Neurology Flashcards
What are the main types of primary headaches in children?
- Tension-type
- Migraine with/without aura
- Cluster headaches
- Trigeminal neuralgia
What are secondary headaches attributed to in children?
- Raised ICP - due SOL/hydrocephalus/idiopathic intracranial hypertension etc.
- Infection - meningitis, encephalitis
- Acute sinusitis
- Substance misuse/withdrawal
If a child was presenting with a headache, what would you want to do as part of the examination?
- Growth parameters, OFC, BP
- Sinuses, teeth, visual acuity
- Fundoscopy
- Visual fields (craniopharyngioma)
- Cranial bruit
- Focal neurological signs
- Cognitive and emotional status
What features might point towards a migraine being the cause of a headache in a child?
- Associated abdominal pain, nausea, vomiting
- Focal symptoms/ signs before, during, after attack: Visual disturbance, paresthesia, weakness
- ‘Pallor’
- Aggravated by bright light/ noise
- Relation to fatigue/ stress
- Helped by sleep/ rest/ dark, quiet room
What is the difference between tension headache pain and migraine pain in terms of distribution of pain?
Migraine is hemicranial, whereas tension is diffuse/symmetrical
What is the difference between tension headache pain and migraine pain in terms of quality of pain?
Migaine is throbbing/pulsatile, whereas tension is like a tight band round the head, and is a constant ache
What features might point towards a medication overuse headache?
- Headache is back before allowed to use another dose
- Paracetamol/ NSAIDs
- Particular problem with compound analgesics eg. Cocodamol
What are red flag symptoms of a headache in a child?
- Worse on lying down
- Wakes up with headache
- Associated confusion
- Persistent/morning vomiting
- Recent change in personality
What are red flag clinical signs in headaches in children?
- Growth failure
- Visual field defect
- Squint
- Cranial nerve abnormality
- Torticollis
- Obnormal coordination
- Gait abnormalities
- Papilloedema
- Bradycardia
- Cranial bruits
When would you consider neuroimaging in a child with headaches?
- Features of cerebellar dysfunction
- Features of raised intracranial pressure
- New focal neurological deficit eg. new squint
- Seizures, esp focal
- Personality change
- Unexplained deterioration of school work
How would you manage migraines in children?
- Acute - NSAIDs, Triptans
- Preventative - Pizotifen, propranalol, amytriptilline, topiramate, valproate
How would you manage tension type headaches in children?
- Aim at reassurance: no sinister cause
- MDT management - Attention to underlying chronic physical, psychological or emotional problems
- Acute attacks: simple analgesia
- Prevention: Amitryptiline
- Discourage analgesics in chronic TTH
What is the definition of an epileptic seizure?
An abnormal excessive hyper synchronous discharge from a group of (cortical) neurons
What is the definition of epilepsy?
A tendency to recurrent, unprovoked (spontaneous) epileptic seizures
What are non-epileptic type seizures which can occur in children?
- Acute symptomatic seizures: due to acute insults eg. Hypoxia-ischaemia, hypoglycemia, infection, trauma
- Reflex anoxic seizure: common in toddlers
- Syncope
- Parasomnias eg. night terrors
- Behavioural stereotypies
- Psychogenic seizures (NEAD)
What is the difference between a partial and a generalised seizure?
Partial is focal, whereas generalised seizures are across the entire cortex
