Neurology Flashcards
What is developmental delay?
Developmental delay is when a child does not reach developmental milestones at the expected time in one or more areas: gross motor, fine motor, language, cognitive, social, or emotional development.
What are the primary domains of development assessed in children?
Gross motor
Fine motor and vision
Speech and language
Social and emotional
List common causes of global developmental delay.
Genetic syndromes (e.g., Down syndrome, Fragile X syndrome)
Metabolic disorders (e.g., hypothyroidism, phenylketonuria)
Cerebral palsy
Autism spectrum disorder (ASD)
Perinatal asphyxia
Prematurity and associated complications
What is the most common genetic cause of developmental delay?
Down syndrome.
What are red flags for developmental delay in infants?
Lack of head control by 4 months
Inability to sit unsupported by 9 months
No babbling by 9 months
No walking by 18 months
Persistent primitive reflexes beyond 6 months
_________ is the most common preventable cause of intellectual disability worldwide.
Hypothyroidism
Delayed __________ development may present as difficulty grasping objects or manipulating small items.
Fine motor
__________ is a neurodevelopmental disorder characterized by deficits in social communication and restrictive, repetitive behaviors.
Autism spectrum disorder (ASD)
Failure to smile by __________ months is a red flag for social developmental delay.
2 months
The Denver Developmental Screening Test assesses __________, __________, __________, and __________ domains.
Gross motor, fine motor, language, social
Which of the following is NOT typically associated with developmental delay?
A. Congenital hypothyroidism
B. Down syndrome
C. Chickenpox
D. Fragile X syndrome
C. Chickenpox
What is the best initial test for suspected developmental delay caused by a metabolic disorder?
A. MRI brain
B. Genetic testing
C. Blood and urine metabolic screening
D. Electroencephalogram (EEG)
C. Blood and urine metabolic screening
Scenario: A 2-year-old child is not speaking any words, has poor eye contact, and is not engaging in play with peers.
Q: What condition should be considered, and what is the next step in management?
Condition: Autism spectrum disorder (ASD). Next step: Refer for a detailed developmental assessment and early intervention services.
Scenario: A 10-month-old infant is unable to sit unsupported and has poor head control. Parents report feeding difficulties.
Q: What is the likely cause, and what investigation should be prioritized?
Likely cause: Cerebral palsy.
Investigation: Brain MRI to assess for hypoxic-ischaemic injury or structural abnormalities.
Arrange the steps in the assessment of developmental delay:
A. Detailed history and developmental milestones review
B. Physical examination and neurological assessment
C. Screening for hearing and vision deficits
D. Laboratory tests and imaging as needed
E. Multidisciplinary referral (e.g., speech therapy, physiotherapy)
A → B → C → D → E
What type of developmental delay is Autism spectrum disorder
Language and social delay
What type of developmental delay is Cerebral palsy
Motor delay
What type of developmental delay is Fragile X syndrome
Global developmental delay
What type of developmental delay is Strabismus or severe visual impairment
Fine motor delay
What are the pros and cons of developmental screening tools like the Ages and Stages Questionnaire (ASQ)?
Pros:
Early identification of delays
Easy to administer
Guides referrals for intervention
Cons:
May miss subtle delays
False positives can cause parental anxiety
Why is early intervention important in developmental delay?
Early intervention maximizes the child’s potential, improves long-term outcomes, and helps mitigate secondary complications such as social isolation and behavioral challenges.
Febrile Convulsions
Seizures which occur in children with a high fever between the ages of 6 months and 5 years
Simple Febrile Convulsions
Simple febrile convulsions are generalised tonic clonic and last less than 15 minutes and only occur once during a single febrile illness
Complex Febrile Convulsions
Complex febrile convulsions are focal seizures, last more than 15 minutes or occur multiple times during the same febrile seizures
Other causes for Febrile Convulsions like episodes
Rule out other causes such as epilepsy, syncopal episode, trauma, space-occupying lesions and neurological infection
Management of Febrile Convulsions
Identify and manage source of infection
Control fever with simple analgesia
Parental education
Prognosis is slightly higher for seizures/epilepsy in the future
Advice for parents with child who has 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 they have complex febrile convulsions, risk is slightly higher for developing epilepsy compared to the simple febrile convulsions and for ordinary people
Epilepsy
An umbrella term for a tendency to have seizures which are transient episodes of abnormal electrical activity in the brain.
Generalised Tonic-Clonic Seizures
Loss of consciousness with tonic (rigidity) and clonic (rhythmic jerking) phase with possible tongue biting, incontinence, groaning and irregular breathing - After this there is a postictal period where the person is confused, drowsy and feels irritable/low
Management of Generalised Tonic-Clonic Seizures
sodium valproate, lamotrigine or carbamazepine
Focal Seizures
These begin in the temporal lobes and affect speech, memory and emotions. - They can present with hallucinations, memory flashbacks and deja vu.
Management of Focal Seizures
lamotrigine or levetiracetam
Absence Seizures
the become blank and stare into space then abruptly return to normal - During this, they are unaware of their surroundings and will not respond and these generally last for around 10-20 seconds. - Most patients stop having these with age
Management of Absence Seizures
ethosuximide.
Myoclonic Seizures
Sudden brief muscle contractions where the person remains awake - These are often part of juvenile myoclonic epilepsy
Management of Myoclonic Seizures
sodium valproate or levetiracetam
Tonic/Atonic Seizures
Sudden tension/stiffness affecting the body
Management of Tonic/Atonic Seizures
sodium valproate or lamotrigine
Which is the most common type of seizure in children?
Absence Seizures
Ix for Epilepsy
Full history
EEG should be performed after the second simple tonic-clonic seizures
MRI brain to help diagnose structural abnormalities
Blood electrolytes, glucose, cultures and LP can also be considered
Management of Acute Seizures
Recovery position if possible - Put something soft under the head to prevent injury - Remove any obstacles that could lead to injury - Make a note of time of start and end of seizures - Call an ambulance if the seizures lasts longer than 5 minutes
Side Effects of Sodium Valproate
Teratogenic, Liver damage, Hair loss, Tremors
Side Effects of Carbamazepine
- Agranulocytosis, Aplastic anaemia
Side Effects of Ethosuzimide
Night tremors, Rashes, N+V
Side Effects of Lamotrigine
- DRESS syndrome, Leukopenia
What is DRESS syndrome?
Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS) Syndrome
Status Epilepticus
Medical emergency where a seizures lasts more than 5 minutes or 2 or more seizures without regaining consciousness
Management of Status Epilepticus
Management includes securing airway, high concentration oxygen, assess cardiac and respiratory function and IV lorazepam which can be repeated after 10 minutes if it continues
Medical options to treat Status Epilepticus in the community
buccal midazolam and rectal diazepam.
