Neurology Flashcards
What can cause headaches in children?
- simple tension headaches
- migraines
- ear, nose and throat infections (sinusitis)
- analgesic (overuse) headache
- problems with vision
- raised intracranial pressure
- brain tumours
- meningitis or encephalitis
- carbon monoxide poisoning
Describe a tension headache?
- mild ache across forehead - typically symmetrical
- band like pressure around the head
- come on and resolve gradually
- don’t cause visual changes or pulsating sensation
- young children may become quiet, pale and tired
What can trigger tension headaches in children?
- stress, fear or discomfort
- skipping meals
- dehydration
- infection
How should tension headaches be managed?
- reassurance, analgesia, regular meals, avoid dehydration and reduce stress.
How does a migraine present?
- unilateral, severe headache
- throbbing in nature
- takes longer to resolve than tension
Associated with
- visual aura
- photophobia and phonophobia
- nausea and vomiting
- abdo pain
How are migraines in children managed?
- rest, fluids and low stimuli environment
- analgesia - paracetamol, iBuprofen
- sumatriptan
- antiemetics (domperidone)
What can be given for prophylaxis of migraines?
- propranolol (avoid in asthma)
- Pizotifen (often causes drowsiness)
- topiramate (teratogeneic so give contraceptive in girls of child bearing age)
What are breath holding spells?
Involuntary episodes where a child holds their breath - usually triggered by something upsetting or scaring them.
What age group are affected by breath holding spells?
6 and 18 months of age. Most children outgrow them by 4 or 5 years.
What are the two types of breath holding spells?
- cyanotic
- pallid - also known as reflex anoxic seizures
What happens during a cyanotic breath holding spell?
- when the child is really upset, worked up and crying
- let out a long cry and then stop breathing, become cyanotic and lose consciousness
- gain consciousness again within a minute
What happens during a reflex anoxic seizure / pallid breath holding spell?
- when child is startled
- vagus nerve sends strong signals to the heart, causing it to stop
- child will suddenly go pale, lose consciousness and may have some seizure-like muscle twitching
- within 30 seconds the heart restarts and they become conscious again
How should breath holding spells be managed?
- exclude other pathology
- reassure parents
- do FBC as linked with iron deficiency anaemia. Treat if needed.
What is a squint?
Misalignment of the eyes
What is another name for a squint?
Strabismus
What is amblyopia?
When the misaligned eye becomes ‘lazy’ because the other one becomes dominant. The ‘lazy eye’ becomes more disconnected from the brain, making the problem worse.
What is esotropia?
Inward positioned squint eye (towards nose)
What is exotropia?
Outward positioned squint (towards ear)
What is hypertropia?
squint where affected eye moves upwards
What is hypotropia?
squint where affected eye moves downwards
What can cause squints?
- usually idiopathic
- hydrocephalus
- cerebral palsy
- space occupying lesions (e.g. retinoblastoma)
- trauma
Do i need to know the special tests for eye squints??
- fundoscopy
- visual acuity
- Hirschberg’s test
- Cover test
How are squints managed?
- start treatment before 8 ( this is when the visual fields stop developing)
- occlusive patch- cover good eye - forcing the weaker eye to develop
- see specialist ophthalmologist
What are febrile convulsions?
A type of seizure in children with a high fever (between 6 months and 5 years)
What are simple febrile convulsions?
Generalised, tonic clonic seizures, lasting less than 15 mins. Only occur once during a single febrile illness
What are complex febrile convulsions?
Consist of partial or focal seizures, last more than 15 mines or occur multiple times within the same febrile illness
What are differentials for a febrile convulsion?
- epilepsy
- meningitis, encephalitis or other neuro infections
- intracranial space occupying lesions
- syncope
- electrolyte abnormalities
- trauma
How are febrile seizures managed?
- find underlying cause and treat
- treat fever with ibuprofen or paracetamol
- simple febrile convulsions do not need investigating
- give parents advice around how to deal with if another occurs
What is cerebral palsy?
Permanent neurological problems occurring due to damage to the brain around the time of birth. This means there is a huge variation in severity and type of symptoms.
What can cause cerebral palsy?
Antenatal
- maternal infections
- trauma during pregnancy
Perinatal
- birth asphyxia (deprived of oxygen)
- pre-term birth
Postnatal
- meningitis
- severe neonatal jaundice
- head injury
What are the different types of cerebral palsy?
- spastic - hypertension and reduced function due to damage to upper motor neurones
- dyskinetic - problems controlling muscle tone - hyper and hypotonia - causing athetoid movements and oro-motor problems - due to damage to the basal ganglia
- ataxic - problems with co-ordinated movement - due to damage to the cerebellum
- mixed
What is a different name for spastic cerebral palsy?
Pyramidal CP
What are the different names for dyskinetic cerebral palsy?
Athetoid or extrapyramidal CP
What are the patterns of spastic cerebral palsy?
- monoplegic - one limb affected
- hemiplegic - one side of the body
- diplegic - 4 limbs affected but mostly the legs
- quadriplegic - 4 limbs affected more severely
What are the signs or symptoms of cerebral palsy?
- failure to meet milestones
- increased or decreased tone
- hand preference below 18 months
- problems with co-ordinations, speech or walking
- feeding or swallowing problems
- learning difficulties
Go over upper vs lower motor neurone injuries properly!!
What are the features of upper motor neurone lesions?
- muscle bulk preserved
- hypertonia
- power slightly reduced
- brisk reflexes (hyper-reflexia)
What are the features of lower motor neurone lesions?
- reduced muscle bulk with fasciculations
- hypotonia
- dramatically reduced power
- hyporeflexia
What does a hemiplegic / diplegic gait indicate?
upper motor neurone lesion
What does a broad based/ ataxic gait indicate?
a cerebellar lesion
What does a high stepping gait indicate?
foot drop or a lower motor neurone lesion
What does a waddling gait indicate?
pelvic muscle weakness due to myopathy
What does a antalgic gait indicate?
localised pain
What conditions are associated with cerebral palsy?
- learning disability
- epilepsy
- kyphoscoliosis
- muscle contractures
- hearing and visual impairement
- GORD
How is cerebral palsy managed?
- manage symptoms and maximise function
- physiotherapy
- occupational therapy
- speech and language therapy
- dieticians
- ortho surgeons - e.g. to release contractures
- medications such as muscle relaxants, anti-epileptics etc.
- social workers and support groups
What is syncope?
Temporary loss of consciousness due to a disruption of blood supply to the brain, often causing a fall. Also known as vasovagal or fainting.
What happens during a vasovagal episode?
- vagus nerve receives a strong stimuli - e,g, emotional event, pain, change in temp
- stimulates parasympathetic nervous system
- causes vasodilation, hence dropping the blood pressure in the cerebral circulation
- leading to hypo perfusion and then a loss of consciousness
What are the signs and syndromes of the prodrome before syncope?
- hot or clammy
- sweaty
- heavy
- dizzy or lightheaded
- vision going blurry or dark
- headache
What can cause syncope?
Primary
- dehydration, missed meals, extended standing, vasovagal response to a stimuli
Secondary
- hypoglycaemia
- dehydration
- anaemia
- infection
- arrhythmias
- heart disease
What examination and investigation should be done after syncope?
- any physical injuries?
- any concurrent illness?
- neuro examination
- lying and standing blood pressure
- cardiac examination and ECG (potentially echocardiogram)
- bloods - FBC, electrolytes and blood glucose
How should syncope be managed?
- exclude other pathologies
- reassure and give simple advice
- avoid dehydration, don’t skip meals, avoid prolonged standing
- when experiencing prodromal symptoms, sit or lie down, have some water and something to eat and rest
What is craniosynostosis?
Premature closure of the skull sutures - causing abnormal head shapes and restriction to the growth of the brain, hence raised ICP.
What symptoms can craniosynostosis cause?
- abnormal head shape that is small in proportion to the body
Symptoms of raised ICP - developmental delay
- cognitive impairment
- vomiting
- irritability
- visual impairment
- neurological symptoms
- seizures
How is craniosynostosis managed?
- if mild = monitor and follow up over time
- more severe = surgical reconstruction of the skull
This has good prognosis with proper management
What is plagiocephaly and brachycephaly?
Abnormal head shapes in otherwise normal healthy babies. This is very common
What is hydrocephaly?
Abnormal build up of CSF within the ventricles in the brain and spinal cord.
What are the common causes of hydrocepahlus?
Can be due to problems with over production, drainage or absorption.
- Aqueductal stenosis = most common - cerebral aqueduct between the 3rd and 4th ventricles is narrowed.
- arachnoid cysts
- other congenital malformations or chromosomal abnormalities
How does hydrocephalus present?
- rapidly enlarging head circumference in babies (as the sutures haven’t yet fused)
- bulging anterior fontanelle
- poor feeding and vomiting
- poor tone
- sleepiness
How is hydrocephalus commonly managed?
By surgically creating a ventriculoperitoneal shunt - so that the CSF from the ventricles drains into the peritoneal cavity
What are the complications to a ventriculoperitoneal shunt?
- infection
- can become blocked
- excessive drainage of CSF
- intraventricular haemorrhage during the surgery
- child outgrows them - so need replacing about every 2 years
What is Duchennes muscular dystrophy?
A X linked recessive genetic condition that causes gradual weakning and wasting of muscles. This is a defective gene for dystrophin on the X chromosome - this normally helps to hold muscles together at a cellular level
How does Duchennes muscular dystrophy present?
- Normally boys around 3-5 years.
- weakness around their pelvis which is progessive until all muscles affected
- Gowers sign (using a downward dog and then their legs to get up)
What is the prognosis for Duchennes muscular dystrophy?
- usually wheelchair bound by teenage years
- life expectancy of 25-35 years - due to resp and cardiac complications
How is Duchennes muscular dystrophy managed?
Supportive to ensure best quality of life
- occupational therapy
- physio - access to wheelchairs etc.
- management of any complications
Oral steroids - can slow progession slightly
Creatine supplements to slightly improve muscle strength
What is spinal muscular atropy?
Rare autosomal recessive condition that causes progressive loss of lower motor neurones in the spinal cord and hence progressive muscular weakness
What are signs of a lower motor neurone lesion?
- fasciculation’s
- hypotonia
- hyporeflexia
- reduced power
- reduced muscle bulk
How is spinal muscular atropy managed?
- physiotherapy - maximising strength in muscles and retaining resp function. Access to walking aids / wheelchairs.
- respiratory support may be needed
- PEG feeding if unsafe swallow
How is spinal muscular atropy managed?
- physiotherapy - maximising strength in muscles and retaining resp function. Access to walking aids / wheelchairs.
- respiratory support may be needed
- PEG feeding if unsafe swallow
