Neurology Flashcards
What are febrile convulsions? (1)
What age group of children are normally affected? (1)
Febrile convulsions are seizures provoked by fever in otherwise normal children.
They typically occur between the ages of 6 months and 5 years and are seen in 3% of children.
How long should a febrile convulsion last before the parent calls 999? (1)
What type of seizure activity is usually seen? (1)
5 minutes - put in recovery position and call 999
Tonic or Tonic-clonic
A child has had a febrile convulsion and the mother is concerned about further episodes. What is the chance of a further febrile convulsion? (1)
33% (1/3) More if positive FH
What is the most commonly form of epilepsy seen in children?
Name 2 common triggers?
Name 2 commonly used medications for this type of seizure.
What percentage of children will be free from this type of. Epilepsy by 16 years old?
Absence seizures
Stress, hyperventilation
Sodium valproate, ethosuxamide
90-95% seizure free by adulthood
What is benign rolandic seizures and what age group are ost commonly affected? (2)
Form of childhood epilepsy that occurs in 4-12 year olds.
Typically seizures are partial and occur at night
Name 3 causes of microcephaly? (3)
Normal variation, congenital infection, craniosyntosis, syndromic eg patau, foetal alcohol syndrome, perinatal brain injury eg HIE
Define cerebral palsy. (2)
What are the 3 types of causation and give an example of each. (3)
Non degenerative brain lesions with abnormal movement and posture. Ante natal (80%) TORCH infection Peri natal (10%) Birth asphyxia Post natal (10%) intraventricular haemorrhage, head trauma, meningitis
What are the 3 classifications of cerebral palsy? (3)
clue: types not classification of causes.
Spastic - pyramidal tracts affected - UMN signs
Ataxic - (extrapyramidal) cerebellum affected - poor balance, delayed motor milestones, hypotonia
Dyskinetic - (extrapyramidal) basal ganglia affected - chorea, athetosis, dystonia, hypotonia, delayed motor milestones
How should cerebral palsy be managed? (2)
Conservatively - MDT, parent/patient education, support groups
Medically - Baclofen, Botox, Hyoscine for secretions, treat complications
What is meningitis? (2)
Infection of the subarachnoid space and associated inflammation of the meninges.
Name 3 causes of meningitis. (3)
0-2 month - Group B streptococcus, gram negative bacilli e.g. e coli
1m+ neisseria meningitidis (meningococcus), streptococcus pneumoniae, HiB
Any age - mycobacterium tuberculosis
VIRAL - enteroviruses, CMV
Name 3 risk factors that can put a child a greater risk of developing meningitis. (3)
impaired immunity - young, splenic defect (SCD), defects of complement system
low SES - overcrowding, poverty.
What symptoms in a history would make you suspicious of meningitis in a neonate and in a child? (4)
Neonate - fever, irritability, lethargy, seizures, shrill cry, rash
Child - fever, headache, neck stiffness, decreasing GCS, nausea, vomiting, photophobia, anorexia, rash or seizures.
What is Kernig’s sign? (1)
Sign of meningeal irritation - supine, knee and hip are flexed and there is pain on extending leg
Name 3 signs of raised ICP. (3)
Papilloedema, decreased consciousness, focal neurology (6th nerve palsy), Cushing reflex (high BP, low HR), decerebrate posturing (extended arms, internally rotated)
Descrive the rash that is typically associated with meningococcal infection. (2)
Purpuric or petechial rash usually non-blanching.
What is a full septic screen? (5)
FBC, blood, urine and CSF cultures, CXR
How would CSF help to differentiate between a bacterial and viral cause of meningitis? (3)
Bacterial - neutrophils, high protein, low glucose
Viral - neutrophils early then lymphocytes, normal/mildly elevated protein, normal glucose, PCR can diagnose
What is the management of suspected meningitis? (3)
Full septic screen
Empirical antibiotics - ceftriaxone
Supportive care - fluids, analgesics, antipyretics
Notification - meningitis is notifiable disease
Give 3 complications of meningitis. (3)
During infection: seizures, cerebral oedema, circulatory shock, DIC
Post-infection: Hearing loss, visual impairment, cerebral palsy, hydrocephalus, cerebral abscess, learning disability, subdural effusions (resolve spontaneously)
Which form of meningitis has the best prognosis? (1)
Viral: 95% complete recovery with no neuro probe
In meningococcal infection with septicaemia the mortality is 20-50%
Name 4 potential causes of seizures in children. (4)
Febrile convulsions, epilepsy, hypoglycaemia, hypocalcaemia, hypomagnesia, hyponatraemia, hypernatraemia, uraemia, HIE, meningitis, space occupying lesion, poisoning, encephalitis
What is Todd’s paralysis? (1)
Focal weakness of part of the body following a seizure
Define status epilepticus. (1)
Seizure activity lasting over 30 minutes
Name 3 causes of infantile spasms. (3)
Idiopathic (normal development and normal CT)
Prenatal: TORCH infection, tuberous sclerosis
Perinatal: birth asphyxia
Postnatal: meningitis, encephalitis, head trauma
Descrive infantile spasms. (3)
Occur between 3 and 12months old.
Can be flexor or extensor spasms of neck, trunk, arms and legs or mixed.
May be preceded by a cry, and mainly occur when drowsy or awakening
Associated with developmental delay
Describe the floppy infant when lying supine or on pulled to sit. (1)
Marked hypotonia causes…
Lying in frog position
Head lag
Name 2 systemic, central and peripheral causes of a floppy infant. (6)
Systemic: hypothyroidism, infection, inborn error of metabolism, congenital lax ligaments
Central: Encephalopathy, Chromosomal abnormalities eg Downs (21), Prader-Willi (15), Ataxic cerebral palsy
Peripheral:
Spinal cord; compression/transection
Anterior horn cell; rare autosomal recessive disease
Neuromuscular junction; myasthenia gravis
Peripheral nerve; guillain-barre
Muscle; myotonic dystrophy
