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Paeds > Neurology > Flashcards

Neurology Flashcards

1
Q

What is syncope

A

Temporary loss of consciousness due to disruption to blood flow to the brain

Often leads to a fall

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2
Q

How might a patient have felt before an episode of syncope

A

Hot or clammy

Sweaty

Heavy

Dizzy or light headed

Vision going blurry or dark

Headache

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3
Q

What are the primary causes of syncope in children

A

Simple fainting

Dehydration

Missed meal

Extended standing in warm environment

Vasovagal response to stimuli (surprise, pain)

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4
Q

What are the secondary causes of syncope in children

A

Hypoglycaemia

Dehydration

Anaemia

Infection

Anaphylaxis

Arrhythmias

Valvular heart disease

Hypertrophic obstructive cardiomyopathy

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5
Q

What investigations are needed for syncope

A

Lying standing blood pressure

ECG (consider 24 hour tape)

ECHO

Bloods (normal, glucose)

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6
Q

What is the management for syncope

A

Reassurance

Simple advice (stay hydrated, avoid missing meals, sit down when experiencing symptoms)

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7
Q

What is epilepsy

A

Umbrella term for conditions where there is a tendency to have seizures

Abnormal activity in the brain

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8
Q

What are generalised tonic-clonic seizures

A

Loss of consciousness

Muscle tensing and jerking

May have: tongue biting, incontinence, groaning, irregular breathing

Prolonged post-ictal period

Management: sodium valproate (first line), lamotrigine, carbamazepine

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9
Q

What are focal seizures

A

Start in temporal lobe

Affect hearing, speech, memory and emotions

May have: hallucinations, flashbacks, deja vu, doing strange things on autopilot

Management: lamotrigine or carbamazepine (first line), sodium valproate

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10
Q

What are absence seizures

A

Blank, stare into space

Abruptly return to normal

Unaware of surroundings, do not respond

Usually last 10-20 seconds

Most stop as child grows up

Management: sodium valproate, ethosuximide

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11
Q

What are atonic seizures

A

Aka drop attacks

Brief lapses in muscle tone

Usually last less than 3 minutes

Usually begin in childhood

Management: sodium valproate (first line), lamotrigine

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12
Q

What are myoclonic seizures

A

Sudden brief muscle contractions

Awake during episode

Management: sodium valproate (first line), lamotrigine, levetiracetam, topiramate

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13
Q

What are infantile spasms

A

Start at around 6 months

Clusters of full body spasms

Poor prognosis

Management: prednisolone, vigabatrin

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14
Q

What are the investigations for epilepsy

A

Allow one simple seizure before investigation

History

Video

EEG

MRI brain if: first seizure in under 2, focal seizure, no response to first line management

ECG

Bloods (normal + glucose)

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15
Q

What general advice should be given to patients with epilepsy

A

Take showers, not baths

Close supervision when swimming

Caution with weights

Caution with traffic

Caution with hot/heavy/electrical equipment

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16
Q

What is the management for seizures

A

Put patient in safe position

Recovery position if possible

Put something soft under head

Remove obstacles that could lead to injury

Note start and end times

Call ambulance if: > 5 mins, first seizure

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17
Q

What is status epilepticus

A

A medical emergency

Seizure lasting > 3 mins

More than 3 seizures in 1 hour

Management: IV lorazepam (repeat after 10 mins), IV phenytoin, consider intubation and ventilation, buccal midazolam, rectal diazepam

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18
Q

What are febrile convulsions

A

Seizure in a child with a fever

At 6 months - 5 years

Simple: generalised, tonic-clonic, last < 15 mins, only once during a febrile episode

Complex: partial or focal, last > 15 mins, multiple times during a febrile episode

Small risk of developing epilepsy

Management: control fever, call ambulance if last > 5 mins

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19
Q

What are breath holding spells

A

Involuntary episodes of a child holding their breath

Triggered by something upsetting/scaring them

At 6-18 months

Most outgrow them by age 4-5

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20
Q

What are cyanotic breath holding spells

A

When child very upset and crying

After letting out a long cry, stop breathing, become cyanotic, lose consciousness

Regain consciousness and restart breathing within 1 minute

Tired and lethargic after episode

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21
Q

What are reflex anoxia seizures

A

When child is startled

Vagus nerve sends strong signal to heart to stop beating

Go pale, lose consciousness, may have some muscle twitching

Resolves in under 30 seconds

22
Q

What is the management for breath holding spells

A

Educate and reassure parents

Treat any iron deficiency anaemia (linked to future episodes)

23
Q

What are tension headaches

A

Band-like pattern around head

Resolve gradually over 30 mins

No visual changes or pulsatile sensations

Quiet, stop playing, pale, tired

Triggers: stress, fear, discomfort, skipped meals, dehydration, infection

Management: reassurance, analgesia, regular meals, hydration

24
Q

What are migraines

A

Occur in attacks

With or without aura

Unilateral, severe, throbbing, take a long time to resolve

Associated with: visual aura, photophobia, phonophobia, nausea, vomiting, abdominal pain

Management: rest, fluids, simple analgesia, antiemetics

Consider prophylactic treatment (propranolol, pizotifen, topiramate)

25
Q

What are the causes of headaches in children

A

Tension headache

Migraine

ENT infection

Analgesic headache

Problems with vision

Raised intracranial pressure

Brain tumour

Meningitis

Encephalitis

Carbon monoxide poisoning

26
Q

What is cerebral palsy

A

Permanent neurological problems resulting from damage to the brain around birth

Not progressive

27
Q

What are the causes of cerebral palsy

A

Antenatal: maternal infection, trauma during pregnancy

Perinatal: birth asphyxia, pre-term birth

Postnatal: meningitis, severe neonatal jaundice, head injury

28
Q

What are the types of cerebral palsy

A

Spastic hypertonic (upper motor neurone damage)

Dyskinetic (problems controlling muscles, damage to basal ganglia)

Ataxia (problems with coordinating movement, damage to cerebellum)

Mixed

29
Q

How might a patient with cerebral palsy present

A

Failure to meet milestones

Increased/decreased tone

Hand preference before 18 months

Problems with coordination, speech, walking

Feeding or swallowing problems

Learning difficulties

30
Q

What might you find on examination of the gait of a patient with cerebral palsy

A

Hemiplegic/diplegic (upper motor neurone lesion)

Broad based/ataxic (cerebellar lesion)

High stepping (lower motor neurone lesion)

Waddling (pelvic muscle weakness)

Antalgic (localised pain)

31
Q

What are the complications associated with cerebral palsy

A

Learning disability

Epilepsy

Kyphoscoliosis

Muscle contracture

Hearing and visual impairment

GOR

32
Q

What is a squint

A

Misalignment of the eyes

Experience double vision

Children have a lazy eye

Concomitant: due to differences in control of extraocular muscles

Paralytic: due to paralysis of one or more extraocular muscle

33
Q

What are the causes of squints

A

Usually idiopathic

Hydrocephalus

Cerebral palsy

Space occupying lesion

Trauma

34
Q

What are the investigations for squint

A

General inspection

Eye movements

Fundoscopy

Visual acuity

Hirschberg’s test and cover test (specific to squints)

35
Q

What is the management for squints

A

Start treating before age 8 (when visual fields still developing)

Occlusive patch (cover good eye, force weak eye to develop)

Atropine drops (in good eye to blur vision, force weak eye to develop)

36
Q

What is hydrocephalus

A

Abnormal buildup of CSF in brain or spinal cord

Problems with draining or absorbing CSF

37
Q

What are the congenital causes for hydrocephalus

A

Aqueduct stenosis (problem with drainage)

Arachnoid cyst (block outflow of CSF)

Arnold-Chiari malformation (cerebellum herniates through foramen magnum, block outflow of CSF)

Chromosomal abnormalities

38
Q

How might a patient with hydrocephalus present

A

Enlarged and rapidly growing head circumference

Bulging anterior fontanelle

Poor feeding

Vomiting

Poor tone

Lethargy

39
Q

What is the management for hydrocephalus

A

Ventriculoperitoneal shunt

Complications: infection, blockage, excessive drainage, intraventricular haemorrhage

Need to be replaced every 2 years as child grows

40
Q

What is craniosynostosis

A

Skull sutures close prematurely (before age 1)

Abnormal head shape

Restriction to brain growth

41
Q

What are the investigations for craniosynostosis

A

Skull X-ray

CT head

42
Q

What is the management for craniosynostosis

A

Mild: monitor and follow up

Severe: surgical reconstruction

43
Q

What is plagiocephaly

A

Flattening of one side of baby’s head

Due to baby resting head on a particular point

Present at 3-6 months with abnormal head shape

44
Q

What is the management for plagiocephaly

A

Look for congenital muscular torticollis (shortened SCM on one side)

Reassurance (most return to normal shape as child grows)

45
Q

What is muscular dystrophy

A

Umbrella term for genetic conditions that cause gradual weakening and wasting of muscles

Commonly see Gower’s sign (kids get on hands and feet and then push off to stand up, a sign of proximal muscle weakness)

46
Q

What is Duchenne’s muscular dystrophy

A

Defective gene for dystrophin

X-linked recessive

Presents at age 3-5, with weakness of muscles around pelvis

Usually wheelchair bound by teenage years

Life expectancy 25-35

Management: oral steroids (slow progression), creatine supplements (improve muscle strength)

47
Q

What is Becker’s muscular dystrophy

A

Symptoms appear at 8-12

Muscle weakness around hips at age 3-5

Some need wheelchair in 20s and 30s

Management: oral steroids (slow progression), creatine supplements (improve muscle strength)

48
Q

What is myotonic dystrophy

A

Presents in adulthood

Progressive muscle weakness

Prolonged muscle contractions

Cataracts

Arrhythmias

49
Q

What is facioscapulohumeral muscular dystrophy

A

Presents in childhood

Weakness around face, shoulders, and arms

Sleep with eyes slightly open

Weakness in pursed lips

50
Q

What is oculopharyngeal muscular dystrophy

A

Presents in late adulthood

Weakness of ocular muscles (bilateral ptosis, restricted eye movements)

Difficulty swallowing

51
Q

What is spinal muscular atrophy

A

Autosomal recessive

Progressive loss of motor neurones

Progressive muscle weakness

Get lower motor neurone signs (fasciculations, reduced muscle bulk, reduced tone, reduced power, reduced or absent reflexes)

Types 1 to 4 (1 most severe)

52
Q

What is the management for spinal muscular atrophy

A

Supportive MDT management (physio, may need NIV, may need PEG feeding)

Paeds (17 decks)

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