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Exam - M - Paediatrics (Megan) > Neurology > Flashcards

Neurology Flashcards

Febrile convulsions Migraine Tension Headache Epilepsy

1
Q

What is a febrile convulsion?

A

A type of seizure associated with a febrile illness (an illness that causes a fever).

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2
Q

Which ages can febrile convulsions occur in?

A

6 months - 5 years.

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3
Q

What type of seizures are seen in febrile convulsions?

A

Generalised tonic-clonic seizures.
Usually only occur once in each febrile episode.
Last for <15 minutes.

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4
Q

What is a complex febrile seizure?

A

A seizure that lasts >15 mins.

A seizure that occurs more than once during a single febrile illness.

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5
Q

What can cause febrile convulsions?

A

Human herpes virus 6.
Virus.
Bacterial infection - tonsilitis.

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6
Q

How are febrile convulsions managed?

A

The first one should always go to hospital to rule out other neurological causes.
Medication: paracetamol, ibuprofen (to reduce temperature).

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7
Q

When should a febrile convulsion be investigated further?

A

When they are complex (>15 mins or more than 1 in a single febrile episode).

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8
Q

When should you call an ambulance during a seizure?

A

If the seizure lasts for >5 minutes.

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9
Q

What is the likeliness of epilepsy developing after a febrile convulsion?

A

Normal population = 1%
After a simple febrile convulsion = 2%
After a complex febrile convulsion = 4-12%

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10
Q

What is the chance of having another febrile convulsion?

A

30-40% of children who have had a febrile convulsion will have another one.

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11
Q

What are signs of raised ICP?

A

Pain made worse when - coughing, straining, bending over, lying down.
Child is woken up at night with headache or vomits.

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12
Q

What are the signs of an analgesic overuse headache?

A

The pain returns before the child is allowed another dose of medication (common after having chronic tension headaches).

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13
Q

When should neuroimaging be considered?

A

Cerebellar signs (tripping, falling, ataxia, discoordinated nose to finger pointing)
Raised ICP
Seizures
Personality changes
Unexplained deterioration in school work.

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14
Q

What is sinusitis?

A

Headache associated with - Inflammation and facial pain behind the nose, forehead and eyes. Tenderness over the affected sinuses.

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15
Q

How long does sinstitis take to resolve?

A

2-3 weeks

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16
Q

What are the signs of a tension headache?

A

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.

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17
Q

How long do tension headaches take to improve?

A

Resolve quicker in children than in adults (usually within 30 mins).

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18
Q

What are the triggers for a tension headache?

A 
Skipping meals
dehydration
infection
stress
fear
dyscomfort 
(can often progress to medication overuse headaches).
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19
Q

What is the treatment for tension headaches?

A

Analgesia
regular meals
reducing stress
avoiding dehydration

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20
Q

What are the signs of a migraine?

A 
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
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21
Q

What is a common preceding symptom of migraines?

A

In young children: abdominal pain or nausea.

Older children: visual aura first.

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22
Q

What are the types of migraine?

A

with or without aura
Silent migraine (migraine with aura but no headache)
Hemiplegic
Abdominal

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23
Q

What is an abdominal migraine?

A 
Central abdominal pain lasting for more than 1 hour, examination will be normal.
Nausea
vomiting
anorexia
pallor.
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24
Q

What is the acute management of a migraine?

A 
Rest
fluids
Lw stimulus environment 
paracetamol
Ibuprofen
Triptans (sumatriptan)
Anti emetics (domperidone)
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25
Q

What is the prophylactic management of a migraine?

A 
Propanolol (NOT in asthmatics)
pizotifen (can cause drowsiness)
Topiramate (teratogenic)
Amitryptiline
Valproate
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26
Q

When should prophylaxis be given for migraines?

A

When they are affecting school or living.

If they have a migraine at least 1x a week.

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27
Q

What do children presenting with migraines often have a history of?

A

Abdominal migraines only.

28
Q

What is an epileptic fit?

A

A tendency for recurrent, unprovoked spontaneous seizures.

29
Q

What is a seizure?

A

A transient episode of abnormal electrical activity in the brain.

30
Q

What are the different types of seizures?

A 
Generalised tonic-clonic seizures
Focal seizures 
Absent seizure
Atonic seizure 
Tonic seizure
Myoclonic seizure 
Status epilepticus
31
Q

What is a generalised tonic-clonic seizures?

A 
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.

32
Q

What is the treatment for a generalised tonic clonic seizure?

A 
1st line (males) - sodium valproate
1st line females - levetiracetam

2nd line - lamotrigine or carbamazepine.

33
Q

What are focal seizures?

A 
They are seizures affecting the temporal lobe.
Hearing 
speech
memory 
emotions
hallucinations
deja bu 
memory flashbacks
doing things on autopilot.
34
Q

What is the treatment for focal seizures?

A

1st line - lamotrigine or carbamazepine.

2nd line - sodium valproate or levetiracetam.

35
Q

What is an absent seizure?

A

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.

36
Q

What is the management for absent seizures?

A

1st line - sodium valproate or ethosuccimide.

37
Q

What are atonic seizures?

A

drop attacks where there is brief lapses in muscle tone.
Last 3 minutes
begins in childhood.

38
Q

What is the treatment for atonic seizures?

A

1st line - sodium valproate

2nd line - lamotrigine

39
Q

What are myoclonic seizures?

A

where there a sudden brief muscle contraction

patient remains awake

40
Q

what is the treatment for myoclonic seizures?

A

1st line - sodium valproate

2nd line - lamotrigine, levetiracetam, topiramate.

41
Q

What is 1st line treatment for every type of seizure apart from focal?

A 
Sodium valproate (in males).
Levetiracetam (in females).
42
Q

What is 1st line treatment for focal seizures?

A

carbamazepine.

43
Q

What medication is first line for all girls with generalised seizures?

A

Levetiracetam.

44
Q

What is the purpose of an EEC?

A

To show the TYPE of seizure (most useful during octal period).
Can hep support epilepsy diagnosis but isn’t used for diagnosis alone.

45
Q

when are children investigated for epilepsy?

A

After their 2nd seizure.
All children are left after their 1st seizure.
NOT - after febrile convulsion or a vasovagal episode.

46
Q

What is status epilepticus?

A

A seizure lasting >5 minutes.
OR
2 or more seizures without regaining consciousness in between.
CLINICAL EMERGENCY,

47
Q

what is the treatment of status epilepticus?

A

ABCDE
IV lorazepam
IV phenobarbital
IV phenytoin

48
Q

What surgery is rarely done for epilepsy?

A

Vagal nerve surgery

49
Q

When is epilepsy classed as being unresponsive?

A

When theres no response after trying 2 different types of medication.

50
Q

What side effect does carbamazepine have?

A

Induces the P450 enzyme - interacts with many different drugs.

51
Q

What is hydrocephalus?

A

when theres too much CSF in the brain and spinal cord.

52
Q

What creates CSF?

A

the 4 choroid plexuses in the 4 ventricles

53
Q

where is CSF absorbed?

A

into the venous system via the arachnoid granulations

54
Q

What is the most common cause of hydrocephalus?

A

Aqueductal stenosis - where the aqueduct between the 3rd and 4th ventricle is narrowed.

55
Q

What are the signs of hydrocephalus?

A 
Rapidly enlarging occipito-frontal circumference
bulging anterior fontanelle
poor feeding
vomiting
poor tone
sleepiness
distention of veins across scalp
sunsetting of eyes (late presentation).
56
Q

How is hydrocephalus diagnosed?

A

cranial ultrasound through the anterior fontanelle

57
Q

What is the treatment for hydrocephalus?

A

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.

58
Q

What is encephalitis?

A

inflammation of the brain

59
Q

What is the most common cause of encephalitis in children vs neonates?

A

Children - HSV1 from cold sores.
Neonates - HSV2 from mothers genital warts.

Others: 
chicken pox 
Epstein barr virus 
Polio
mumps
mumps
rubella
60
Q

what is the signs of encephalitis?

A 
altered consciousness
unusual behaviour 
acute onset of focal seizures 
focal neurological symptoms 
fever
61
Q

How is encephalitis diagnosed?

A

Lumbar puncture - viral PCR testing.

62
Q

What type of test is recommended for all patients with encephalitis?

A

HIV testing

63
Q

What are contraindications of lumbar puncture?

A

GCS <9
Active seizures
Post octal period after seizure

64
Q

What is the treatment for encephalitis?

A

acyclovir

Ganciclovir

65
Q

What are the complications of encephalitis?

A 
fatigue
personality changes 
mood changes 
changes to memory 
learning disabilities
headaches
chronic pain
movement disorders 
sensory disturbance 
seizures 
hormonal imbalance

Exam - M - Paediatrics (Megan) (57 decks)

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