neurology Flashcards
why is child neurology considered dynamic?
- brain continues to grow and function evolves
- static lesions produce evolving features
give examples of common neurological problems in childhood
- headache
- fits, faints, funny turns
- unusual head
- neuromuscular disorders
what is assessed in a developmental history?
- motor milestones: gross and fine motor skills
- speech and language
- vision and hearing
- play
- self-help skills
- cognitive development
what is looked at in a paediatric neurological examination?
- appearance
- gait
- head size
- skin findings
what is the epidemiology of headache disorders?
- 40% of children by age 7
- 75% of children by age 15
what are the 4 classifications of headache?
- isolated acute
- recurrent acute
- chronic progressive
- chronic non-progressive
what do you want to know about the typical episode of chronic headache?
- warning
- location
- severity
- duration
- frequency
what does a headache examination consist of
- growth parameters, OFC, BP
- sinuses, teeth, cranial bruit
- visual acuity, visual fields (craniopharyngioma), fundoscopy
- focal neurological signs
- cognitive and emotional status
what features would suggest childhood migraine?
- abdominal pain, nausea, vomiting
- focal signs: visual disturbance, paraesthesia, weakness
- pallor
- photophobia, phonophobia
- relation to fatigue/stress
- relieved by sleep/rest/ dark, quiet room
- family history
what is the typical presentation of migraine?
- hemicranial pain
- throbbing/pulsatile
- abdo pain, nausea, vomiting
- relieved by rest
- photophobia/phonophobia
- visual, sensory, motor aura
- positive family history
what is the typical presentation of tension headache?
- diffuse, symmetrical
- band-like distribution
- present most of the time (but there may be symptom free periods)
- “constant ache”
what type of headache would suggest raised intracranial pressure?
aggravated by activities that raise ICP eg. coughing, straining at stool, bending
woken from sleep with headache +/- vomiting
what type of headache would suggest analgesic overuse headache?
headache is back before allowed to use another dose
- paracetamol/NSAIDs, compound analgesics eg cocodamol
what are the indications for neuroimaging in headache?
- cerebellar dysfunction
- raised intracranial pressure
- new focal neurological deficit eg. new squint
- seizures, esp focal
- personality change
- unexplained deterioration of school work
how is migraine treated in children?
acute attack: effective pain relief and triptans
preventative: pizotifen, propranolol, amitryptiline, topiramate, valproate
how are tension type headaches treated in children?
- acute attacks: simple analgesia
- prevention: amitryptiline
- discourage analgesics in chronic TTH
what are paroxysmal events
- seizure/fit
- syncope
- convulsion
what is a seizure/fit
sudden attack from whatever cause
what is epilepsy?
tendency to recurrent, unprovoked (spontaneous) epileptic seizures
what is an epileptic seizure
abnormal excessive hypersynchronous discharge from a group of (cortical) neurons
paroxysmal change in motor, sensory or cognitive function
depends on seizure’s location, degree of anatomical spread over cortex, duration
what non-epileptic seizures and mimics can occur in children?
- acute symptomatic seizures: hypoxia-ischaemia, hypoglycemia, infection, trauma
- syncope
- reflex anoxic seizure
- parasomnias eg. night terrors
- behavioural stereotypies
- psychogenic seizures (NEAD: Non-epileptic attack disorder)
what is febrile convulsion?
a seizure occurring in infancy/childhood (3 months - 5 years)
associated with fever but without evidence of intracranial infection or defined cause for the seizure
what are the different seizure types?
jerk/shake: clonic, myoclonic, spasms
stiff: tonic seizure
fall: atonic/ tonic/ myoclonic
vacant attack: absence, complex partial seizure
what is the mechanism of epileptic fits?
chemical stimulation produces an electrical current
summation of a multitude of electrical potentials results in depolarisation of many neurons which can lead to seizures
can be recorded from surface electrodes (electroencephalogram)
