Neurology Flashcards
How does a medulloblastoma present?
Arise in midline of posterior fossa and may spread through CNS via CSF –> spinal metastases
–> truncal ataxia, coordination difficulties, abnormal eye movements and morning vomiting
Younger child
50% 5 year survival
How does a brainstem glioma present?
Commoner in young children
Cranial nerve defects, pyramidal tract signs, ataxia and normal ICP (refusing to walk, unable to climb stairs)
Very poor prognosis
How does a craniopharyngioma present?
Developmental tumour arising from remnants of Rathke’s pouch
–> bitemporal hemianopia, pituitary failure (growth failure, weight gain and diabetes insipidus)
Good survival
What are clinical features of brain tumours?
Headache - worse in morning Vomiting - worse in morning Behaviour/personality changes Visual disturbances Papilloedema Separating of fontanelles Increased head circumference Head tilt Developmental delay
Spinal tumours –> back pain, peripheral weakness of arms/legs or bladder/bowel dysfunction
How does an astrocytoma present?
Vary from benign to highly malignant
Occur in cerebral hemispheres, thalamus an hypothalamus
–> seizures, headaches, hemiplegia, focal neurological signs
Teenager
Poor prognosis
What causes a motor deficit?
Central motor deficit - cerebral palsy
Congenital myopathy
Spinal cord lesions - spina bifida
Global developmental delay
How do gross motor skills develop?
Newborn - flexed limbs, head lag pulling up 8 weeks - raises head to 45 degrees 6 months - sits unsupported 9 months - crawling 10 months - cruising 12 months - walks unsteadily 15 months - walks steadily
How do fine motor skills and vision develop?
6 weeks - follows moving objects 4 months - reaches for toys 6 months - grasps toys 7 months - passes hand to hand 10 months - pincer grips 18 months - makes marks with pen 5 years - draws triangle
What is cerebral palsy?
An abnormality of movement and posture
May be associated with disturbances of cognition, communication, seizure disorder
Lesion is non-progressive but manifests over time
Must occur before 2 years
What causes cerebral palsy?
Antenatal (80%) - vascular occlusion, cortical migration disorders, structural maldevelopment of brain
Perinatal (10%) - hypoxia-ischaemic injury, peri-ventricular leucomalacia
Postnatal (10%) - meningitis/encephalitis, encephalopathy, head trauma, hypoglycaemia, hyperbilirubinaemia
How does cerebral palsy present?
- Abnormal limb/trunk posture or tone with delayed motor milestones
- Feeding difficulties, slow feeding, gagging, vomiting
- Abnormal gait
- Asymmetric hand function before 12 months
- Persistence of primitive reflexes
What is spastic cerebral palsy?
Damage to upper motor neurone pathway (pyramidal or corticospinal tract)
Increased limb tone (spasticity) and reflexes
Presents early
Hemiplegia - unilateral involvement of arm and leg
- present at 4-12 months
- fisting of hand, flexed arm
- tiptoe (toe-heel) walk
Quadriplegia - all four limbs affected (severe)
- involvement of trunk, poor head control
- associated with seizures, microcephaly and intellectual impairment
Diplegia - all limbs, but legs worse than arms
- associated with pre-term birth due to peri-ventricular brain damage
What is dyskinesic cerebral palsy?
Involuntary movements more evident with active movement and stress
Muscle tone is variable and primitive reflexes continue
- chorea - irregular, sudden and brief non-repetitive movements
- athetosis - slow, writhing movements occurring distally
- dystonia - simultaneous contraction of agonist and antagonist muscles of the trunk and proximal muscles –> twisting appearance
Intellect may be unimpaired
Commonly caused by HIE –> damage to basal ganglia
What is ataxic (hypotonic) cerebral palsy?
Mostly genetic
Early trunk and limb hypotonia, poor balance
Intention tremor
Ataxic gait
How is cerebral palsy treated?
Physical therapy
Devices and equipment - crutches, casts (strengthen muscles in another part of the body), wheelchairs
Antispasmodics - baclofen, botox, diazepam
Antiepileptics - lamotrigine
Anticholinergics (help with uncontrollable movements and drooling)
Surgery - increase range of movement, prevent hip dislocation, scoliosis, selective dorsal rhizotomy (cut nerves to tight muscles in legs)
What are generalised seizures and which types are there?
Discharges arise from both hemispheres Includes: - absence - myoclonic - tonic - tonic-clonic - atonic
Describe an absence seizure.
Transient loss of consciousness with abrupt onset and termination
Can be precipitated by hyperventilation
Describe a myoclonic seizure.
Brief but repetitive jerking movements of limbs, neck and trunk
Describe a tonic seizure.
Increase in tone therefore very stiff
Describe a tonic-clonic seizure.
Rhythmic contraction of muscle groups following tonic phase
Fall to ground and become cyanosed
Tongue biting and incontinence
Followed by unconsciousness or deep sleep
Describe an atonic seizure.
Often combined with myoclonic jerk followed by loss of muscle tone causing drop to floor
What is a focal seizure?
Discharges arise from one hemisphere
How does a frontal seizure present?
Motor/premotor cortex
Clonic movement
Or assymmetrical tonic seizure
How does a temporal seizure present?
Most common type of all
Strange warning feelings with smell and taste anomalies
Lip-smacking
Deja-vu
How does an occipital seizure present?
Visual distortion
