Neurology Flashcards
What investigations should be done in a syncope event?
ECG + 24 hr ECG
Echo
Bloods- FBC, Electrolytes, blood glucose
Neuro exam
BP lying and standing
Cardio exam
What are the features and management of generalised tonic clonic seizures in paeds?
Muscle tensing and muscle jerking
Tongue biting incontinence, groaning and irregular breathing
Post ictal period
Management
Boys first line: Sodium Valporate
Second line / first line girls- Lamotrigine/ Carbemazepine
What are the features and management of focal seizures
Start in the temporal lobes
Affect hearing, speech, memory and emotions
Focal- F for fuck there’s loads of presentations
Hallucinations
Memory flash backs
Deja vu
Doing things on auto pilot
First line: Carbemazepine/ Lamotrigine
Second line: Sodium valproate/ Levetiracetam
What are the features and management of absence seizures?
Children
When patient becomes blank and stares into space then returns to normal
Unaware of surroundings and won’t respond
10-20 sends
Grow out of it
First line: Ethosuximide / Sodium Valporate
What are the features and management of Atonic seziures?
Drop attacks
Brief loss of muscle tone
No more than 3 mins
Start in childhood
Can indicate lennox-Gastaut syndrome (severe epilepsy)
Management : First line sodium val
Second line lamotrigine
What are the features and management of myoclonic seizures
Brief muscle contractions- sudden jump- patient still conscious
Usually happen as part of juvenile myoclonic epilepsy
Management
First line: Sodium valproate
Second line: Lamotrigine, levetiracetam or topiramate
What are the features of infantile spasms
West syndrome
Starts at around 6 months
Poor prognosis 1/3 die by age 25
Treat with : Prednisolone
Vigabatrin
What investigations are done after a seizure
Children allowed one seizure before investigation
EEG done after the seance tonic clinic seizure
Consider MRI brain when
-First seizure in child under 2
-Focal seizures
-No response to first line anti-epileiptics
What are some important side effects for the anti-epileptic drugs
Sodium valproate- teratogenic, liver damage, tremor
Carbamazerpine- Agranulocytosis, aplastic anaemia
Phenytoin- Folate and Vit D déficient
Ethosuximide- night terrors
Lamotrigine- Stephen-Johnson syndrome- DRESS and leukopenia
What is the management of status epilepticus
A seizure lasting more than 5 mins or 2 or more seizures without regaining consciousness
Management
Secure airway
High flow o2
Assess cardiac and reps function
Check blood glucose
IV access
IV lorazepam (repeat after 10 mins if seizure continues)
Final step IV of phenytoin - intubate and ventilate
Community medications
Buccal midazolam (m for mouth)
Rectal diazepam (D goes in the rectum)
What are the features and management of febrile convulsions ?
Occur in children with a high fever- 6 months- 5 yrs
Simple febrile convulsions- generalised tonic clonic seizures -less than 15 mins- once during a febrile illness
Complex febrile convulsions- Partial or focal seizures more than 15 mins and occur multiple times during the same febrile illness
Management
Identify underlying source of infection and control fever with paracetamol/ ibuprofen
Normal seizure management
Bring to hospital after first seizure anyway
What are the features of breath holding spells
6-18 months
Child holds breath due to something upsetting/ scaring them
Grow out of them 4-5 yrs and not harmful
Cyanotic breath holding spells- child crying- stops breathing becomes cyanotic and passes out- regain consciousness and breathes again- can be tired and lethargic after
Reflex anoxic seizures- Child is startled- heart stops beating briefly and child goes pale, loose conciseness, seizure like twitching- 30 secs child becomes conscious
Management
Reassure parents
Look for iron def anaemia
What are the features of tension headaches
Band like pain around the head
No visual changes or pulsing sensations
Symmetrical
Triggers
Stress, fear, skipping meals, dehydration, infection
Management - reassurance, analgesia, regular meals, avoiding dehydration, reduce stress
What are the features and management of migraines
Unilateral, throbbing, severe pain, takes a while to resolve
Visual aura, photophobia, photophobia, nausea and vomiting, abdo pain- abdominal migraine
Management in children
Rest, fluids, low stimulus environment
Paracetamol
Ibuprofen
Sumatriptan
Antiemetics (domperidone)
Prophylaxis if missing lot’s of school
Propanolol
Pizotifen
Topiramate (teratogenic)
What are the causes of cerebral palsy
Antenatal
Maternal infections
Trauma during pregnancy
Perinatal
Birth asphyxia
Pre-term birth
Post natal
Meningitis
Severe neonatal jaundice
Head injury
What are the different types of cerebral palsy
Spastic- Hypertonia and reduced function- damage to UMN
Dyskinetic- problems controlling muscle tone- hypo and hypertonia, ora-motor problems- damage to basal ganglia
Ataxic- problems with co-ordinated movement- damage to cerebellum
Mixed
What is the presentation of cerebral palsy
- Failure to meet milestones
-Increased/ decreased tone
-Hand preference below 18 months ***
-Coordination, speech and walking issues
-Feeding/ swallowing problems
-Learning difficulties
What is the management of cerebral palsy
MDT
Physio
OT
SLT
May need NG or peg tube
Dieticians
Medications
Muscle relaxants (baclofen) for muscle spasticity and contractors
Anti-epileptic drugs for seizures
Glycopyrronium bromide - drooling
What are the different types of squint
Stabismus- misalignment of the eyes (double vision will occur to correct one eye works harder and one eye becomes lazy eye)
Amblyopia- Affected eye becomes passive and has reduced function (lazy eye) compared to other eye
Estropia- inward squint towards nose
Exotropia- outward squint towards ear
Hypertropia- Upward moving affected eye
Hypotropia- downward moving affected eye
What are the causes of squint and how are squints managed
Idiopathic
Hydrocephalus
Cerebral palsy
Space occupying lesions
Trauma
Until 8 visual fields are still developing
Need treatment before 8 for best outcome
Occlusive patch to cover the good eye and develop the weak eye
Atropine drops can cause vision to be blurred in good eye if don’t want patch
What are the causes of hydrocephalus
CSF building up in the brain and spinal cord
Problems with overproduction, draining or absorbing CSF
Congenital causes
-Aqueductal stenosis- cerebral aqueduct connecting 3rd and 4th ventricles becomes narrow and blows normal CSF flow into 4th ventricle- build up in 3rd and lateral ventricles
Other causes
Arachnoid cysts if large enough
Arnold-Chiari malformation- cerebellum herniates down through foramen magnum blocking CSF
Chromosomal abnormalities and congenital malformations
What is the presentation and management of hydrocephalus
Enlarged/ rapidly enlarging head circumference
Bulging anterior fontanelle
Poor feeding/ vomiting
Poor tone
Sleepy
VP shunt to drain CSF from other ventricles and drainage via peritoneal cavity - regulate how much CSF drains from ventricles
Complications of a VP shunt
-Infection, blockage, excessive drainage, outgrowing them every 2 yrs, intraventricular haemorrhage
What are the features of Craniosynostosis
Skull sutures close prematurely - before 1
If left untreated will lead to raised ICP
Presentation
Saggital synostosis- long narrow head front to back
Coronal synostosis- bulging on one side
Metopic synostosis- pointy triangular forehead
Lambdoid synostosis- flattened one side
Investigations
Skull X-ray First line
CT head
Management
Follow up if mild
Surgical reconstruction if severe
What are the features of Plagiocephaly and brachycephaly
Very common- abnormal heads
Plagiocephaly -flat head
Brachycephaly- flat at the back of the head
Presentation 3-6 months
Management
Exclude craniosynotosis
Look for congenital muscular torticollis (shortened sternocleidomastoid)
Reassure
Encourage baby not to rest on the flattened area
What is Gower’s sign
Children with proximal muscle weakness will stand up from a lying position - transfer their hands to their knees and walk their hands up their legs - pelvic muscles not strong enough to get upper body erect without arm help
What are the features of duchenne’s muscular dystrophy
Most common
X-linked recessive
Affects boys
Present around 3-5 with weak muscles around pelvis
Progressive and will affect all muscles
Wheelchair by 13
Life expectancy 25-35
Oral steroids and creatine useful in treatment
What are the features of Beckers muscular dystrophy
Symptoms start 8-12
Wheelchair by 20s-30s or can walk with assistance
Some function of dystrophin gene left
Management similar to Duchenne’s
What are the features of myotonic dystrophy
Presents in adulthood
-Progressive muscle weakness
-Prolonged muscle contractions - can’t let go after shaking hands/ can’t let go of door handle
-Cataracts
-Cardiac arrhythmia
What are the features of spinal muscular atrophy
Rare autosomal recessive
Progressive loss of motor neurones leading to progressive muscle weakness
Affects lower motor neurones- fasciculation’s, reduced muscle milk, reduced tone, power, no reflexes
SMA type 1 - 1st few months of life- death before 2
SMA type 2- Onset in 18 months- survive to adulthood
SMA type 3- Onset after 1 yr- loose ability after that
SMA type 4- Onset in 20s- ability to walk short distance but need wheelchair
Management
Resp support especially in type 1- tracheostomy
PEG tube
