Neurology 4

Question 1

What is craniosynostosis?

Answer 1

one or more of the fibrous sutures in an infant skull prematurely
lead to distortion of the head shape
most often affects the sagittal suture, when it results in long narrow skill- rarely, it affects lambdoid suture to result in skull asymmetry

Question 2

What are the inv and management for craniosynostosis?

Answer 2

fused suture may be felt or seen as a palpable ridge and confirmed on skull X-ray or cranial CT scan
treated surgically because of raised ICP or for cosmetic reasons, such operations are performed in specialist centres for craniofacial reconstructive surgery

Question 3

What are the types of craniosynostosis?

Answer 3

Sagittal suture- long narrow skull
Coronal suture- asymmetrical skull
Lamboid suture- flattening of skull
Generalised:
Multiple sutures resulting in microcephaly and developmental delay
Genetic syndromes- syndactyly in Alpert syndrome, exophthalmos in crouton syndrome

Question 4

What is plagiocephaly?

Answer 4

Positional moulding, all sutures are open

Flattening on one side of the skull

Question 5

What is the classification of headaches?

Answer 5

Primary- 4 main groups, comprising migraine, tension-type headache, cluster headache (primary malfunction of neurons)
Secondary- symptomatic of some underlying pathology- eg. raised ICP and space- occupying lesions
Trigeminal and other cranial neuralgias, and other headaches including root pain from herpes zoster

Question 6

What are tension type headaches?

Answer 6

symmetrical headache of gradual onset, often described as tightness, a band or pressure
usually no other symptoms

Question 7

What is a migraine with aura?

Answer 7

90%
children episodes last 1-72hrs and is most commonly bilateral
it is characteristically pulsatile
over temporal or frontal area and is often accompanied by unpleasant GI disturbance, such as N&V, abdo pain and photophobia/phonophobia aggravated by physical activity

Question 8

What is a migraine with aura?

Answer 8

10%
preceded by an aura (visual, sensory or motor), but may occur without a headache
features are the absence of problems between episodes and the frequent presence of premonitory symptoms
the most common aura comprises of visual disturbances – there are rarely unilateral, sensory or motor symptoms
o Negative phenomena- eg. hemianopia or scotoma
o Positive phenomena- eg. fortication spectra (zigzag lines)

Question 9

What are the features of secondary headaches?

Answer 9

worse when lying down and morning vomiting is characteristic and may also cause night-time waking
change in mood, personality or educational performance

Question 10

What are the features which suggest a space-occupying lesion?

Answer 10

o Visual field defects eg. craniophyrngioma
o Cranial nerve abnormalities- causing diplopia, new-onset squint or facial nerve palsy
o Abnormal gait
o Torticollis- head tilting
o Growth failure
o Papilloedema- a late feature
o Cranial bruits- may be head in AV malformations

Question 11

How does ICP present?

Answer 11

o Abnormal examination- heel-toe walking, finger-nose coordination, eye movements, and fundi (eg. papilloedema)
o Severe short history- vomiting, morning headache and visual disturbances
MRI gold standard, CT doesn’t identify thrombosis of a cerebral sinus

Question 12

What are the signs of raised ICP?

Answer 12

o Abnormal respiratory pattern
o Unequal or unreactive pupils
o Impaired or absent oculocephalic or oculovestibular responses
o Systemic hypertension & bradycardia
o Tense fontanelle
o Abnormal body posture or muscle flaccidity

Question 13

What is the management for raised ICP?

Answer 13

o The head positioned midline
o The head end of the bed tilted 20-30o
o Isotonic fluids at 60% maintenance
o Intubation & ventilation if GCS <9
o Mannitol or 3% saline as osmotic diuretics
o Maintaining normothermia and high normal blood pressure
o NB – an intracranial mass lesion may require neurosurgical intervention

Question 14

What is a subdural haematoma?

Answer 14

tearing of the veins as they cross the subdural space
• Retinal haemorrahges are usually present
• Characteristic lesion in non-accidental injury

Question 15

What are the signs and symptoms of acute SDH?

Answer 15

o	Encephalopathy
	Irritability
	Crying
	Inconsolability
	Unsettled behaviour
	Lethargy
	Meningism
	Decreased or increased tone
	Seizures
	Imparied consciousness
o	Vomiting & poor feeding
o	Breathing abnormalities & apnoea
o	Pallor & shock
o	Tense fontanelle- raised ICP
o	Early post-traumatic seizures- occur more frequently in inflicted than in non-inflicted head injury

Question 16

What are the signs and symptoms of subacute or chronic SDH?

Answer 16

o Expanding head circumreference
o Vomiting
o Failure to thrive
o Neurological deficits

Question 17

What are the differential diagnoses for SDH?

Answer 17

o Trauma or traumatic labour
o Neurosurgical complications or cranial malformation- aneurysm, arachnoid cyst
o Cerebral infections
o Coagulation and haematological disorders
o Metabolic- glutaric aciduria, galactosaemia
o Biochemical disorders- hypernatraemia