Neurological Flashcards
What is a seizure
Sudden disturbance of neurological function caused by an abnormal or excessive neuronal discharge
What is a febrile seizure
type of seizure accompanied by a fever which is not caused by epilepsy or other neurological pathology such as meningitis or tumour
What is only age range that can get febrile convulsions
6 months-5years
What is a simple febrile convulsion
generalised, tonic clonic seizure. Last less than 15 minutes and only occur during a single febrile illness
What is a complex febrile convulsion
partial or focal seizures, last more than 15 minutes or occur multiple times during same febrile illness.
How is a diagnosis of febrile convulsion made
Exclude all differentials such as epilepsy, meningitis, brain tumour, intracranial hemmorhage, syncope, trauma.
Typical presentation of febrile convulsion
around 18month child, 2-5 tonic clonic seizure during a high fever. Fever caused by underlying viral/bacterial illness such as tonsillitis.
Tx of Febrile seizure
Manage underlying source of infection
When is lumbar puncture contraindicated
If child is unconscious or has cardiovascular/resp instability, raised ICP.
What is a paroxysmal disorder and different types
Broad diagnosis of ‘funny turns.’ Include epilepsy, breath-holding attacks, reflex anoxic seizures, syncope, migraine.
What is syncope/vasovagal
temporarily losing consciousness due to disruption of blood flow to brain, often leading to a fall. Caused by emotional event, change in temperature, painful sensation, extended standing.
Why is reflex anoxic seizure common pitfall for epilepsy diagnosis
Syncope or triggering event causes faint to floor. Hypoxia induces a generalised tonic-clonic seizure.
What is epilepsy
a tendency to have seizures.
What is a seizure
transient episode of abnormal electrical activity in the brain
Generalised tonic clonic seizure signs
loss of consciousness and tonic (muscle tensing) and clonic (muscle jerking) movements. May be associated tongue biting, incontinence, irregular breathing.
What is post-ictal period
person is confused, drowsy, feels irritable
Tx of general tonic-clonic
1st line: sodium valproate
2nd line: lamotrigine or carbamazepine
What is a focal seizure
seizures arise from one lobe - e.g. temporal lobe -> Affect hearing, speech, memory and emotions
How can a focal seizure present
temporal - hallucination, dejavu, memory flashbacks, lip smacking, picking at ones clothing.
Frontal - involves motor cortex. May lead to clonic movements (Jacksonian March).
Tx of focal seizure
Opposite of tonic-clonic:
1st line: carbamazepine or lamotrigine
2nd: Sodium Valproate
What is a absence, atonic and myoclonic seizure
Absence: blank, stares into space and then abruptly returns to normal.
Atonic: drop attacks, brief lapses in muscle tone
Myoclonic: Sudden brief muscle contractions, like a sudden jump.
What is a squint? Whats its medical name? Types of squint?
- misalignment of the eyes
- Strabismus
- Esotropia = affected eye positioned towards nose
- Exotropia = affected eye positioned outward and towards ear
- Hypertropia = upward moving affected eye
- Hypotropia = downward moving affected eye
- Amblyopia = affected eye has reduced function compared to dominant eye
- Esotropia = affected eye positioned towards nose
Causes of squint
- usually idiopathic
- retinoblastoma (space occupying lesion)
- cataracts
- cerebral palsy
- trauma
How to diagnose squint
cover test: occlude one eye and observe other for a shift in fixation. Direction of shift in fixation determines type of tropia: medial shift (when opposite eye is occluded) = exotropia lateral shift (when opposite eye is occluded) = esotropia
How to treat squint and what could happen if dont treat
- Eye patch over unaffected eye to train affected eye.
- squint may become permanent, can lead to ambylopia = defective visual acuity
What is Cerebral palsy
permanent neurological problems resulting from damage to the brain around the time of birth.
- not progressive however symptoms may change over time during growth or development
Causes of cerebral palsy
- majority antenatal -> maternal infections or trauma during pregnancy
- perinatal -> birth asphyxia, pre-term birth
- post natal -> meningitis, head injury
Types of Cerebral palsy
- Spastic (pyramidal CP): From damage to upper motor neurones = Hypertonia (stiff) and reduced function. MOST COMMON (80%)
- Dyskinetic (extrapyramidal): Damage to basal ganglia = hypertonia + hypotonia, athethoid movements (slow, involuntary movements of fingers, hands, toes)
- Ataxic: Damage to cerebellum. Problems with coordinated movement.
- Mixture of all.
Patterns of spastic cerebral palsy
Monoplegia: one limb affected
Hemiplegia: one side of the body affected
Diplegia: four limbs are affects, but mostly the legs
Quadriplegia: four limbs are affected more severely, often with seizures, speech disturbance and other impairments
Px of cerebral palsy
- spastic: flexion of arms, extension of legs + plantar flexion of feet. Normal muscle bulk, increased tone.
- Athetoid movements = indicate basal ganglia involvement/dyskinetic CP
- Cerebellar involvement = loss of coordination and balance (walk different, trouble writing, depth perception).
- developmental problems: failure to meet milestones, hand preference below 18 months, coordination/speech/walking problems, learning difficulties
- strabismus
What investigation confirms cerebral palsy diagnosis
- MRI
Mx of cerebral palsy
- multi disciplinary
- physio
- occupational therapy
- speech and language
- dietician
- orthopaedic
- paediatricians
Differentials for a upper motor neuron lesion
+ presentation
- acquired brain injury
- tumour
- cerebral palsy
- increased tone, fast reflexes, increased muscle bulk/preservance
5 Types of gait and what indicate
Hemi/diplegic: UMN lesion
Ataxic: Cerebellar lesion - wide based (clumsy, staggering)
High stepping gait: Foot drop or LMN lesion
Waddling gait: myopathy/ pelvic muscle weakness
Antalgic gait: limp/localised pain
