Neurology Flashcards
Febrile convulsions
Seizures occuring in children with a high fever, between the ages of 6 months and 6 years
Simple vs Complex febrile convulsions
Simple:
- generalised tonic-clonic,
- LESS THAN 15 MINUTES,
- ONLY OCCUR ONCE during a single febrile illness
Complex:
- PARTIAL/FOCAL
- MORE than 15 MINUTES
- MULTIPLE during course of same illness
- May also get Todd’s paresis
DDx for Febrile convulsions
- Epilepsy
- Neuro INFECTION (mening, enceph, cerebral malaria)
- Space occupying lesions
- SYNCOPE
- ELECTROLYTE abnormalities
- TRAUMA
Presention of febrile convulsions
Typically:
- Child around 18 MONTHS
- 2-5 MINUTE TONIC CLONIC
- HIgh fever
Management of febrile convulsions
Identify + manage underlying infection. ALAGESIA for fever.
if simple - no further investigation - just reassure + educate.
If complex educate + investigate underlying causes/DDx
Always need hospital assessment for first instance
Parental advice for managing febrile convulsions
- Stay with the child
- Put the child in a safe place, for example on a carpeted floor with a pillow under their head
- Place them in the recovery position and away from potential sources of injury
- Don’t put anything in their mouth
- Call an ambulance if the seizure lasts more than 5 minutes
If confident, can manage episodes after 1st one at home and just see GP asap
What things must be asked about for a paediatric neuro Hx specifically
BIRTH HISTORY (pre/ante+post-natal)
Developmental milestones
Paediatric neuro disorders
- Meuromuscular conditions
- Autoimmune
- Demyelinating
- Movement disorders
- Neurodegenerative
- Stroke
- EPILEPSY (most common in childhood specifically)
Cerebral palseies
Group of developmental disorders of movement + posture - activity limitation
- attributed to NON-PROGRESSIVE pathology that occured in developing fetal/infant brain
- Sx can be progressive as child grows up (due to diff functioning needs)
Types of cerebral palse
Spastic (pyramidal)
Dyskinetic: Hypotonic/Dystonic (Athetosis?) (extrapyramidal)
Ataxic
Mixed
Patterns of cerebral palsey
- Monoplegia: one limb affected
- Hemiplegia: one side of the body affected
- Diplegia: four limbs are affects, but mostly the legs
- Quadriplegia: four limbs are affected more severely, often with seizures, speech disturbance and other impairments
Cerebral palsey causes
Antenatal:
Maternal infections
Trauma during pregnancy
Perinatal:
Birth asphyxia
Pre-term birth
Postnatal:
Meningitis
Severe neonatal jaundice
Head injury
Cerebral palsey Px
- Failure to meet milestones
- Increased or decreased tone, generally or in specific limbs
- Hand preference below 18 months is a key sign to remember for exams
- Problems with coordination, speech or walking
- Feeding or swallowing problems (BULBAR PROBLEMS)
- Learning difficulties
Oft have co-morb
Complications/co-morbs of cerebral palsey
- Learning disability
- Epilepsy
- Kyphoscoliosis
- Muscle contractures (can get status dystonicus)
- Hearing and visual impairment
- Gastro-oesophageal reflux
- Issues with secretions due to lack of muscle control
Classification of cerebral palsey severity
1 mild - 5 severe
Cerebral palsey Mx
If no seizures, oft treated by neurodisability team
MSK: Positioning, Splints, Serial casting
- physio/occupational
Medical Tx for spasticity:
- Baclofen (muscle relaxants)
- Diazepam (muscle spasms)
- Glycopyrronium bromide (excessive drooling)
- Botulinium toxins, anticholinergics if specific muscle group affected + significantly affecting
Surgical: Intrathecal baclofen, dorsal rhisotomy, tendon lengthening
Feeding: Nutritional, NGT, PEG, SALT
Vision + auditiory
Social workers
Cerebral palsey DDx
- Segawa disease (dopamine responsive dystonia)
- Hereditary spastic paraperesis
- Inborn errors of metabolism
- Spinal cord injuries
Epilepsy clinical basis for diagnosis
2 or more unprovoked seizures occuring more than 24hrs apart
Types of seizures
Generalised tonic clonic
Absence
Focal
Myoclonic
Atonic
Infantile spasms (West syndrome)
Febrile convulsions
Infantile spasms (West syndrome) + Tx
Rare
Triad of:
- Spasms starting ~ 4-7 MONTHS
- full body spasms (oft affecting arms) - usually symmetrical
- hypsarrhythmia (disorganised activity) on EEG
- Developmental regression
Associated with variable encephalopathy
Poor prognosis (1/3 die by 25; 1/3 seizure free)
Tx: PREDNISOLONE + VIGABATRIN
Infantile spasms diagnosis
Spasms + HYPSSARRHYTHMIA in EEG
Rolandic epilepsy
Focal onset - Facial/Perioral with 2ndry generalisation
EEG - Centrotemporal spikes
Childhood absence epilepsy
Brief arrest of speech + activity
EEG 3 Hz spike + slow wave activity
Check if happening in more than one setting; Having automatisms
Can affect academic achievement
Epilepsy Ix
- Imaging if no evident aetiology
- Karyotyping (if intractable, learning diff, infantile onset)
- Metabolic work-up
- EEG is gold but changes only occur during episodes
- HISTORY TAKING (witness account is very important)
- Epilepsy is stereotypical so if each episode is diff, probs not epilepsy