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Paeds > Neurology > Flashcards

Neurology Flashcards

1
Q

What investigations should be done in a syncope event?

A

ECG + 24 hr ECG
Echo
Bloods- FBC, Electrolytes, blood glucose
Neuro exam
BP lying and standing
Cardio exam

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2
Q

What are the features and management of generalised tonic clonic seizures in paeds?

A

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

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3
Q

What are the features and management of focal seizures

A

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

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4
Q

What are the features and management of absence seizures?

A

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

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5
Q

What are the features and management of Atonic seziures?

A

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

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6
Q

What are the features and management of myoclonic seizures

A

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

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7
Q

What are the features of infantile spasms

A

West syndrome
Starts at around 6 months
Poor prognosis 1/3 die by age 25

Treat with : Prednisolone
Vigabatrin

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8
Q

What investigations are done after a seizure

A

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

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9
Q

What are some important side effects for the anti-epileptic drugs

A

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

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10
Q

What is the management of status epilepticus

A

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)

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11
Q

What are the features and management of febrile convulsions ?

A

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

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12
Q

What are the features of breath holding spells

A

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

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13
Q

What are the features of tension headaches

A

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

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14
Q

What are the features and management of migraines

A

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)

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15
Q

What are the causes of cerebral palsy

A

Antenatal
Maternal infections
Trauma during pregnancy

Perinatal
Birth asphyxia
Pre-term birth

Post natal
Meningitis
Severe neonatal jaundice
Head injury

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16
Q

What are the different types of cerebral palsy

A

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

17
Q

What is the presentation of cerebral palsy

A
  • Failure to meet milestones
    -Increased/ decreased tone
    -Hand preference below 18 months ***
    -Coordination, speech and walking issues
    -Feeding/ swallowing problems
    -Learning difficulties
18
Q

What is the management of cerebral palsy

A

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

19
Q

What are the different types of squint

A

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

20
Q

What are the causes of squint and how are squints managed

A

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

21
Q

What are the causes of hydrocephalus

A

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

22
Q

What is the presentation and management of hydrocephalus

A

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

23
Q

What are the features of Craniosynostosis

A

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

24
Q

What are the features of Plagiocephaly and brachycephaly

A

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

25
Q

What is Gower’s sign

A

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

26
Q

What are the features of duchenne’s muscular dystrophy

A

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

27
Q

What are the features of Beckers muscular dystrophy

A

Symptoms start 8-12
Wheelchair by 20s-30s or can walk with assistance
Some function of dystrophin gene left
Management similar to Duchenne’s

28
Q

What are the features of myotonic dystrophy

A

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

29
Q

What are the features of spinal muscular atrophy

A

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

Paeds (17 decks)

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