Neurological/Head Flashcards
What is the management for migraine in children?
1) Headache diary
2) Simple analgesia - paracetomal/ibuprofen (Aspirin > 16 yr olds - Risk of Reye’s syndrome)
3) Nasal sumitriptans
4) Combination therapy - nasal triptan and analgesia - consider anti-emetic
5) Follow up in a month - but tell them to come back if sx get worse
Prophylaxis - topiramate/propanolol?
Remember to ask: affect on schooling, suspected triggers/stresses, general health in between attacks
What is the management for headache?
1) Exclude red flags i.e. giant cell arteritis, SOL, meningitis, raised ICP
2) Lifestyle: sleep, hydration, reduce screen time
3) Medication: Analgesia, antiemetics (prochlorperazine), nasal triptans
4) Physical tx: cold compress, warm pads, forehead balms
5) Prophylaxis: Na+ channel blockers - topiramate, valproate, Beta blockers (NOT IN ASTHMA), tricyclics, acupuncture
6) Psychosocial support: removal/tackling of stressors, relaxation, mindfulness, meditation
What are the investigations for headache?
Bedside: Neurological exam - cranial nerves, Cardiac exam, full set of obs, photophobia/neck stiffness test (Meningitis)
Bloods: ESR, CRP (GCA), FBC, U&Es, LFTs, blood cultures
Imaging: CT head, MRI head (SOL)
Special: Lumbar puncture, Temporal artery biopsy, SOL biopsy, chest and abdo XR?
What are differentials for seizure?
- Epilepsy
- Febrile convulsions
- Reflexanoxic seizure
- Hypoglycaemia
- Hypercalcaemia
- Hyponatraemia
- Baby jitters
What are the Ix for seizure?
Bedside: Neurological examination - cranial nerves, check eyes for retinal haemorrhages! Monitor Obs -> PEWS score
Bloods: U&Es, HbA1c, Blood gas, WBC, blood cultures
Imaging: EEG (if suspected epilepsy)
Other: ECG
What is the Mx for febrile seizure?
Assess and manage using:
A - may need senior anaesthetist and paediatrician involvement B C - cannulation - IV access D E In the acute setting
Medication: Diazepam, Abx if suspected bacterial cause i.e. cefotaxime?
Communicate, educate parents so can manage at home i.e. how to cope when child is having i.e. don’t restrain, put in recovery position afterwards.
What are the signs of raised ICP?
- Headache.
- Blurred vision.
- Feeling less alert than usual.
- Vomiting.
- Changes in your behavior.
- Weakness or problems with moving or talking.
- Lack of energy or sleepiness.
What is retinoblastoma?
Retinoblastoma is the most common ocular malignancy found in children. The average age of diagnosis is 18 months.
What is the aetiology of retinoblastoma?
Autosomal dominant; caused by a loss of function of the retinoblastoma tumour suppressor gene on chromosome 13; around 10% of cases are hereditary
What is the clinical presentation of retinoblastoma?
1) absence of red-reflex, replaced by a white pupil (leukocoria) - the most common presenting symptom
2) strabismus (abnormal alignment of the eyes)
3) visual problems
What is the Mx of retinoblastoma?
Management
- enucleation is not the only option
- depending on how advanced the tumour is other options include external beam radiation therapy, chemotherapy and photocoagulation
What is the prognosis of retinoblastoma?
> 90%
Define West syndrome
Infantile spasms (West syndrome) is a form of epilepsy which starts around age 4-8 months.
What are some signs of raised intracranial pressure?
Fixed dilated pupils
Bradycardia
Hypertension
How is meningitis managed if a child presents to GP with it?
IM benzylpenicillin - 300mg/600mg/1.2g and urgent transfer to hospital
