Neurology Flashcards
Name some causes of headaches in children and what would you be looking for in each (in the history)?
Primary:
- Tension headache: band, stress/tiredness
- Migraine: aura, pulsatile, GI upset and photophobia
- Cluster headache: episodes of attacks
- Trigeminal neuralgia: dermatomal distribution
Secondary:
- Meningitis: fever, sepsis, rash, photophobia, stiffness
- Intracranial bleeds: trauma
- SOL: balance/movement, fits/faints, vomiting
- Hypertension: renal
A 14 year old girl has come to the GP complaining of headaches for the past 3 months. She says they come and go, and she feels the pain all over her head. What are your differentials so far and what do you want to know next?
- ?Tension headaches
- ?Migraines
- ?SOL
eg. non-acute headache.
Progression
Specific triggers eg. early morning/lying down, stress, foods
How long do they last? What does she try to get rid of them eg. lie down in dark room
Any other symptoms: vomiting, visual disturbance or smells or sensations, fits, weight loss, fever
Impact on life
PMH, Dhx, allergy
What are some red flags for headaches?
- Vomiting
- Rashes
- Fever
- Neck stiffness
- Seizures or any focal neuro
- History of trauma
- Sudden onset worst headache ever
- Waking at night with pain
Describe the management of migraines
Conservative: avoid triggers (consider using headache diary for 8 weeks), stress reduction, cold/heat pack
Medical:
-Acute: simple analgesia (paracetamol, NSAID) + nasal sumatriptan combo. Antiemetics eg. prochlorperazine.
-Prophylactic: topiramate or propranolol -> tricyclics.
Describe the treatment for tension headaches
- Conservative: reduce stress, hydration
- Medical: simple analgesia
Define seizures: both medical and layman
- An episode of signs/symptoms caused by transient abnormality of electrical functioning in the brain
- An episode of abnormal brain function
Define epilepsy
A condition predisposing a patient to recurrent unprovoked seizures
Name some causes of seizures
Primary: epilepsy (idiopathic, HIE, tumour) Secondary: -Febrile seizure -Infection: meningitis or encephalitis -Hypoxia -Brain injury -Drugs -Metabolic: hypoglycaemia, electrolyte abnormality
What is a febrile seizure? How does it present?
- A seizure that occurs in the presence of fever but the absence of intracranial infection eg. meningitis/encephalitis
- Common. Usually in infants/children 6mos-6years
- Early in an infection. Usually a focus of infection
- Brief, generalised tonic-clonic
What is the management for febrile seizures? What is the prognosis?
- Rule out red flags
- Education! Diagnosis, what to do when seizure occurs, when to seek help
- Prognosis: most will grow out, they may recur but there is no risk of brain damage and epilepsy risk is not increased
A child has just been diagnosed with a febrile seizure. Please explain the diagnosis to the parents
- Febrile seizure: type of seizure triggered by fever. Common in young children. The brain is just more sensitive to fever but as it matures this will stop.
- No management. Not at risk of any brain damage. Only tiny bit more risk of epilepsy than other children.
- Possibly recur in future illness. Can’t be prevented with meds to lower fever.
- If it happens: make sure child safe eg. no sharp objects near head. Start timer. When stops, put in recovery position.
- When to call for help: if >5 mins long, if severely unwell with fever eg drowsy, non-blanching rash.
The parent of a child calls the GP because their child has had a seizure. When should a child be sent to A&E?
- First episode of seizure
- Signs of meningitis/encephalitis
- <18 months
- Severely unwell
- Focal seizure
- New neuro signs
- Uncertainty over cause
What is a breath-holding attack?
Occurs in toddlers when upset. Crying -> hold breath -> go blue -> +/- LOC
What is a reflex anoxic seizure? What is the underlying cause?
Triggering event (eg fear, cold, pain) -> pale -> fall over +/- convulsions -Due to reflex cardiac asystole (vagal response)
Describe the classification of epileptic seizures and briefly how they present
Complex (LOC) or partial (no LOC)
Generalised: LOC, no warning. Tonic-clonic, atonic, myoclonic, absence, tonic.
Focal:
-Temporal (strange sensations/aura, lip-smacking, plucking at clothes, automatisms, deja vu)
-Frontal (behavioural change, motor dysfunction eg. Jacksonian march)
-Parietal (sensory dysfunction)
-Occipital (visual hallucinations)
How does an absence seizure present?
LOC, staring into space, +/- eyelids flickering
How does a tonic-clonic seizure present?
Fall to the ground (tonic), cyanosis
Jerking movements, salivation, tongue-biting, incontinence
Unconsciousness/drowsiness/sleeping
Name some types of epilepsy syndromes (7 types)
- Infantile spasms (West syndrome)
- Lennox-Gastaut syndrome
- Childhood absence epilepsy
- Benign rolandic epilepsy
- Panaylotopoulos syndrome
- Juvenile absence epilepsy
- Juvenile myoclonic epilepsy
Describe infantile spams/West syndrome (presentation, EEG findings, Mx)
Occurs in infants 3-12 months
Flexion -> extension
Multiple short bursts, lasting 1-2 seconds
Eventually regress + LDs
Hypsarrhythmia on EEG (chaotic slow waves, sharp multifocal areas)
Mx: vigabitrin
Describe Lennox-Gastaut syndrome (presentation, EEG findings, Mx)
1-3 years Multiple types eg. absence, atonic Developmental delay, behavioural issues EEG: slow generalised spike, 1-3 Hz Mx: lamo/valproate
Describe childhood absence epilepsy (presentation, EEG findings, Mx)
4-12 years
Sudden onset, brief absence seizures. Normal otherwise
EEG: generalised 3/s spike+wave (3-4 Hz)
Describe benign rolandic epilepsy (presentation, EEG findings, Mx)
4-10 years
Tonic-clonic seizures in sleep, or simple focal.
EEG: focal sharp waves in Rolandic area
Usually no need for Mx/carba or lamo
Describe Panayiotopoulos syndrome (presentation, EEG findings, Mx)
1-5 years
Autonomic features, staring
EEG: posterior sharp focal waves, occipital
Mx: carbamazepine or lamotrigine
