations and diagnosis of ADHD
Behavioural observation (NB symptoms are not constant) Discuss with teachers CLINICAL DIAGNOSIS Conner's scale Screen for organic cause.
Treatment of ADHD
Non-pharm = patient CBT, positive parenting. Pharm = Ritalin/Methylphenidate 1st line, Atomoxetine 2nd line
Definition of Autism Spectrum Disorder
Persistent disorder, present from childhood which causes significant impairments to ADLS of patient. There are significant deficits in social communication, social interaction and restricted repetitive behaviour/interests patterns.
Common autism spectrum disorder patient
MALE. Present when patient’s capacity is not enough to manage social demands, despite it being present since childhood.
Risk factors for ASD
Preterm (before 35weeks)
Sibling with ASD
FHx of mental health problems e.g. schizophrenia.
Maternal sodium valproate in pregnancy.
Congenital conditions such as cerebral palsy, Downs, neonatal encephalopathy.
Manifestations of impaired social communication in ASD
Lack of close friendships. Enjoys privacy. No appreciation for others/lack of empathy. Lack of acting to social cues Avoid gaze
Manifestations of restricted, repetitive behaviours
Stereotype movement (spinning). Narrow fixations. Insists on following routine. Distress/tantrum over change. Echolalia
Other manifestations of ASD
Impaired imagination = abnormal communication.
Language delay/regression.
Investigating ASD
Specialist team.
Collateral info from school.
Observe behaviour in different settings.
Diagnostic instruments e.g. Autism Diagnostic Observation Schedule or diagnostic interviews.
Management of ASD
Early intensive behavioural intervention e.g. applied behavioural analysis.
Speech therapy.
Parental training and education.
Risk factors for cerebral palsy
Preterm Low birth weight Neonatal encephalopathy Neonatal sepsis Neonatal meningitis Chorioamnionitis
Some causes of cerebral palsy
Antenatal = TORCHS infections = vascular occlusion, structural maldevelopment. Postnatal = Hypoxic-ischaemia injury, intraventricular haemorrhage, hyperbilirubinaemia. Preterm = periventricular leukomalacia.
Definition of cerebral palsy
Umbrella term used to describe permanent motor dysfunction resulting in postural and movement abnormalities. Caused by non-progressive lesion in developing brain.
Symptom progression in cerebral palsy
Lesion to brain is non-progressive, however, as brain and cerebrum develops with aging manifestations of the lesion change.
Some clinical features of cerebral palsy
Paucity in movements Hypotonia, spasticity, dyskinesia. Poor head control, rolling or crawling. Persistent primitive reflexes. Feeding difficulties. Not sitting by 8months Not walking by 18months. Asymmetry in hand function before 12months.
Subtypes of cerebral palsy
Spastic - further divided in hemiplegia, diplegia, quadriplegia.
Dyskinetic - involuntary movements.
Ataxic
Mixed
Differences between subtypes of spastic cerebral palsy
Hemiplegia = unilateral arm and leg involvement with arm > leg. Diplegia = legs > arms. Quadriplegia = all 4 limbs and trunk with seizures.
Management of cerebral palsy
MDT = community paediatrician, SALT, nurse, dietician, physio, OT, social worker.
Analgesia if in pain.
Botulinum toxin for excessive, painful spasticity..
Manage co-morbidities.
Differentials for delay in walking
Duchenne muscular dystrophy.
Birth trauma/DDH.
Spina bifida.
Global developmental delay
Causes of global developmental delay
Down syndrome Fragile X Duchenne muscular dystrophy Hydrocephalus Prenatal alcohol or smoking. Congenital infections (TORCHS) Periventricular leukomalacia. Hyperbilirubinaemia Hypoglycaemia Meningitis and head injuries.
Primitive reflexes
Palmar reflex Plantar reflex Rooting reflex Moro reflex Asymmetrical tonic neck reflex.
Significance of persistent primitive reflexes
Neurodevelopmental pathology eg Cerebral palsy
Significance of asymmetrical primitive reflex
Peripheral neuropathy or CNS lesion
Onset and disappearance of primitive reflex
Onset = 28wks gestation.
Go by as postural reflexes appear. 6months?! CHECK
Features of a tonic clonic seizure
Stiff limbs, jerking, LOC
Absence seizure
Brief period of unawareness/vacany and staring, eyes may roll back
Rx = valproate
West syndrome
Infantile spasm - 5months
Head nodding, arm jerks
EEG = hypsarrythmia
Rx = prednisolone then vigabatrin
Myoclonic jerks/juvenile myoclonus
1-4yrs, mor common in femaless
Most after waking up.
Throwing items which are in patients hand.
Ix = EEG polyspike, photosensitive pattern.
Rx = sodium valproate 1st line, Keppra 2nd line
2/3 at risk fo GTC in later life.
Causes of seizures in children
CNS tumour Idiopathic Cerebral vascular occlusion Febrile seizure Hypoglycaemia Hypocalcaemia/magnesaemia/natraemia. Meningitis or encephalitis.
Clinical features of a febrile convulsion
Generalised tonic clonic, symmetrical seizure.
Fever/pyrexia.
Rx = recovery position, if lasting >5mins buccal midazolam/IV lorazepam.
Parent reassurance and education.
If simple no risk of developing epilepsy, complex do have increased risk.
Reflex anoxic seizure
Vagal inhibition = cardiac asystole = syncope.
Provoked by pain and discomfort.
Pale, atonic (falls to floor), tonic-clonic movements.
EEG = slow wave discharge.
What to monitor with patients on Ritalin
weight and height
Definition of failure to thrive
Failure to gain adequate weight or grow at normal rate for ages. Suboptimal weight gain.
Need 2 measurements 3-6months apart showing child fall across 2 major centiles.
Panayiotopoulos syndrome
Seizure of autonomic symptoms occurring mainly at night and can last over 30mins. Pale, vomiting, pupil dilation, sweating.
Differentials for a seizure
Benign myoclonus of infancy
Arrhythmia
Daydreaming - ASD
Syncope
Organic causes of a seizure
Infection Hypoglycaemia Hyponatraemia Low calcium or magnesium Chemotherapy Lack of sleep
Causes of hydrocephalus
Infection/meningitis = non obstructive.
Subarachnoid haemorrhage
Aqueduct stenosis
Chiari malformation
Features in hydrocephalus
Large head
Bulging fontanelle
Downward gaze = sunsetting eyes
Raised ICP = headache, papilledema, n+v
Ventricles in hydrocephalus
dilate superior to obstruction in CSF flow
Treatment for hydrocephalus
LP
Ventriculoperitoneal shunt
