Neurology Flashcards
A child presents complaining of headaches, what would you want to ask?
- Recurrence?
- More than 1 type?
- Warning?
- SOCRATES
- Use of analgesia?
What would you examine on a kid with a headache?
Growth parameters (height, weight, OFC, BP)
Sinuses & teeth
Visual acuity, fields and fundoscopy
Listen for cranial bruit
Focal neurological signs
Cognitive/emotional status
Headaches in kids fall into 4 groups:
- Migraines
- TTHs
- Raised ICP
- Analgesic Overuse
How would you make the diagnosis of a migraine?
Hemicranial, throbbing & pulsatile headache
Relieved by rest
Often photo/phonophobic
Presence of an aura
Also useful to look for FH
How would you diagnose a tension type headache?
If a child sufferes from a constant diffuse, symmetrical (band-like distribution) headache
How would you treat a migraine?
Give them simple analgesics for acute attacks
Maybe Triptans if bad enough
If atleast 1/wk give preventative drugs:
- Propranolol
- Amitriptyline
- Valproate
How do you manage a tension type headache?
Reassure the parent it’s nothing sinister
Attend to chronic underlying physical/psychological/emotional stressors
Discourage chronic use of analgesics
If necessary you can use simple analgesics acutely and amitriptyline preventatively
How would you spot a medication overuse headache
High use of PCM/NSAIDs (more problematic if with compound analgesics e.g. cocodamol)
Pain returns before they can have another dose
What would be red flags of a raised ICP headache?
- Wakens them from sleep
- Aggravated by raising ICP e.g. coughing, toilet straining or bending over
Headaches are diagnosed clinically, when would you want to use imaging?
1) Cerebellar dysfunction e.g. ataxia
2) Raised ICP
3) New focal deficit e.g. new squint
4) Seizures
5) Personality change
6) Unexplained deterioration in schoolwork
What are the major causes of fits/falls/funny turns in kids?
1) Epilepsy
2) Acute Symptomatic seizures e.g. febrile convulsion
3) Reflex Anoxic Seizures
4) Syncope
5) Parasomnias e.g. night terrors
6) Psychogenic Seizures
What causes reflex anoxic seizures?
Trigger e.g. pain or fright –> Vagal overactivity –> bradycardia –> hypoxia & seizure
It’s not abnormal in toddlers
What is an Acute Symptomatic Seizure?
A response to an acute insult e.g. hypoglycaemia, infection or hypoxia
The most common form is a Febrile Convulsion (very common, ~1in20 kids). Seizure ass with fever but with no intracranial inf or defined cause
What can you use to diagnose epilepsy?
Mostly a clinical diagnosis!!!
- History
- Video recordings
- ECG
- Interictal/Ictal EEG
- MRI (For malformations)
- Genetics (Familial & single gene disorders e.g. Tuberous Sclerosis)
- Metabolic tests if ass with developmental delay
What causes epilepsy in kids?
Mostly it’s idiopathic
Is childhood epilepsy generalised or focal?
Mostly generalised
What factors are important when determining drug treatment for epilepsy?
- Age
- Gender
- SEizure type
- Epilepsy type
What drugs do we use for childhood epilepsy?
Generalised = Sodium Valproate
Focal = Carbamazepine
New better tolerated drugs e.g. Lamotrigine
What are the major SEs of Anti-Epileptic Drugs (AEDs)?
CNS - Drowsiness, impacted learning, cognition & behaviour
Others include rashes & bone marrow problems
Other than AEDs how can you treat epilepsy?
Some forms respond to Vagus Nerve Stimulation or Surgery
What signs would raise concern of a neuromuscular disorder in a pre-walking child?
- Floppy
- Slips from hands
- Paucity of limb movements
- Alert but low motor activity
- Delayed motor milestones
- Myopathic facies
What signs would suggest a neuromuscular disorder in a walking child?
- Frequent falls
- Awkward/clumsy positioning e.g. holding shoulders back, belly out, walking on toes
- Gait e.g. waddling
- Pes Cavus & hammer toes
What is pes cavus and hammer toes indicative of?
Charcot Marie Tooth Disease
How can you differentiate a neuropathy from a myopathy?
Myopathy:
- Proximal weakness
- Purely motor
- Preserved reflexes
- Contractures
- ~Myocardial dysfunction
Neuropathies:
- Distal weakness
- ~sensory involvement
- Loss of reflexes
- ~Fasciculations
