Neurology Flashcards

1
Q

Clinical features of Lennox-Gastaut syndrome and management

A

Generalized motor
1-3 y/o
Multiple seizure types, most commonly drop attacks
Neurodevelopment arrest/regression, behaviour disorder, poor prognosis
Needs long-term sodium valproate

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2
Q

Tests for febrile seizures

A

No need if simple, when focus of infection is identifiable clinically and child returns to baseline mental state.

Otherwise depending on presentation

LP: Must do if any S&S indicative of intracranial infection, persistent lethargy and not fully active. Consider if age <12 months, prior antibiotic therapy

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3
Q

Management of febrile seizure

A

Seizure first aid
- maintain airway by placing on lateral
- do not restrain/insert item in mouth
- ensure safe surroundings
- observe seizure and time it
- if >5 mins, rectal diazepam and go clinic
Post-seizure: child may be cranky for a day or so
Control fever: avoid excessive clothing, use anti-pyretics
Inpatient mx: if recurring prolonged febrile seizure and if febrile status epilepticus
Discharge: when return to normal mental state, when serious bacterial infection excluded
Parental education: benign, no long-term risk of brain injury but might have seizure with next fever

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4
Q

Active seizure + status epilepticus management

A

If suspected causative pathology, cardio-respiratory compromise, duration of seizure >5 minutes or unknown, need to commence active treatment.

Continuous monitoring, oxygen
Obtain venous access
Check BGL
Give benzodiazepine

If after 5 minutes still seizing, give benzodiazepine

If after another 5 minutes persisting, give levetiracetam/phenytoin

Reassess 5 minutes after infusion completed - if ongoing give the alternative 2nd agent

Reassess 5 minutes after infusion completed, if ongoing seek help from senior staff +/- airway management

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5
Q

Benzo dose for seizure

A

Midazolam 0.15mg/kg IV/IM

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6
Q

Levitiracetam dose seizure

A

40mg/kg IV/IO

Dilute to 50mg/ml, infuse over 5 mins

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7
Q

Phenytoin dose seizure

A

20mg/kg IV/IO

Infuae into large vein over 20 minutes

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8
Q

Migraine management

A

Just like adult one, but remember to review triggers,

non-pharmaco management; darkened quiet room, regular exercise, relaxation, healthy diet

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9
Q

Spastic cerebral palsy cause, features

A

Damage to UMN (pyramidal or corticospinal)
Hypertonic with associated brisk deep tendon reflexes and extensor plantar responses
Tone is velocity dependent, so faster the muscle stretched the greater the resistance
May have clasp knife rigidity

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10
Q

Dyskinesia cerebral palsy causes and features

A

Damage to basal ganglia/pathways

Fluctuating tone leading to frequent involuntary movements especially with movement/stress
- chorea
- athetosis (more distally)
- dystocia
Intellect might be relatively unimpaired
Floppy, poor trunk control, delayed motor development
May only appear towards end of first year of life

RF: Kernicterus, HIE

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11
Q

Ataxic cerebral palsy causes and features

A

Damage to cerebellum, most genetically determined

Same side as lesion, symmetrical
Early Trunk and limb hypotonia, Poor balance, delayed motor developments
Later, incoordinate movements, intention tremor and ataxic gait

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12
Q

Investigation for CP

A
TFT 
Urine/plasma metabolic screen
Consider TORCHES 
Genetic testing
MRI brain: periventricular leukomalacia, vascular lesion, malformation
Thrombophilia screen (strong fam hx of stroke) 
Screening for associated disorder 
- EEG for seizure 
- hearing 
- vision
- speech and language 
- formal cognitive assessment 
- nutrition and growth
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13
Q

Management for CP spasticity

A

Diazepam, dantrolene sodium, baclofen (generalised)
Inhibitory cast
Botulinum toxin - reduce localized
Selective dorsal rhizotomy

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14
Q

Dystonia CP management

A

Levodopa

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15
Q

Athetosis and chorea management

A

Reserpine, tetrabenezine

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16
Q

Saliva control

A

Botulinum toxin in salivary glands
Anticholinergic
Speech therapy
Surgery

17
Q

Orthopedic CP management

A
Knee: hamstring surgery 
Ankle: 
- toe walking: orthoses, inhibitory casts, botulinum toxin A 
- older children: surgery 
May require multilevel surgery at 8-12 
Scoliosis may need correction
18
Q

Associated conditions CP

A

Visual: strabismus, refractive errors, amblyopia, visual field defect, reduced acuity
Hearing impairment
Speech: aphasia, dysarthria
Neurodev: ASD, ADHD, OCD
Intellectual disability
Epilepsy
Respiratory: frequent infection, chronic disease
GI: chronic constipation, GORD, swallowing disorder
Orthopedic:
- spasticity, contracture, scoliosis
- osteoporosis
- hip: hip subluxation and dislocation, progressive dysphasia
- knee: flexion contracture
- ankle: equines deformity
Urinary: enuresis, frequency, urgency, incontinence
Growth failure due to feeding issues

19
Q

Spastic hemiplegia key findings

A

Early hand preference
Circumductive gait
Tippy toe walk and equinovarus deformity
When child runs upper extremity flexed

20
Q

Spastic diplegia key findings

A
Legs moree spastic than arms 
Commando crawl 
Cannot sit 
Scissoring posture 
Due to periventricular leukomalacia
21
Q

Spastic quadriplegia key findings

A

Highly associated with intellectual disability and seizures
Swallowing difficulties
Due to multi cystic cortical encephalomalacia