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Paeds > Neurology > Flashcards

Neurology Flashcards

1
Q

Causes of syncope?

A

primary:
dehydration
missed meals
extended standing
vasovagal response to stimuli

secondary:
hypoglycaemia
dehydration
anaemia
infection
anaphylaxis
arrhythmias
valvular heart disease
HOCM

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2
Q

Syncope vs seziure?

A

Syncope:
prolonged upright position
light-headedness prior
sweating prior
blurring of vision prior
reduced tone
return of consciousness shortly after falling
no prolonged post-ictal period

Seizure:
epilepsy aura
head turning or abnormal limb positions
tonic clonic activity
tongue biting
incontinence
cyanosis
>5 mins
prolonged post-ictal period

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3
Q

Investigations for syncope?

A

Hx and Exam
lying and standing BP
ECG
Holter
Echo
Bloods (FBC, electrolytes, glucose)

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4
Q

Mx of primary syncope?

A

reassurance
advice on what to do if feeling faint
avoid dehydration, prolonged standing, missing meals

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5
Q

What is epilepsy?

A

epilepsy refers to conditions in which the patient is prone to having seizures, which are caused by abnormal electrical activity within the brain

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6
Q

Types of seizures?

A

generalised tonic-clonic seizure
focal seizure
absence seizure
atonic seizure
myoclonic seizure
infantile spasms (West Syndrome)
febrile convulsions

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7
Q

What are generalised tonic-clonic seizures?

A

typical seizure
LOC + muscle tensing and muscle jerking movements
may be tongue biting, incontinence, groaning, irregular breathing
post-ictal period

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8
Q

Mx of generalised tonic-clonic epilepsy?

A

first-line - sodium valproate, lamotrigine, levetiracetam

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9
Q

Mx of focal seizures?

A

lamotrigine, levetiracetam

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10
Q

Mx of myoclonic seziures?

A

sodium valproate, levetiracetam

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11
Q

Mx of tonic and atonic seizures?

A

sodium valproate, lamotrigine

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12
Q

Mx of absence seizures?

A

ethosuximide

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13
Q

What are focal seizures?

A

seizures that start in the temporal lobe, thus affecting speech, hearing, memory and emotions
hallucinations
flashbacks
deja vu
doing strange things on autopilot (automatism)

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14
Q

What are absence seizures?

A

typically only affect children, who grow out of them
unaware of their environment and non-responsive

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15
Q

What are atonic seizures?

A

‘drop attacks’
may be indicative of Lennox-Gastaut syndrome

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16
Q

What are myoclonic seizures?

A

jerking of muscles but child remains conscious for it
occur in juvenile myoclonic epilepsy

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17
Q

What are infantile spasms?

A

aka West Syndrome
starts at around 6 months
characterised by clusters of full body spasms with upset in between
developmental regression
poor prognosis - 1/3 die before 25, 1/3 are seizure free by 25

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18
Q

What are febrile convulsions?

A

seizures that occur in children when they have a fever
6 months - 6 years
recur but only a slight incr. risk of developing epilepsy

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19
Q

Mx of infantile spasms?

A

prednisolone
vigabatrin

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20
Q

EEG results in infantile spasms?

A

hypsarrhythmia

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21
Q

Investigations for epilepsy?

A

Hx and Exam
start investigations after second simple seizure
EEG
MRI brain

ECG
blood electrolytes
blood glucose
blood, urine cultures, LP

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22
Q

General advice in epilepsy?

A

education!!!!
showers > baths
avoid swimming
be cautious with heights
be cautious with traffic
be cautious with heavy equipment
be cautious with hot things
driving

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23
Q

Simple vs Complex Febrile convulsions?

A

simple - generalised tonic, clonic seizures lasting less than 15 minutes with good recovery and only occurring once during a febrile illness

complex - partial or focal seizures, last more than 15 minutes, occurring multiple times during the same illness, not recovering in between episodes

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24
Q

DDx of febrile convulsions?

A

epilepsy
meningitis
encephalitis
SOL (tumour, haemorrhage)
syncopal episode
electrolyte abnormalities
trauma (NAI)

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25
Q

Mx of febrile convulsions?

A

identify and treat underlying infection
anti-pyretic
reassurance if simple and advice
further investigations if complex

Advice:
stay with child
safe place
recovery position
don’t put anything in their mouth
call an ambulance if >5 mins

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26
Q

Prognosis of febrile convulsions?

A

1/3 have further febrile convulsion
1.8% risk of epilepsy in general population
2-5% risk after simple febrile convulsions
10-20% after complex febrile convulsions

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27
Q

What are breath holding spells?

A

involuntary episodes affecting children between 6-18 months where they hold their breaths after an upsetting stimulus

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28
Q

2 types of breath holding spells?

A

cyanotic breath holding spells
reflex anoxic seizures

29
Q

Causes of headache in children?

A

tension headache
migraine
ENT
analgesic headache
vision problems
raised ICP
brain tumours
meningitis
encephalitis
carbon monoxide poisoning

30
Q

Triggers for tension headaches in children?

A

stress, fear, discomfort
skipping meals
dehydration
infection

31
Q

Mx of tension headaches?

A

reassurance
analgesia
regular meals
avoiding dehydration
underlying stress

32
Q

Types of migraine?

A

migraine with aura
migraine without aura
silent migraine
hemiplegic migraine
abdominal migraine (v common in children)

33
Q

Symptoms of migraine?

A

unilateral headache
photophobia
phonophobia
visual aura
nausea and vomiting
anorexia
abdominal pain

34
Q

Mx of migraine?

A

rest, fluids, low stimulus environment
paracetamol
ibuprofen
sumatriptan
antiemetics

If impacting QOL, prophylaxis:
propranolol
pizotifen
topiramate (not in child-bearing age)

35
Q

What is cerebral palsy?

A

condition characterised by the permanent neurological problems resulting from damage to the brain at the time of birth
not progressive, however may present differently at times due to different stages of development
huge variation in presentations

36
Q

Causes of cerebral palsy?

A

antenatal:
maternal infections
trauma during pregnancy
perinatal:
birth asphyxia
pre-term
post-natal:
meningitis
severe neonatal jaundice
head injury

37
Q

Types of cerebral palsy?

A

spastic (pyramidal)
dyskinetic (extrapyramidal, athetoid)
ataxic
mixed

38
Q

How does spastic cerebral palsy present?

A

hypertonia and reduced muscle function due to damage to UMNs

39
Q

How does dyskinetic cerebral palsy present?

A

problems controlling tone, causing athetoid and oro-motor problems due to damage to the basal ganglia

40
Q

How does ataxic cerebral palsy present?

A

problems with coordinated movements due to damage to the cerebellum

41
Q

Patterns of spastic cerebral palsy?

A

monoplegia
diplegia
hemiplegia
quadriplegia

42
Q

Presentation of CP?

A

difficult to predict from birth injury -> follow-up needed

failure to meet milestones
incr. or decr. tone
hand preference before 18 months
problems with coordination, speech or walking
feeding or swallowing problems
learning difficulties

43
Q

Complications of CP?

A

learning disability
epilepsy
kyphoscoliosis
muscle contractures
hearing and visual difficulties
GOR

44
Q

Mx of CP?

A

MDT approach, link with the disability network
physio
OT
SALT
dietician
(may require NG or PEG)
orthopaedic surgeons
paediatricians
social worker
support groups

45
Q

Medical Mx of CP?

A

muscle relaxants (baclofen) for spasticity or contractions
anti-epileptics
glycopyrronium bromide (drooling)

46
Q

Causes of strabismus?

A

usually idiopathic
hydrocephalus
CP
SOL e.g., retinoblastoma
trauma

47
Q

Mx of strabismus?

A

don’t delay treatment, visual fields are still developing up till 8
occlusive patch or atropine drops in good eye
coordinated by ophthalmologist and correct any refractive errors

48
Q

What is a hydrocephalus?

A

when CSF builds up abnormally within the brain and the spinal cord
either caused by an overproduction of CSF or a problem with the drainage or absorption

49
Q

Congenital causes of hydrocephalus?

A

aqueductal stenosis
arachnoid cysts
Arnold-Chiari malformation
chromosomal abnormalities
congenital malformations can cause obstruction to drainage

50
Q

What is Arnold-Chiari malformation?

A

where the cerebellum herniates down through the foramen magnum, blocking the flow of CSF

51
Q

Presentation of hydrocephalus?

A

enlarged and increasing OFC
bulging anterior fontanelle
poor feeding and vomiting
poor tone
sleepiness

52
Q

Mx of hydrocephalus?

A

insertion of a ventriculoperitoneal shunt

53
Q

Complications of VP shunts?

A

infection
blockage
excessive drainage
IVH during shunt surgery
outgrowing them (need replacement every 2 yrs)

54
Q

What is craniosynostosis?

A

occurs when skull sutures close prematurely, leading to abnormal skull shapes and restriction of the brain, causing raised ICP

55
Q

Presentation of craniosynostosis?

A

abnormal head shape, depending on which suture is affected
anterior fontanelle closing before 12 months
small head in proportion to body

56
Q

Shape of skull depending on affected suture?

A

sagittal suture -> long and narrow from front to back
coronal suture -> bulging on one side of forehead
metopic suture -> pointy triangular forehead
lambdoid suture -> flattening on one side of the occiput

57
Q

Mx of craniosynostosis?

A

skull X ray
CT head
watch and wait
if severe -> Sx reconstruction
good prognosis

58
Q

What is plagiocephaly?

A

flattening of one area of the baby’s head
brachycephaly -> flattening of the back of the baby’s head

59
Q

Why is plagiocephaly more common?

A

baby’s sleeping on their back -> SIDS

60
Q

Mx of plagiocephaly?

A

exclude craniosyntosis
exclude torticollis
reassurance

position on the other side
tummy time supervised
minimising time in push chairs

?plagiocephaly helmets

61
Q

What is muscular dystrophy?

A

an umbrella term for a group of genetic conditions that cause gradual weakness and wasting of muscles

62
Q

Types of muscular dystrophy?

A

Duchenne muscular dystrophy
Becker muscular dystrophy
myotonic dystrophy

63
Q

What is Gower’s sign?

A

due to proximal muscle weakness, use their hands to stand up and climb up their legs

64
Q

Mx of muscular dystrophy?

A

no curative treatment
aim is to give highest QOL for highest amount of time
MDT
OT, physio, medical appliances
manage complications such as scoliosis and heart failure

65
Q

Inheritance pattern of Duchenne muscular dystrophy?

A

X-linked recessive
dystrophin gene affected

66
Q

Presentation of Duchenne muscular dystrophy?

A

boys 3-5yrs
weakness in muscles around pelvis initially
spreads to all muscles
usually wheelchair bound by teenage years
life expectancy 25-35 yrs

67
Q

What is spinal muscular atrophy?

A

rare autosomal recessive condition that causes a progressive loss of lower motor neurones in the spinal cord, causing progressive muscular weakness

68
Q

Categories of SMA?

A

1-4, most - least severe
2 most common (onset within 18 months, most never walk but survive into adulthood)

69
Q

Mx of SMA?

A

no curative treatment
MDT
physio
medical appliances
respiratory support
PEG feeding

Paeds (16 decks)

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