Neurology Flashcards
What is syncope
Temporary loss of consciousness due to disruption to blood flow to the brain
Often leads to a fall
How might a patient have felt before an episode of syncope
Hot or clammy
Sweaty
Heavy
Dizzy or light headed
Vision going blurry or dark
Headache
What are the primary causes of syncope in children
Simple fainting
Dehydration
Missed meal
Extended standing in warm environment
Vasovagal response to stimuli (surprise, pain)
What are the secondary causes of syncope in children
Hypoglycaemia
Dehydration
Anaemia
Infection
Anaphylaxis
Arrhythmias
Valvular heart disease
Hypertrophic obstructive cardiomyopathy
What investigations are needed for syncope
Lying standing blood pressure
ECG (consider 24 hour tape)
ECHO
Bloods (normal, glucose)
What is the management for syncope
Reassurance
Simple advice (stay hydrated, avoid missing meals, sit down when experiencing symptoms)
What is epilepsy
Umbrella term for conditions where there is a tendency to have seizures
Abnormal activity in the brain
What are generalised tonic-clonic seizures
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
What are focal seizures
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
What are absence seizures
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
What are atonic seizures
Aka drop attacks
Brief lapses in muscle tone
Usually last less than 3 minutes
Usually begin in childhood
Management: sodium valproate (first line), lamotrigine
What are myoclonic seizures
Sudden brief muscle contractions
Awake during episode
Management: sodium valproate (first line), lamotrigine, levetiracetam, topiramate
What are infantile spasms
Start at around 6 months
Clusters of full body spasms
Poor prognosis
Management: prednisolone, vigabatrin
What are the investigations for epilepsy
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)
What general advice should be given to patients with epilepsy
Take showers, not baths
Close supervision when swimming
Caution with weights
Caution with traffic
Caution with hot/heavy/electrical equipment
What is the management for seizures
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
What is status epilepticus
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
What are febrile convulsions
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
What are breath holding spells
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
What are cyanotic breath holding spells
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
What are reflex anoxia seizures
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
What is the management for breath holding spells
Educate and reassure parents
Treat any iron deficiency anaemia (linked to future episodes)
What are tension headaches
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
What are migraines
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)
What are the causes of headaches in children
Tension headache
Migraine
ENT infection
Analgesic headache
Problems with vision
Raised intracranial pressure
Brain tumour
Meningitis
Encephalitis
Carbon monoxide poisoning
What is cerebral palsy
Permanent neurological problems resulting from damage to the brain around birth
Not progressive
What are the causes of cerebral palsy
Antenatal: maternal infection, trauma during pregnancy
Perinatal: birth asphyxia, pre-term birth
Postnatal: meningitis, severe neonatal jaundice, head injury
What are the types of cerebral palsy
Spastic hypertonic (upper motor neurone damage)
Dyskinetic (problems controlling muscles, damage to basal ganglia)
Ataxia (problems with coordinating movement, damage to cerebellum)
Mixed
How might a patient with cerebral palsy present
Failure to meet milestones
Increased/decreased tone
Hand preference before 18 months
Problems with coordination, speech, walking
Feeding or swallowing problems
Learning difficulties
What might you find on examination of the gait of a patient with cerebral palsy
Hemiplegic/diplegic (upper motor neurone lesion)
Broad based/ataxic (cerebellar lesion)
High stepping (lower motor neurone lesion)
Waddling (pelvic muscle weakness)
Antalgic (localised pain)
What are the complications associated with cerebral palsy
Learning disability
Epilepsy
Kyphoscoliosis
Muscle contracture
Hearing and visual impairment
GOR
What is a squint
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
What are the causes of squints
Usually idiopathic
Hydrocephalus
Cerebral palsy
Space occupying lesion
Trauma
What are the investigations for squint
General inspection
Eye movements
Fundoscopy
Visual acuity
Hirschberg’s test and cover test (specific to squints)
What is the management for squints
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)
What is hydrocephalus
Abnormal buildup of CSF in brain or spinal cord
Problems with draining or absorbing CSF
What are the congenital causes for hydrocephalus
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
How might a patient with hydrocephalus present
Enlarged and rapidly growing head circumference
Bulging anterior fontanelle
Poor feeding
Vomiting
Poor tone
Lethargy
What is the management for hydrocephalus
Ventriculoperitoneal shunt
Complications: infection, blockage, excessive drainage, intraventricular haemorrhage
Need to be replaced every 2 years as child grows
What is craniosynostosis
Skull sutures close prematurely (before age 1)
Abnormal head shape
Restriction to brain growth
What are the investigations for craniosynostosis
Skull X-ray
CT head
What is the management for craniosynostosis
Mild: monitor and follow up
Severe: surgical reconstruction
What is plagiocephaly
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
What is the management for plagiocephaly
Look for congenital muscular torticollis (shortened SCM on one side)
Reassurance (most return to normal shape as child grows)
What is muscular dystrophy
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)
What is Duchenne’s muscular dystrophy
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)
What is Becker’s muscular dystrophy
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)
What is myotonic dystrophy
Presents in adulthood
Progressive muscle weakness
Prolonged muscle contractions
Cataracts
Arrhythmias
What is facioscapulohumeral muscular dystrophy
Presents in childhood
Weakness around face, shoulders, and arms
Sleep with eyes slightly open
Weakness in pursed lips
What is oculopharyngeal muscular dystrophy
Presents in late adulthood
Weakness of ocular muscles (bilateral ptosis, restricted eye movements)
Difficulty swallowing
What is spinal muscular atrophy
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)
What is the management for spinal muscular atrophy
Supportive MDT management (physio, may need NIV, may need PEG feeding)
