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Paediatrics > Neurological > Flashcards

Neurological Flashcards

1
Q

What is a seizure

A

Sudden disturbance of neurological function caused by an abnormal or excessive neuronal discharge

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2
Q

What is a febrile seizure

A

type of seizure accompanied by a fever which is not caused by epilepsy or other neurological pathology such as meningitis or tumour

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3
Q

What is only age range that can get febrile convulsions

A

6 months-5years

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4
Q

What is a simple febrile convulsion

A

generalised, tonic clonic seizure. Last less than 15 minutes and only occur during a single febrile illness

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5
Q

What is a complex febrile convulsion

A

partial or focal seizures, last more than 15 minutes or occur multiple times during same febrile illness.

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6
Q

How is a diagnosis of febrile convulsion made

A

Exclude all differentials such as epilepsy, meningitis, brain tumour, intracranial hemmorhage, syncope, trauma.

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7
Q

Typical presentation of febrile convulsion

A

around 18month child, 2-5 tonic clonic seizure during a high fever. Fever caused by underlying viral/bacterial illness such as tonsillitis.

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8
Q

Tx of Febrile seizure

A

Manage underlying source of infection

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9
Q

When is lumbar puncture contraindicated

A

If child is unconscious or has cardiovascular/resp instability, raised ICP.

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10
Q

What is a paroxysmal disorder and different types

A

Broad diagnosis of ‘funny turns.’ Include epilepsy, breath-holding attacks, reflex anoxic seizures, syncope, migraine.

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11
Q

What is syncope/vasovagal

A

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.

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12
Q

Why is reflex anoxic seizure common pitfall for epilepsy diagnosis

A

Syncope or triggering event causes faint to floor. Hypoxia induces a generalised tonic-clonic seizure.

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13
Q

What is epilepsy

A

a tendency to have seizures.

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14
Q

What is a seizure

A

transient episode of abnormal electrical activity in the brain

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15
Q

Generalised tonic clonic seizure signs

A

loss of consciousness and tonic (muscle tensing) and clonic (muscle jerking) movements. May be associated tongue biting, incontinence, irregular breathing.

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16
Q

What is post-ictal period

A

person is confused, drowsy, feels irritable

17
Q

Tx of general tonic-clonic

A

1st line: sodium valproate

2nd line: lamotrigine or carbamazepine

18
Q

What is a focal seizure

A

seizures arise from one lobe - e.g. temporal lobe -> Affect hearing, speech, memory and emotions

19
Q

How can a focal seizure present

A

temporal - hallucination, dejavu, memory flashbacks, lip smacking, picking at ones clothing.
Frontal - involves motor cortex. May lead to clonic movements (Jacksonian March).

20
Q

Tx of focal seizure

A

Opposite of tonic-clonic:
1st line: carbamazepine or lamotrigine
2nd: Sodium Valproate

21
Q

What is a absence, atonic and myoclonic seizure

A

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.

22
Q

What is a squint? Whats its medical name? Types of squint?

A
  • misalignment of the eyes
  • Strabismus
    1. Esotropia = affected eye positioned towards nose
      1. Exotropia = affected eye positioned outward and towards ear
      2. Hypertropia = upward moving affected eye
      3. Hypotropia = downward moving affected eye
      4. Amblyopia = affected eye has reduced function compared to dominant eye
23
Q

Causes of squint

A
  • usually idiopathic
  • retinoblastoma (space occupying lesion)
  • cataracts
  • cerebral palsy
  • trauma
24
Q

How to diagnose squint

A 
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
25
Q

How to treat squint and what could happen if dont treat

A
  • Eye patch over unaffected eye to train affected eye.

- squint may become permanent, can lead to ambylopia = defective visual acuity

26
Q

What is Cerebral palsy

A

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

27
Q

Causes of cerebral palsy

A
  • majority antenatal -> maternal infections or trauma during pregnancy
  • perinatal -> birth asphyxia, pre-term birth
  • post natal -> meningitis, head injury
28
Q

Types of Cerebral palsy

A
  • 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.
29
Q

Patterns of spastic cerebral palsy

A

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

30
Q

Px of cerebral palsy

A
  • 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
31
Q

What investigation confirms cerebral palsy diagnosis

A
  • MRI
32
Q

Mx of cerebral palsy

A
  • multi disciplinary
  • physio
  • occupational therapy
  • speech and language
  • dietician
  • orthopaedic
  • paediatricians
33
Q

Differentials for a upper motor neuron lesion

+ presentation

A
  • acquired brain injury
  • tumour
  • cerebral palsy
  • increased tone, fast reflexes, increased muscle bulk/preservance
34
Q

5 Types of gait and what indicate

A

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

Paediatrics (14 decks)

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