Neurology Flashcards
Headaches
What are the types of headache?
The younger the child the more likely it is to be a scondary headache (e.g. caused by a tumour ect).
Isolated acute
Recurrent acute- completey aymptomatic inbetween
Chronic progressive- worse over hours or days
Chronic Non-progressive
Chronic progressive and isolated acute both need further investigation.
What are the differences between migrain and tension headaches?
Migraine is usually throbbing and pulsatile and can be hemicranial where as tension are diffuse and symmetrical.
Migraines can also present with abdo pain, nausea, vomiting, photophobia, phonophobia, and can have visual, sensory of motor aura. Usually a positive family history.
Tension headaches are present most of the time and are a constant ache.
What are some indicators of a headache caused by raised intracranial pressure?
Aggravated by activites that raised ICP such as coughing, straining and bending
Woken from sleep with headache and vomiting
This case would need neuroimaging.
What are indicators for neuroimaging?
Personality change
Features of cerebellar dysfunction e.g. tripping and falling, abnormal finger nose pointing
New focal neurological deficent e.g. squint
Seizures
Unexplained deterioration of school work
What suggests the headache is an analgesia induced headache?
Headache returns before another dose of analgesia is allowed
Particulalry brought on by compound analgesics e.g. Cocodamol
How is mirgaine managed?
Acute: pain relief e.g. paracetamol
If at least 1 headache per week then preventative treatment:
Pizotifen
Propranolol
Amitryptyline
How is Tension headache managed?
Reassurance
Resolution of underlying chronic phsyical, psychological or emotional problems
Acute: analgesia (should be discouraged in chronic)
Define an epileptic seizure
An abnormal excessive hypersynchronous discharge from a gorup of cortical neurones usually within the cerevral cortex.
What is a febrile convulsion?
A seizure occuring in infancy/ childhood (usually 3months to 5 years) it is associated with fever but without evidence of intracrainial infection or defined cause for the seizure.
It is the commonest cause of an acute seizure in childhood.
What is the difference between a generalised and partial/focal seizure?
Partial/focal seizure is restricted to one hemisphere or part of one hemisphere
Generalised seizure affects both hemispheres.
How are epileptic seizures managed?
Should only be give anti-eplieptic drugs if diagnosis is clear.
Sodium valproate (not given to girls)
Generalised- Levetiracetam
Focal- Carbamazepine
Also give steroids, immunoglobulins and ketogenic diet (increased ketos inhibits the excessive electrical signals which cause an epileptic fit)
What Anti eplieptic medication is first line for generalised seizures?
Levetiracetam
What is the first line for focal epileptic seizures?
Carbamazepine
Define mild microcephaly
More 2 standard deviations below the normal size
Define Moderate/severe Microcephaly?
More 3 standard deviations below the normal ocipitofrontal circumference
