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Paediatrics > Neurology > Flashcards

Neurology Flashcards

1
Q

Definition of seizure

A

Sudden disturbance of neurological function caused by abnormal/ excessive neuronal discharge. Can be epileptic or non-epileptic

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2
Q

Causes seizures

A

epileptic

non-epileptic

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3
Q

Causes epileptic seizures

A 
Idiopathic (70-80%)
Secondary (cerebral dysgenesis/ malformation, vascular occlusion, damage)
Cerebral tumour
NDD
Neurocutaneous syndromes
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4
Q

Causes non-epileptic seizures

A 
Febrile seizures
Metabolic: hypoglycaemia, hypomagnesia, hypocalcemia, hypo/hyperNa+
Head trauma
Meningitis/ encephalitis
Poisins/ toxins
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5
Q

Definition febrile seizure

A

Seizure accompanied by fever in the absence of intracranial infection due to bacterial meningitis or viral encephalitis

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6
Q

Epidemiology febrile seizure

A

Occur 3% children between 6 months and 5 years
30-40% will have further febrile seizures
Genetic predisposition

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7
Q

Characteristics febrile seizures

A

Usually early in viral infection when temperature is rising rapidly
Usually brief and generalised tonic-clonic

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8
Q

Factors increasing likelihood further febrile seizures

A

Younger the child
Shorter duration of illness prior to seizure
Lower temp at time of seizure
Positive family history

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9
Q

Complications febrile seizures

A

Simple: Do NOT cause brain damage/ affect child’s subsequent intellectual performance
1-2% risk developing epilepsy (similar as for all children)
Complex: increased risk (4-12%) subsequent epilepsy

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10
Q

Complex febrile seizures definition

A

Focal
Prolonged (>5 mins)
Repeated in same illness

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11
Q

Ix febrile seizures

A 
Focus on cause (usually viral illness but must exclude bacterial meningitis)
Infection screen (esp if
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12
Q

Mx febrile seizures (not immediate)

A

Antipyretics don’t prevent febrile seizures
Teach family first aid mx of seizures
If hx prolonged seizures, supply rescue therapy (rectal diazepam/ oral midazolam)
Oral prophylactic anti-epileptics not given (don’t reduce recurrence rate seizures/ risk epilepsy)
EEG NOT indicated

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13
Q

Breath-holding attacks

A

Occur in some toddlers when upset
Child cries, holds breath and turns blue
Some briefly lose consciousness but rapidly recover
Resolve spontaenously (drugs unhelpful) but behaviour modification therapy can be helpful

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14
Q

Definition epilepsy

A

Chronic neurological disorder characterised by recurrent unprovoked seizures consisting of transient signs and/ or symptoms associated with abnormal/ excessive or synchronous activity in the brain

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15
Q

Classification epileptic seizures

A 
General: discharge from both hemispheres. Can be:
absence
myoclonic
tonic
tonic-clonic
atonic
Focal: seizures from one or part of one hemisphere
Frontal
Temporal
Occipital 
Parietal
In many children, esp
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16
Q

Features frontal lobe seizures

A

Clonic movements, which may travel proximally (Jacksonian march)
Asymmetrical tonic seizures
Atonic seizures

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17
Q

Features temporal lobe seizures

A

Most common of all epilepsies
Strange aura with smell/ taste abnormalities and distortion of sound/ shape
Automatisms: lip-smacking, plucking at clothing, walking in non-purposeful manner
Deja vu, jamais vu

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18
Q

Features occipital lobe seizures

A

Distortion of vision

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19
Q

Features parietal lobe seizures

A

Contralat dysaesthaesias

Distorted body image

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20
Q

West syndrome age of onset

A

4-6 months

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21
Q

West syndrome seizure pattern

A

Violent flexor spasms of head, trunk and arms followed by extension of arms (‘salaam spasms’)
Flexor spasms last 1-2s, often multiple bursts 20-30 spasms, often on waking
Social interaction often deteriorates

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22
Q

Causes west syndrome

A

2/3 underlying neurological cause

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23
Q

West syndrome EEG

A

Hypsarrythmia: chaotic pattern of high-voltage slow waves and multi-focal sharp wave discharges

24
Q

Tx West syndrome

A

vigabatrin (anti-epileptic, increases GABA) or corticosteroids
Good response in 30-40% but unwanted effects common

25
Q

Prognosis West syndrome

A

Most subsequently lose skills/ develop learning disability or epilepsy

26
Q

Lennox-Gastaut syndrome age of onset

A

1-3 years

Often 2y to other neuro disorders, e.g. enceph, meningitis, brain malformations

27
Q

Lennox-Gastaut syndrome seizure pattern

A

Multiple types

Mainly drop attacks (astatic seizures)/ tonic seizures/ atypical absences

28
Q

Other sx Lennox-Gastaut syndrome

A

Neurodevelopmental arrest/ regression

Behaviour disorder

29
Q

Lennox-Gastaut syndrome EEG

A

Characteristic EEG

Interictal: generalised 1.5-2.5Hz slow spike-and-wave discharges

30
Q

Lennox-Gastaut syndrome prognosis

A

Poor, seizures often resistant to treatment

Minority able to work normally

31
Q

Lennox-Gastaut syndrome mx

A

Anti-epileptics mainstay of tx but optimum regimen uncertain

Corpus callosectomy can help w drop attacks

32
Q

Childhood absence epilepsy age of onset

A

4-12 years

33
Q

Childhood absence epilepsy seizure pattern

A

Stare momentarily and stop moving
Lasts few seconds to absolute max 30s
Child has no recall
Episodes can be induced by hyperventilation

34
Q

Childhood absence epilepsy development

A

Normal development but seizures can interfere w schooling

35
Q

Childhood absence epilepsy epidemiology

A
36
Q

Childhood absence epilepsy EEG

A

Generalised 3/second spike and wave discharge

Bilaterally synchronous during and sometimes between episodes

37
Q

Childhood absence epilepsy prognosis

A

Good: 95% remission in adolescence

5-10% may develop tonic-clonic seizures in adult life

38
Q

Benign epilepsy with centrotemporal spikes (BECTS) age of onset

A

4-10 years

39
Q

BECTS seizure pattern

A

Tonic-clonic seizures in sleep

Simple focal seizures w awareness of abnormal feelings in tongue and distortion of face

40
Q

BECTS epidemiology

A

15% of all childhood epilepsies

41
Q

BECTS EEG

A

Focal sharp waves from Rolandic or centrotemporal area

42
Q

BECTS other name

A

Benign Rolandic Epilepsy

43
Q

BECTS mx

A

Benign, doesn’t always require tx

Almost all remit in adolscence

44
Q

Early-onset benign childhood occipital epilepsy (Panayiotopoulos type) age of onset

A

1-14 yrs

45
Q

Early-onset benign childhood occipital epilepsy seizure pattern

A

Younger kids: periods unresponsiveness, eye deviation, vomiting, autonomic features
Older kids: headache + visual disturbance, distortions of images, hallucinations

46
Q

Early-onset benign childhood occipital epilepsy EEG

A

Occipital discharges

47
Q

Early-onset benign childhood occipital epilepsy prognosis

A

Remit in childhood

48
Q

Juvenile myoclonic epilepsy age of onset

A

Adolescence to adulthood

49
Q

Juvenile myoclonic epilepsy seizure pattern

A

Myoclonic seizures, can also get tonic-clonic and absences

Typical hx = throwing drinks/ cereal in am as myoclonus occurs at this time

50
Q

Juvenile myoclonic epilepsy EEG

A

Characteristic

51
Q

Juvenile myoclonic epilepsy mx and prognosis

A

Response to tx usually good but tx is lifelong

Remission unlikely

52
Q

Epilepsies with characteristic EEG

A 
Juvenile myclonic epilepsy
BECTS
Childhood absence epilepsy
Lennox-Gaustaut syndrome
West syndrome
53
Q

Imaging afebrile seizures

A

MRI/ CT not routinely needed for childhood generalised epilepsies
Ix if neuro signs between seizures or if seizures focal

54
Q

Which MRI sequences better detect mesial temporal sclerosis in temporal lobe epilepsy?

A

MRI FLAIR

55
Q

Principles mx epilepsy

A

Tx not routinely instituted after single unprovoked seizure
Monotherapy at minimum dosage = required goal
Children w prolonged seizures given rescue therapy to keep with them, e.g. buccal midazolam, rectal diazepam
AEDs can be discontinued after 2yrs free of seizures

56
Q

AED mx epilepsy

A 
Generalised: 
Tonic clonic = Valporate, carbamazepine
Absence= Valproate, ethoxisumide
Myoclonic = Valproate (carbamazepine can worsen absence/ myoclonic seizures) 
Focal:
Carbamazepine, valproate
57
Q

Classification headaches

A

1y: (migraine, tension-type headache, cluster, other primaries)
2y: symptomatic of other underlying pathology, e.g. raised ICP, SOL
Trigeminal and other cranial neuralgias, other headaches includiing root pain from herpes zoster

Paediatrics (7 decks)

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