Neurology #2 Flashcards
What are the signs & symptoms of raised ICP?
Abnormal exam: heel-toe walking, finger-nose coordination, eye movements Papilloedema Vomiting Short history Morning headache Visual disturbance
What are the causes of raised ICP?
Unknown- benign intracranial hypertension
Malignant posterior fossa tumour
Thrombosis of cerebral sinus
How is raised ICP investigated?
CT head
What are the cause of benign intracranial hypertension?
Drugs: Steroid withdrawal, Vit A, thyroid replacement, OCP, Phenothiazine
Systemic disease: G-B Syndrome, SLE, iron deficiency
Endocrine: Adrenal failure, hyperthyroid, pregnancy, obesity, menarche, hypoparathyroid
Head injury
What are the signs & symptoms of benign intracranial hypertension?
Infants: Irritable, vomiting
Child: Headache worse with coughing/bending over, blurred/double vision, tinnitus, vomiting
Papilloedema/Scotoma
How is benign intracranial hypertension treated?
Weight loss Removal causal meds Diuretics: Furosemide Steroids Serial LPs or surgery Monitor vision
How are migraines treated in children?
Avoid trigger
Paracetamol & Domperidone
Prophylaxis: 3m trial of Pizotifen then Propanolol then Amitripytline
What are the causes of congenital hydrocephalus?
Congenital: Congenital infection CMV, cerebral tumour, aqueduct stenosis
Acquired: SAH, Meningitis
How is congenital hydrocephalus managed?
Surgical indwelling drainage device: Ventriculo-peritoneal shunt
What are the causes of hydrocephalus in older children?
Obstructive: Aqueduct stenosis, posterior fossa & other tumours
Communicating: SAH, Meningitis, IV haemorrhage
What are the features of hydrocephalus?
Headache Vomiting Impaired consciousness Rapid inc in head size >98th centile Bulging fontanelle Papilloedema Hyperreflexia Spasticity
What is the pathophysiology of hydrocephalus
Inc in CSF in cerebral ventricles Usually due to impaired absorption Can be due to excessive production Ventricular dilation Permeates from ependymal lining to periventricular white matter Causes damage & glial scarring
How is hydrocephalus investigated?
CT head
USS through ant fontanelle showing ventricular dilation
How is hydrocephalus managed?
LP if communicating
Furosemide/Mannitol
Ventricular shunt
What is plagiocephaly?
Back or side of head appears flattened
What are the causes of plagiocephaly?
Pressure on skull
Sleeping in incubator (nursed from side to side)
Oligohydramnios
Muscle problems
How is plagiocephaly investigated?
Palpate
Measure head circumference
How is plagiocephaly treated?
Tummy time
Switch toys to other side of baby
Helmets
Physio
What should be done in status epilepticus for a child?
Anaesthetist called after 20mins
How is a seizure in a child treated?
1) High flow O2 & assess glucose levels
5MINS AFTER START:
2)Vascular access
Y: IV Lorazepam 0.1mg/kg
N: Buccal Midazolam/ rectal Diazepam 0.5mg/kg
CONTINUES FOR 10MINS
Repeat step 2 & call senior
3) Call anaesthetics/ICU, IV Phenytoin 20mg/kg over 20mins
CONTINUES FOR 20MINS
4) RSI with Thiopentone
What are the signs of septicaemia?
Tachycardia
Tachypnoea
CRT >2s
Hypotension
