Neurology Flashcards
Febrile convulsions Migraine Tension Headache Epilepsy
What is a febrile convulsion?
A type of seizure associated with a febrile illness (an illness that causes a fever).
Which ages can febrile convulsions occur in?
6 months - 5 years.
What type of seizures are seen in febrile convulsions?
Generalised tonic-clonic seizures.
Usually only occur once in each febrile episode.
Last for <15 minutes.
What is a complex febrile seizure?
A seizure that lasts >15 mins.
A seizure that occurs more than once during a single febrile illness.
What can cause febrile convulsions?
Human herpes virus 6.
Virus.
Bacterial infection - tonsilitis.
How are febrile convulsions managed?
The first one should always go to hospital to rule out other neurological causes.
Medication: paracetamol, ibuprofen (to reduce temperature).
When should a febrile convulsion be investigated further?
When they are complex (>15 mins or more than 1 in a single febrile episode).
When should you call an ambulance during a seizure?
If the seizure lasts for >5 minutes.
What is the likeliness of epilepsy developing after a febrile convulsion?
Normal population = 1%
After a simple febrile convulsion = 2%
After a complex febrile convulsion = 4-12%
What is the chance of having another febrile convulsion?
30-40% of children who have had a febrile convulsion will have another one.
What are signs of raised ICP?
Pain made worse when - coughing, straining, bending over, lying down.
Child is woken up at night with headache or vomits.
What are the signs of an analgesic overuse headache?
The pain returns before the child is allowed another dose of medication (common after having chronic tension headaches).
When should neuroimaging be considered?
Cerebellar signs (tripping, falling, ataxia, discoordinated nose to finger pointing)
Raised ICP
Seizures
Personality changes
Unexplained deterioration in school work.
What is sinusitis?
Headache associated with - Inflammation and facial pain behind the nose, forehead and eyes. Tenderness over the affected sinuses.
How long does sinstitis take to resolve?
2-3 weeks
What are the signs of a tension headache?
Mild headache around the forehead with pain/pressure felt in a band around the head.
Featureless apart from the headache itself.
Come on gradually - no vision changes or pulsations.
Symmetrical.
How long do tension headaches take to improve?
Resolve quicker in children than in adults (usually within 30 mins).
What are the triggers for a tension headache?
Skipping meals dehydration infection stress fear dyscomfort (can often progress to medication overuse headaches).
What is the treatment for tension headaches?
Analgesia
regular meals
reducing stress
avoiding dehydration
What are the signs of a migraine?
Headache + other symptoms: Unilateral throbbing/pulsating hemiplegic abdominal pain visual disturbance (aura) paraesthesia weakness pallor helped by sleep or vomiting positive family history photophobia photophobia
What is a common preceding symptom of migraines?
In young children: abdominal pain or nausea.
Older children: visual aura first.
What are the types of migraine?
with or without aura
Silent migraine (migraine with aura but no headache)
Hemiplegic
Abdominal
What is an abdominal migraine?
Central abdominal pain lasting for more than 1 hour, examination will be normal. Nausea vomiting anorexia pallor.
What is the acute management of a migraine?
Rest fluids Lw stimulus environment paracetamol Ibuprofen Triptans (sumatriptan) Anti emetics (domperidone)
What is the prophylactic management of a migraine?
Propanolol (NOT in asthmatics) pizotifen (can cause drowsiness) Topiramate (teratogenic) Amitryptiline Valproate
When should prophylaxis be given for migraines?
When they are affecting school or living.
If they have a migraine at least 1x a week.
What do children presenting with migraines often have a history of?
Abdominal migraines only.
What is an epileptic fit?
A tendency for recurrent, unprovoked spontaneous seizures.
What is a seizure?
A transient episode of abnormal electrical activity in the brain.
What are the different types of seizures?
Generalised tonic-clonic seizures Focal seizures Absent seizure Atonic seizure Tonic seizure Myoclonic seizure Status epilepticus
What is a generalised tonic-clonic seizures?
The most common type of seizure: The tonic (muscle tensing) phase comes before the clonic (muscle jerking) phase.
Loss of consciousness muscle tensing tongue biting incontinence incontinence groaning irregular breathing.
Post ictal: the person is confused, drowsy, irritable or low.
What is the treatment for a generalised tonic clonic seizure?
1st line (males) - sodium valproate 1st line females - levetiracetam
2nd line - lamotrigine or carbamazepine.
What are focal seizures?
They are seizures affecting the temporal lobe. Hearing speech memory emotions hallucinations deja bu memory flashbacks doing things on autopilot.
What is the treatment for focal seizures?
1st line - lamotrigine or carbamazepine.
2nd line - sodium valproate or levetiracetam.
What is an absent seizure?
These typically occur in children - they go blank and stare into space.
lasts 10-20 seconds
Eyes roll upwards.
90% stop having them as they grow older.
What is the management for absent seizures?
1st line - sodium valproate or ethosuccimide.
What are atonic seizures?
drop attacks where there is brief lapses in muscle tone.
Last 3 minutes
begins in childhood.
What is the treatment for atonic seizures?
1st line - sodium valproate
2nd line - lamotrigine
What are myoclonic seizures?
where there a sudden brief muscle contraction
patient remains awake
what is the treatment for myoclonic seizures?
1st line - sodium valproate
2nd line - lamotrigine, levetiracetam, topiramate.
What is 1st line treatment for every type of seizure apart from focal?
Sodium valproate (in males). Levetiracetam (in females).
What is 1st line treatment for focal seizures?
carbamazepine.
What medication is first line for all girls with generalised seizures?
Levetiracetam.
What is the purpose of an EEC?
To show the TYPE of seizure (most useful during octal period).
Can hep support epilepsy diagnosis but isn’t used for diagnosis alone.
when are children investigated for epilepsy?
After their 2nd seizure.
All children are left after their 1st seizure.
NOT - after febrile convulsion or a vasovagal episode.
What is status epilepticus?
A seizure lasting >5 minutes.
OR
2 or more seizures without regaining consciousness in between.
CLINICAL EMERGENCY,
what is the treatment of status epilepticus?
ABCDE
IV lorazepam
IV phenobarbital
IV phenytoin
What surgery is rarely done for epilepsy?
Vagal nerve surgery
When is epilepsy classed as being unresponsive?
When theres no response after trying 2 different types of medication.
What side effect does carbamazepine have?
Induces the P450 enzyme - interacts with many different drugs.
What is hydrocephalus?
when theres too much CSF in the brain and spinal cord.
What creates CSF?
the 4 choroid plexuses in the 4 ventricles
where is CSF absorbed?
into the venous system via the arachnoid granulations
What is the most common cause of hydrocephalus?
Aqueductal stenosis - where the aqueduct between the 3rd and 4th ventricle is narrowed.
What are the signs of hydrocephalus?
Rapidly enlarging occipito-frontal circumference bulging anterior fontanelle poor feeding vomiting poor tone sleepiness distention of veins across scalp sunsetting of eyes (late presentation).
How is hydrocephalus diagnosed?
cranial ultrasound through the anterior fontanelle
What is the treatment for hydrocephalus?
Ventriculoperitoneal shunt - needs to be replaced every 2 years as the child grows).
The fluid is then drained into the abdominal cavity where its absorbed.
What is encephalitis?
inflammation of the brain
What is the most common cause of encephalitis in children vs neonates?
Children - HSV1 from cold sores.
Neonates - HSV2 from mothers genital warts.
Others: chicken pox Epstein barr virus Polio mumps mumps rubella
what is the signs of encephalitis?
altered consciousness unusual behaviour acute onset of focal seizures focal neurological symptoms fever
How is encephalitis diagnosed?
Lumbar puncture - viral PCR testing.
What type of test is recommended for all patients with encephalitis?
HIV testing
What are contraindications of lumbar puncture?
GCS <9
Active seizures
Post octal period after seizure
What is the treatment for encephalitis?
acyclovir
Ganciclovir
What are the complications of encephalitis?
fatigue personality changes mood changes changes to memory learning disabilities headaches chronic pain movement disorders sensory disturbance seizures hormonal imbalance
