Neurology #2

Question 1

What are the signs & symptoms of raised ICP?

Answer 1

Abnormal exam: heel-toe walking, finger-nose coordination, eye movements
Papilloedema
Vomiting
Short history
Morning headache
Visual disturbance

Question 2

What are the causes of raised ICP?

Answer 2

Unknown- benign intracranial hypertension
Malignant posterior fossa tumour
Thrombosis of cerebral sinus

Question 3

How is raised ICP investigated?

Answer 3

CT head

Question 4

What are the cause of benign intracranial hypertension?

Answer 4

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

Question 5

What are the signs & symptoms of benign intracranial hypertension?

Answer 5

Infants: Irritable, vomiting
Child: Headache worse with coughing/bending over, blurred/double vision, tinnitus, vomiting
Papilloedema/Scotoma

Question 6

How is benign intracranial hypertension treated?

Answer 6

Weight loss
Removal causal meds
Diuretics: Furosemide
Steroids
Serial LPs or surgery
Monitor vision

Question 7

How are migraines treated in children?

Answer 7

Avoid trigger
Paracetamol & Domperidone
Prophylaxis: 3m trial of Pizotifen then Propanolol then Amitripytline

Question 8

What are the causes of congenital hydrocephalus?

Answer 8

Congenital: Congenital infection CMV, cerebral tumour, aqueduct stenosis
Acquired: SAH, Meningitis

Question 9

How is congenital hydrocephalus managed?

Answer 9

Surgical indwelling drainage device: Ventriculo-peritoneal shunt

Question 10

What are the causes of hydrocephalus in older children?

Answer 10

Obstructive: Aqueduct stenosis, posterior fossa & other tumours
Communicating: SAH, Meningitis, IV haemorrhage

Question 11

What are the features of hydrocephalus?

Answer 11

Headache
Vomiting
Impaired consciousness
Rapid inc in head size >98th centile
Bulging fontanelle
Papilloedema
Hyperreflexia
Spasticity

Question 12

What is the pathophysiology of hydrocephalus

Answer 12

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

Question 13

How is hydrocephalus investigated?

Answer 13

CT head

USS through ant fontanelle showing ventricular dilation

Question 14

How is hydrocephalus managed?

Answer 14

LP if communicating
Furosemide/Mannitol
Ventricular shunt

Question 15

What is plagiocephaly?

Answer 15

Back or side of head appears flattened

Question 16

What are the causes of plagiocephaly?

Answer 16

Pressure on skull
Sleeping in incubator (nursed from side to side)
Oligohydramnios
Muscle problems

Question 17

How is plagiocephaly investigated?

Answer 17

Palpate

Measure head circumference

Question 18

How is plagiocephaly treated?

Answer 18

Tummy time
Switch toys to other side of baby
Helmets
Physio

Question 19

What should be done in status epilepticus for a child?

Answer 19

Anaesthetist called after 20mins

Question 20

How is a seizure in a child treated?

Answer 20

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

Question 21

What are the signs of septicaemia?

Answer 21

Tachycardia
Tachypnoea
CRT >2s
Hypotension