Neurodevelopment Flashcards
Autism red flag signs
12 months
- no babbling
- no pointing or waving
- no single words
- no spontaneous 2 word phrases
- any loss of any language or social skills
Side Effects of Ritalin
headache and stomach ache
suppression of appetite
can cause insomnia
hearing defects need to be referred first
Epilepsy
enduring predisposition to generate seizure with neurological cognitive psychological and social consequences
- at least 2 unprovoked / reflex seizures > 24 hours apart
- one unprovoked/ reflex seizure + a probability >/= 60% of further seizures over the next 10 year
- diagnosis of an epilepsy syndrome
recurrent unprovoked seizures
Treatment of epilepsy
First line
absence - sodium valproate
focal and generalised TC - carbamazepine
Side Effects of drugs
Phenobarbitone - increases hyperactivity
Valproate - liver toxicity
Carbamazepine - exacerbates absence and myoclonic seizures
Phenytoin - worsen MG, headache, N and V
Lamotrogine - N/V
Benzodiazepines - induce T/C seizures in LGS
Status epilepticus
seizures for 30 minutes or remains unconscious between seizures
DONT wait 30 min before treating
start on flow chart if fitting for 10 min
- Maintain vital function - ABC
- Stop convulsions - drugs
- IV line
- draw blood
- give bolus glucose
- see the two tables for the drugs to be given - Determine the cause
- Prevent more convulsions
Step 1 = Lorazepam (Ativan) or Diazepam (Valium)
Step 2 = Phenytoin (Epanutin) or Sodium Valproate (Epilim) - 20mg/kg
Step 3 = Thiopentone infusion or Midazolam or Propofol
Neonate treatment
Step 1 = phenobarbitone or lorazepam
Step 2 = phenytoin - NO VALPROATE
Step 3 = thiopentone or midazolam infusion
Febrile seizures
6m-3-4(5) years
fever without evidence of intracranial infection
average age onset 18 to 22 months
boys more girls
1/3 have at least one recurrence
2% risk developing epilepsy
fever can come after seizure
simple - GTC, < 15min, no recurrence in 24hr
complex - focal, > 15min, cluster 2 or more within 24hr
Management febrile seizures
identify underlying disease - LP CT/ MRI - NOT simple routine EEG seldom necessary LT use AED not indicated unless complex - phenobarbitone or sodium valproate rectal diazepam antipyretics?
Contraindication to LP
decreased level of consciousness Glascow < 13
focal deficit - unequal pupils
too sick - haemodynamically unstable or respiratory compromise
septicaemia with petechiae or purpura
low platelets - bleeding disorder
local infection
relative CI - increased ICP
absolutely CI if following is seen on CT - midline shift, loss of cisterns, mass in post fossa
BUT
do blood cultures and start treatment
Clinical signs of raised ICP
Papilloedema
decreased LOC
pushing reflex
CSF findings
bacterial - predominantly neutrophils
increased protein decreased glucose
viral - predominantly lymphocytes
mildly increased protein WNL glucose
TBM - predominantly lymphocytes -
severely increased protein
decreased glucose
Causes of aseptic meningitis
Partially treated meningitis TBM viral meningitis leukaemia uncommon infections - syphillis - mycoplasma - toxoplasmosis
Coma
Unarousable for at least 1 hour total unawareness with closed eyes lack of wakefulness lack of movement noxious stimuli - inappropriate responses
Persistent vegetative state
wakeful unconsciousness diagnosed 1 month after onset of coma
or a period of at least 3 months is required in a baby younger than 6 months
sleep and wake cycles are present
brainstem function and spinal reflexes are present
no cortical fx
autonomic fx is preserved
may shed tears
