Neurology Flashcards
When might you see febrile convulsions in a child?
6 months to 5 years
FHx
How are febrile convulsions treated?
Paracetamol/ibuprofen
What are the differentials for febrile convulsions?
Rigors
Intracranial infections
What do infantile spasms look like on EEG?
Hyposarrythmia
What can infantile spasm cause?
Developmental delay
What is the most common cause of infantile spasm?
Tuberous sclerosis
What others things should you look for in infantile spasm?
Dysmorphism
Skin changes
How is infantile spasm treated?
Vigabatrin
Prednisolon
What do myoclonic jerks mean in children?
Often benign
No treatment
What is a reflex anoxic seizure?
Triggered by pain/strong emotion Results in decreased perfusion to brain ECG - ?arrhythmia EEG - normal Most will grow out of it
What is juvenile myoclonic epilepsy?
Myoclonic jerks
Absence seizures
Worse when tired
Treatment - sodium valproate NOT carbamazepine
How is status epilepticus treated?
ABCDE 5 mins - benzodiazepine 10 mins later - further benzodiazepine eg IV lorazepam Prepare PR paraldehyde Prep phenytoin Call for senior support 10 mins later - IV phenytoin
How do you take a neurological history and what questions should you ask?
From parent/carer (but don’t forget child)
If for funny turns need proper witness description
Thorough history helps plan examination
Family history (neurogenetic/neurometabolic)
Birth history - prenatal, perinatal and postnatal (25% referrals for developmental impairment)
Developmental milestones
- Need to know if there is developmental delay/developmental regression)
- Normal for one age may be abnormal for another age
- Reflection of maturation of child’s nervous system
- Delay and abnormal pattern are indicators of underlying neurological diseases
What are the key principles in neurodevelopment?
Motor development proceeds head to toe fashion
Primitive reflexes are normally present in the term infant and diminish over the next 4 to 6 months of life
Postural reflexes emerge at 3 to 8 months of life
Persistence of primitive reflexes and lack of development of postural reflexes are hallmark of UMN abnormality of infant
Why do we do head circumference in babies?
Accurate reflection of brain size and development Serial important so can plot them on graph Small head (microcephaly) or a large head (macrocephaly or hydrocephalus) can be key findings in explaining the neurological abnormalities of a child
What are the different types of abnormal head shape (sysnostosis)?
Trigonocephaly - fusion of metopic suture - pointed shaped forehead
Brachycephaly - fusion of coronal suture - flat back of head
Solichocephaly/scaphocephaly - fusion of sagittal suture - AP breadth of skull much bigger than lateral breadth - seen in extreme preterm
Plagiocephaly - unilateral premature closure of lambdoid and coronal sutures - flattening of sutures
Oxycephaly - fusion of coronal and lambdoidal sutures - tower skull
What is Gower’s sign?
Hip girdle weakness, when asked to rise from prone position patient uses hands to walk up legs to compensate for proximal lower leg extremity
What should you do in a general physical examination in neurology?
Somatic growth - measure height and weight, compare percentiles with head circumference
Skin search - stigmata of neurocutaneous syndromes eg cafe au lait spot, ash leaf macule, iris lisch nodule, port wine stain, adenoma sebaceum, neurofibroma
Dysmorphic features - look especially at the midface, face reflects the brain, anomalies of the midface often associated with underlying brain malformations
- Facial measurements can be done to determine these
- Williams syndrome, Angelman syndrome, Rett syndrome, Smith-Magenis syndrome
Eyes - can be difficult due to poor concentration, retina is window to brain, fundoscopy
What should you do in a neurological examination to make it easier for you and the child?
Stop look listen - Don't cooperate for standard neuro examination - Tailor to child's age - Learn more by hands off observation - Mental status, cranial nerve examination, co-ordination by watching spontaneous activity Make it a game - Engage curiosity and imagination - Less threatening and child more cooperative when toys used - Not much gained testing power and reflexes Save the worst for last - Undressing child - Looking at fundus - Using auroscope - Testing gag reflex (if essential) - Measuring head circumference Cranial nerves including eye movements
What eye movement problems can you see in children?
Paroxysmal tonic upgaze Opsoclonus myoclonus syndrome Tick disorders Nystagmus Horner's syndrome
What is paroxysmal tonic upgaze?
Initially described as benign phenomenon with negative investigations and eventual complete resolution of symptoms
Similar clinical picture may arise from structural brain lesions, channelopathies, neurotransmitter disorders, and epileptic seizures
CACNA1A related disorders - spectrum of episodic ataxia 2, hemiplegic migraine, benign paroxysmal torticollis of infancy, and paroxysmal vertigo
What is opsoclonus myoclonus syndrome?
Associated with neuroblastoma
Eyes flick in all different directions
Also get myoclonus
What should you do with someone with nystagmus and why?
CT scan to make sure no cerebellar lesion
What is palatal myoclonus?
Rhythmic involuntary jerking movement of soft palate and pharyngopalatine arch
Surprisingly little effect on swallowing
How is palatal myoclonus treated?
Drugs used - clonazepam, carbamazepine, baclofen, anticholinergics, tetrabenazine, valproic acid, phenytoin, lamotrigine
Botulinum toxin but caution as spread of toxin may cause dysphagia and other problems
What are 4 common neurological problems?
Seizures
Syncope
Movement disorders
Cerebral palsy
Name 3 common types of seizure in children
Atonic seizures
Absence seizures
GTCS
Frontal lobe seizures - can progress to tonic-clonic
Name 3 common types of movement disorders in children
Hyperekplexia Chorea Shuddering Sleep myoclonus Tremors Motor tics Motor stereotypy
What is hyperekplexia?
Tonic phase after shocking baby, baby will stop breathing, flex neck will abort attack, genetic condition
What is motor stereotypy associated with?
ASD
