Neurology Flashcards
Examination of a child with headache is to rule out secondary cause for the headache.
What are some of the things to assess?
Growth parameters
Sinuses, teeth, visual acuity
Fundoscopy
Visual fields (craniopharyngioma)
Cranial bruit
Focal neurological signs
Cognitive and emotional status
BP
->ENT exam of sinuses, teeth and eyes is to see if the headache is referred pain
Examination in headache is usually normal.
Features of childhood migraine?
Associated abdominal pain, nausea, vomiting
Focal symptoms before, after, during e.g. visual disturbances, paraesthesia, weakness
Aggravated by bright light/noise
Relation to stress or tiredness
Helped by sleep, rest or a dark, quiet room
FH
If you are worried about raised ICP, what are some questions you can ask?
Headache worse on coughing, straining to have a poo or benidng?
Woken from sleep with headache +/- vomiting?
Indications that a headache needs neuroimaging?
Features of cerebellar dysfunction
Features of raised ICP
New focal neurological deficit
Seizures
Personality change
Unexplained deterioration in school work
Treatment for acute migraines?
Pain relief
Triptans in older children
Treatment to prevent migraines?
If patient gets migraine at least once per week:
Pizotifen
Propranolol
Amitriptyline
Topiramate
Valproate
Treatment for tension type headaches?
Simple analgesia
Amitriptyline can be considered as prophylaxis/prevention
Syncope?
Faint
Convulsion?
Seizure where there is prominent motor activity
Epilepsy?
A tendency to recurrent, unprovoked epileptic seizures
->a seizure is not necessarily epileptic
What is a febrile convulsion?
A seizure occurring in infancy or childhood, usually associated with fever.
No evidence of intracranial infection.
->commonest cause of acute systematic seizure in childhood
If a parent describes their child as having a seizure and they appeared stiff, what kind of seizure may it be?
Usually a tonic seizure
->increased tone, so tonic
If a parent describes their child as having a seizure and they appeared to be jerking or shaking, what kind of seizure may it be?
Clonic
Myoclonic
Spasms
If a parent describes their child as having a seizure and they fell, what kind of seizure could it be?
Atonic
Tonic
Myoclonic
What is the chemical trigger or an epileptic fit?
Decreased inhibition- GABA
Excessive excitation- glutamate and aspartate
Excessive influx of sodium and calcium ions
What are the main two types of epileptic seizures?
Partial seizure
Generalised seizure
Which investigation is good at identifying the type of seizure someone may be experiencing?
EEG
How is a diagnosis of epilepsy made?
Really thorough history about seizure
Even better if video
ECG if convulsive seizures
EEG
MRI brain sometimes to determine aetiology
What does taking an ECG in convulsive seizures rule out?
Long QT syndrome
First line treatment of epilepsy in children?
Anti-epilecptics
->this supresses seizures, not treat underlying cause. Should onl;y be considered if diagnosis is clear, even if you have to wait to start treatment
Anti-epileptics are chosen depending on the age, gender and seizure type of the childen.
All anti-epileptics cause side effects. Give some examples.
Drowsiness
Effect on learning, cognition and behaviour
First line anti-epileptic for focal epilepsies?
Carbamazepine
First line anti-epileptic for generalised epilepsies?
Sodium valproate- not for girls.
Levetiracetam
What are the characteristics of an absence seizure?
Very brief and abrupt
Eyes roll upwards
What are the characteristics of a myoclonic seizure?
Very brief jerk, sometime patients don’t even notice
Common to drop things and cause injury to themself
What are the characteristics of an atonic seizure?
Sudden and abrupt loss of tone, hence A-TONIC.
e.g. a child sitting at a table falls forward and hits head off table
->would recommend the videos showing the different types of seizures
…..girl ik you ain’t gonna watch them dw, just useful
What are the characteristics of a generalised tonic-clonic seizure?
Tonic phase precedes clonic phase
Eyes are usually open
->Lucy, this one looks terrifying. I feel like if we see one, we will end up crying
Which fontanelle closes first?
Posterior fontanelle
When does the posterior fontanelle close?
2-3months
When does the anterior fontanelle close?
1-3yrs of age, usually 18 months
Plagiocephaly?
Flat headed
Branchycephaly?
Short head or flat at back
Scaphocephaly?
Boat shaped skull
What happens in craniosynostosis?
Sutures of the skull have closed too early
What are some of the signs that a child may have a neuromuscular disorder?
Baby ‘floppy’ from birth
Paucity of limb movements
Alert, but less motor activity
Delayed motor milestones
Able to walk but frequent falls
Which gender is affected by Duchenne-Muscular Dystrophy?
Males
Describe the genetics behind Duchenne-Muscular Dystrophy.
X-linked
Xp21, dystrophin gene
Which sign is positive in Duchenne-Muscular Dystrophy?
Grower’s sign
->how quickly can the infant get up after lying flat on the ground
Signs of Duchenne-Muscular Dystrophy?
Symmetrical proximal weakness
Waddling gait
Calf hypertrophy
Grower’s sign positive
->calf muscles are actually weak despite hypertrophy
Which other systems does Duchenne-Muscular Dystrophy cause issues with?
Cardiovascular- cardiomyopathy
Respiratory- in teens
If a baby has muscle weakness all over the face, what may be the cause?
Myopathic facies
Summarise the differences between neuropathy and myopathy.
Neuropathy:
-distal weakness
-may have motor and sensory symptoms
-reflexes lost early
-fasciculations may be present
-myocardial dysfunction is not commonly a feature
Myopathy:
-usually proximal weakness
-usually pure motor symptoms
-reflexes preserved until late
-fasciculations not typical
-may have accompanying cardiac dysfunction
