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3a Child Health > Neurology > Flashcards

Neurology Flashcards

1
Q

What is cerebral palsy

A

umbrella term referring to a non-progressive disease of the brain originating during the antenatal, intrapartum or early postnatal period that results in disorder of movement and posture development

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2
Q

Give 3 antenatal factors that can cause cerebral palsy

A
  • maternal illness - infections (CMV, rubella), thyroid disease etc
  • prematurity
  • cerebral malformation
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3
Q

Give a intrapartum factor that can cause cerebral palsy

A
  • Birth asphyxia - hypoxic ischaemic injury
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4
Q

Give 4 postnatal factors that can cause cerebral palsy

A
  • meningitis/ encephalitis
  • hyperbilirubinemia
  • intraventricular haemorrhage
  • head injuries prior to age 2 (inc NAIs)
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5
Q

What are the 3 main types of cerebral palsy. Put in order of most to least common

A
  • Spastic >80%
  • Dyskinetic
  • Ataxic
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6
Q

What is spastic cerebral palsy

A

increased tone resulting from damage to upper motor neurons

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7
Q

What are the 4 types of spastic cerebral palsy

A
  • monoplegia - single limb involvement
  • hemiplegia (unilateral) - ipsilateral involvement of arm and leg (arm>leg)
  • diplegia - all 4 limbs but the legs affected much more than arms
  • quadriplegia - all 4 limbs and the trunk (more severe)
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8
Q

What 3 signs are often associated with quadriplegia

A
  • Seizures
  • microcephaly
  • moderate or severe intellectual impairment
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9
Q

What is dyskinetic cerebral palsy

A
  • Involuntary, recurring and occasionally stereotyped movements with a varying muscle tone
  • caused by damage to the basal ganglia and substantia nigra
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10
Q

Describe the 3 subgroups of dyskinetic cerebral palsy

A
  • Dystonia - involuntary, sustained contractions resulting in twisting and abnormal postures
  • chorea - rapid, involuntary, jerky and non-repetitive movements
  • athetosis - slow writhing movements occurring more distally
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11
Q

What is ataxic cerebral palsy

A
  • problems with coordinated movement and hypotonia
  • most are genetically determined but can be due to injury to the cerebellum or its connections
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12
Q

Give 6 early features of cerebral palsy

A
  • abnormal limb and/or trunk posture and tone
  • delayed motor milestones
  • feeding difficulties
  • abnormal gait
  • asymmetric hand function before 12 months
  • retention of primitive reflexes - moro reflex
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13
Q

Give 3 clinical features of bilateral spastic cerebral palsy

A
  • predominately affects legs
  • young child - toe walking, scissoring
  • older child - crouch gait pattern when the child gets heavier and can’t remain on their toes
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14
Q

How is cerebral palsy investigated

A
  • MRI brain
  • clinical exam - assess posture, tone and gait
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15
Q

How is cerebral palsy managed

A
  • MDT: OT, physio, SALTs
  • Hypertonia - botulinum toxin A injections
  • oral/ Intrathecal baclofen (skeletal muscle relaxant)
  • selective dorsal rhizotomy (proportion of the nerve roots are cut to reduce spasticity
  • oral diazepam for spasticity
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16
Q

Give 5 complication of cerebral palsy

A
  • learning disability
  • hearing/ visual impairment
  • behavioural problems
  • drooling
  • epilepsy
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17
Q

What are febrile convulsions

A

seizures provoked by fever in otherwise normal children

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18
Q

What is the typical age range for the occurrence of febrile convulsions?

A

typically occur between the ages of 6 months and 5 years

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19
Q

Describe simple febrile convulsions

A
  • < 15 minutes
  • generalised tonic clinic
  • typically no recurrence within 24 hours
  • Should be complete recovery within an hour`
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20
Q

Describe complex febrile convulsions

A
  • last 15-30 minutes
  • focal seizure
  • may occur multiple times within 24 hours
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21
Q

When is a febrile convulsion considered febrile status epilepticus

A

when it lasts > 30 minutes

22
Q

How are febrile convulsions managed

A
  • first seizure/ complex seizure - admit to paeds
  • parental advice: phone for ambulance if seizure lasts over 5 mins
  • antipyretics do not prevent febrile convulsions
  • recurrent febrile convulsions - specialist may consider prescribing rescue rectal diazepam or buccal midazolam
23
Q

What are infantile spasms (west’s syndrome)

A

brief spasms beginning in the first few months of life

24
Q

Describe the presentation of infantile spasms

A
  • flexion of head, trunk, limbs → extension of arms
  • last 1-2 secs, repeat up to 50 times
25
Q

What causes infantile spasms

A

usually secondary to neurological abnormality
* encephalitis
* tuberous sclerosis
* birth asphyxia

26
Q

How are infantile spasms managed

A
  • combo therapy: vigabatrin and high dose prednisolone
  • if <2y seek guidance from and refer urgently to tertiary paeds neurologist
  • carries a poor prognosis
27
Q

describe the presentation of typical absence seizures

A
  • onset 4-8y
  • child becomes blank and stares into space
  • duration few-30 secs; no warning, quick recovery; often many per day
28
Q

How are absence seizures managed

A
  • first line: ethosuximide
  • second line: male - sodium valproate, females - lamotrigine or levetiracetam
  • most are seizure free by adolescence
29
Q

Which antiepileptic may exacerbate absence seizures

A

carbamazepine

30
Q

Describe a generalised tonic-clonic seizure

A
  • loss of consciousness
  • tonic (muscle tensing) and clonic (muscle jerking) movements
  • may be associated tongue biting, incontinence, groaning and irregular breathing
  • prolonged post-ictal period: confused, drowsy, irritable
31
Q

How are tonic-clonic seizures managed

A
  • boys: sodium valproate
  • girls: lamotrigine or levetiracetam
  • girls aged under 10 years and who are unlikely to need treatment when they are old enough to have children may be offered sodium valproate first-line
32
Q

How may a focal seizure present

A
  • Hallucinations
  • Memory flashbacks
  • Déjà vu
  • Doing strange things on autopilot
  • level of awareness varies
33
Q

How are focal seizures managed

A
  • First line: lamotrigine or levetiracetam
  • Second line: carbamazepine, oxcarbazepine or zonisamide
34
Q

Describe the presentation of Lennox-Gastaut syndrome

A
  • atypical absences, falls, jerks
  • 90% have cognitive dysfunction
35
Q

What would indicate Lennox-Gastaut syndrome on electroencephalogram

A

slow spike waves

36
Q

How is Lennox-Gastaut syndrome managed

A
  • specialist paediatric neurologist involvement
  • first line: sodium valproate
  • second line: lamotrigine
  • ketogenic diet if seizures continue
37
Q

Describe the epidemiology of juvenile myoclonic epilepsy

A
  • typical onset is in the teenage years
  • more common in girls
38
Q

Describe the features of juvenile myoclonic epilepsy

A
  • infrequent generalized seizures, often in morning/ following sleep deprivation
  • daytime absences
  • sudden, shock-like myoclonic seizure (these may develop before seizures)
39
Q

How is juvenile myoclonic epilepsy managed

A
  • first line: sodium valproate
  • first line (girls): levetiracetam
40
Q

Which organisms cause neonatal to 3-month-old meningitis?

A
  • Group B Streptococcus
  • E. coli and other Gram-negative organisms
  • Listeria monocytogenes
41
Q

Which organisms are commonly associated with meningitis in children < 6 years?

A
  • Neisseria meningitidis (meningococcus)
  • Streptococcus pneumoniae (pneumococcus)
  • Haemophilus influenzae
42
Q

Which organisms are most common in children older than 6 years with meningitis?

A

Neisseria meningitidis (meningococcus)
Streptococcus pneumoniae (pneumococcus)

43
Q

What are the contraindications for performing a lumbar puncture in suspected meningitis cases?

A

Signs of raised intracranial pressure (ICP)
Focal neurological signs
Papilloedema
Significant bulging of the fontanelle
Disseminated intravascular coagulation
Signs of cerebral herniation

44
Q

What should be done instead of a lumbar puncture in patients with meningococcal septicaemia?

A
  • Blood cultures and PCR
  • LP is contraindicated in meningococcal septicaemia.
45
Q

What antibiotics are used for the management of meningitis in children under 3 months?

A

IV amoxicillin (or ampicillin)
IV cefotaxime

46
Q

What antibiotics are used for the management of meningitis in children over 3 months?

A

IV cefotaxime (or ceftriaxone)

47
Q

When are corticosteroids recommended in the management of meningitis in children?

A
  • Not recommended in children younger than 3 months
    Dexamethasone should be considered if the lumbar puncture reveals:
  • Frankly purulent CSF
  • CSF white blood cell count >1000/microlitre
  • protein concentration >1 g/litre
  • Bacteria on Gram stain
48
Q

How should shock be managed in children with meningitis?

A

Shock should be treated with fluids, such as colloids.

49
Q

What public health measures should be taken in cases of meningococcal meningitis?

A
  • Public health notification
  • Antibiotic prophylaxis for contacts (ciprofloxacin preferred over rifampicin)
50
Q

At what ages are the three doses of the Meningitis B vaccine given?

A
  • 2 months
  • 4 months
  • 12-13 months

3a Child Health (19 decks)

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