Neurological Conditions

Question 1

What is SHAKEN BABY SYNDROME?

Answer 1

Triad of:

• Retinal haemorrhages
• Subdural haematoma
• Encephalopathy

All due to the intentional shaking of a child between 0 -5 years old

Question 2

What are REFLEX ANOXIC SEIZURES?

Answer 2

A syncopal/ presyncopal episode that occurs in response to pain or emotional stimuli
Caused by neurally - mediated asystole with very sensitive vagal cardiac reflexes
Features: Pallor, falls to floor, rapid recovery, secondary seizures are common

Typically ages 6months ~ 3 years

Question 3

What are the features of CEREBRAL PALSY?

Answer 3

A disorder of movement + posture due to a non-progressive lesion of the motor pathways in the developing brain. Can be classified as spastic, dyskinetic, ataxic or mixed
Causes:
- Antenatally: Cerebral malformation/congenital infection
- Intrapartum: Birth asphyxia/trauma
- Postnatal: Intraventricular haemorrhage, meningitis, head trauma

Symptoms: Abnormal tone, delayed motor milestones, abnormal gait, feeding difficulty, learning difficulties, epilepsy, squints, hearing impairment

Management: MDT, Treatments for spasticity, anticonvulsants and analgesia as required

Question 4

What are the contraindications for investigations for MENINGITIS?

Answer 4

Any signs of raised ICP, including:

• Focal neurological signs
• Papilloedema
• Significant bulging of the fontanelle
• DIC
• Signs of cerebral herniations

Also contraindicated for patients with meningococcal septicaemia - blood cultures should be obtained

Question 5

What is the management for MENINGITIS?

Answer 5

1. Antibiotics
2. Steroids (contraindicated for patients <3 months)
   Dexamethasone for patients where LP rveals frankly purulent CSF, White cell count >100/microlitre, protein concentration >1g/l, or bacteria on gram stain
3. Fluids - to treat shock
4. Cerebral monitoring - mechanical ventilation if respiratory impairment
5. Public health notification and antibiotic prophylaxis of contacts

Question 6

What is INTRAVENTRICULAR HAEMORRHAGE?

Answer 6

Bleed into the ventricular system of the brain.
Whilst normally due to severe head injuries in adults, can occur spontaneously in premature neonates. Can cause blood clots and occlude CSF flow, resulting in hydrocephalus.

It typically occurs in the first 72h of birth

Question 7

What is the drug management of ATTENTION DEFICIT HYPERACTIVITY DISORDER (ADHD)?

Answer 7

A holistic approach. Following presentation, a ten-week ‘watch-and-wait’ to observe whether symptoms change or resolve.
If persists, then secondary care and CAMHS is required.
Drug therapy is a LAST RESORT.
First line: Methylphenidate/Lisdexamfetamine/Dexamfetamine if side effects can’t be tolerated

Question 8

What is PLAGIOCEPHALY?

Answer 8

A parallelogram shaped head due to sleeping in the same position on their back.

Question 9

What is CRANIOSYNOSTOSIS?

Answer 9

Premature fusion of skull bones