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 a febrile convulsion?
An event occurring in infancy/ childhood, usually between 3 months and 5 years of age, associated with fever but without evidence of intracranial infection or defined cause for the seizure. Seizures are tonic clonic, symmetrical generalised seizures lasting < 20 minutes
What is the difference between a partial and a generalised seizure?
Partial is focal, whereas generalised seizures are across the entire cortex
Why can diagnosis of epilepsy in children be difficult?
- Non-epileptic paroxysmal disorders are more common in children
- Difficulty in explaining (Children are not young adults)
- Difficulty in interpretation (witness)
- Difficulty in interpretation and synthesising information(physician
What would you want to exclude as causes of seizures in a child who you think has had a febrile convulsion?
- Meningo-encephalitis
- CNS lesion
- Epilepsy
- Trauma
- Hypoglycaemia
- Hypocalcaemia
- Hypomagnasaemia
How would you manage a febrile convulsuion if the seizure lasted <5 minutes?
- IV Lorazepam
- Buccal midazolam
- PR diazepam
How would you approach assessing seizures to try to determine a cause?
- Is the paroxysmal event epileptic in nature?
- Is it epilepsy?
- What seizure types are occurring?
- What is the epilepsy syndrome?
- What is the etiology?
- What are the social and educational effects on the child?
What is first line management for generalised epilepsy in a child?
Sodium valproate
How might you investigate a child presenting with recurrent seizures?
- Video recording of event
- ECG in convulsive seizures
- Interictal/ ictal EEG
- MRI Brain: to determine etiology eg. Brain malformations/ brain damage
- Genetics: idiopathic epilepsies are mostly familial; also single gene disorders eg. Tuberous sclerosis
- Metabolic tests: esp if associated with developmental delay/ regression
What is the first line treatment for partial/focal epilepsies?
Carbemazepine
What is first line treatment for absence seizures?
Ethosuximide
What would you use as first-line treatment for myoclinic seizures in children?
Sodium valproate
What are second line treatment options for generalised seizures?
- Lamotrigine
- Carbemazepine
What are second line treatments for absence seizures?
Sodium valproate
What are second line treatments for myoclonic seizures?
- Leviteracetam
- Topiromate
What are second line treatments for partial seizures?
- Sodium valproate
- Oxcarbazepine
What options are available for drug-resistant epilepsy?
- Ketogenic diet
- Vagus nerve stimulation
What are infantile spasms?
Clusters of head nodding and arm jerks, every 3-30 seconds
How would you treat infantile spasms?
Vigabatrin
