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Child Health > Neurology > Flashcards

Neurology Flashcards

1
Q

List the types of epileptic seizure.

A

Generalised:

  • absence
  • myoclonic
  • tonic
  • tonic-clonic
  • atonic

Partial:
- focal, which can be frontal, temporal, occipital or parietal

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2
Q

What are absence seizures?

A

Transient loss of consciousness, they go blank for a few seconds
Sometimes flickering eyelids, but no other motor changes

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3
Q

In clinic, how can you bring about an absence seizure?

A

Absence seizures are often precipitated by hyperventilation. Get them to blow on a windmill

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4
Q

What’s a myoclonic seizure?

A

Brief, repetitive, jerking movements of limbs, neck or trunk.

Non-pathologic examples: hiccups, sleep myoclonus

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5
Q

What’s a tonic seizure?

A

A generalised increase in tone

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6
Q

What’s a tonic-clonic seizure?

A

Tonic phase: increase in tone held for a few seconds, they collapse to floor and don’t breathe.

Then clonic phase where there’s rhythmic muscle contractions, jerking of limbs

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7
Q

What’s an atonic seizure?

A

Transient loss of muscle tone causing a sudden fall to floor or drop of head

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8
Q

What are the characteristics of:

  • frontal
  • temporal
  • parietal
  • occipital lobe seizures?
A

Frontal: motor phenomena
Temporal: auditory, smell or taste
Parietal: contralateral altered sensation
Occipital: positive or negative visual aura

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9
Q

What are the causes of seizures in children?

A

Can be epileptic or non-epileptic

Epileptic:

  • Idiopathic epilepsy
  • Epilepsy syndrome
  • Cerebral damage
  • Cerebral tumour
  • Neurodegenerative disorders

Non-epileptic:

  • Febrile seizure
  • Syncope
  • Pseudoseizures
  • Head trauma
  • Meningitis
  • Metabolic: hypoglycaemia etc.
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10
Q

Investigation of seizures?

A

Get all the info about the attack, eye-witness account, video

Bloods to rule out metabolic or infectious cause

EEG

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11
Q

Most epilepsies in children are caused by epilepsy syndromes. True or false?

A

False, mostly idiopathic

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12
Q

List as many epilepsy syndromes as you can.

A

West syndrome

Lennox-Gastaut syndrome

Childhood absence epilepsy

Juvenile myoclonic epilepsy

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13
Q

What is West syndrome? At what age does it present? What’s the prognosis?

A

4-6 months old

Violent flexor spasms of the head, trunk and limbs followed by extension of the arms. Multiple bursts of spasms.

Developmental regression, they lose skills

Prognosis is not great, they often have learning disabilities, developmental delay and will develop epilepsy

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14
Q

You see a baby with an EEG showing hypsarrhythmia. What is hypsarrhythmia? What is the diagnosis?

A

Chaotic EEG pattern

West Syndrome

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15
Q

What is Lennox-Gastaut syndrome? At what age does it present? What’s the prognosis?

A

1-3 yrs

Multiple seizure types and developmental arrest and regression.

Prognosis is poor, they often have other neuro problems

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16
Q

What’s the characteristic EEG seen in patients with absence seizures?

A

3 per second spike and wave discharge, seen during and sometimes between episodes

17
Q

What is juvenile myoclonic epilepsy? What’s the age of onset? What’s the prognosis?

A

Adolescence

Mainly myoclonic seizures that occur after waking, sometimes tonic-clonic or absence seizures too.

Lifelong disease, no learning impairment

18
Q

What’s the first line treatment for all generalised seizures?

A

Sodium valproate

19
Q

What’s the first line treatment of focal seizures?

A

Carbemazepine

20
Q

What are some second line treatments used to treat seizures?

A

Lamotrigine
Topiramate
Carbamazepine
Gabapentin

21
Q

What are some side effects of sodium valproate?

A

Weight gain
Hair loss
Teratogenic

22
Q

What is the significance of abnormal persistence of primitive reflexes?

A

Indicates atypical neurology
Motor development is affected
Could be cerebral palsy

23
Q

List the primitive reflexes?

A 
Moro reflex
Grasp reflex
Rooting reflex
Stepping reflex
Asymmetrical tonic neck reflex
Parachute reflex
24
Q

What is the moro reflex?

When does it disappear?

A

Sudden loss of support

  1. spreads out arms
  2. brings arms back in
  3. crying

Goes after 4 months

25
Q

What is the rooting reflex?

A

Head turns to stimulus when touched near the mouth

26
Q

What is the asymmetrical tonic reflex?

A

When head is turned the infant outstretches the arm on that side

27
Q

Which is the only primitive reflex to persist throughout life?

A

If you place the baby on the forearm and lower them down they’ll spread arms and legs out

28
Q

Define cerebral palsy.

A

Disorder of movement and posture

Non-progressive

Injury to brain that occurs before 2 yrs

29
Q

What do babies with CP struggle with?

A

Feeding

They have problems with gagging and vomiting

30
Q

What are some causes of CP?

A

Antenatal:

  • congenital brain abnormality
  • trauma
  • infection
  • vascular occlusion
  • intraventricular haemorrhage

Peri-natal:
- hypoxic-ischaemic brain injury

Post-natal:

  • Infection
  • trauma
  • hypoglycaemia
  • hydrocephalus
31
Q

What are the types of CP?

A

Spastic: increased tone, brisk reflexes

  • hemiplegia
  • quadriplegia
  • diplegia

Dyskinetic: involuntary movements

  • chorea: irregular, sudden
  • athetosis: writhing
  • dystonia: twisting

Ataxic: hypotonic

32
Q

What is dystonia?

A

Simultaneous contracting of agonist and antagonist muscles

Causing twisting movements

33
Q

Investigations for CP?

A

Clinical examination and history to make diagnosis

Then find the cause: metabolic screen, CSF analysis

34
Q

What’s a treatment for spasticity in CP?

A

Botox injection, its a muscle relaxant that reduces spasticity

35
Q

What movements does the inferior oblique muscle do to the eye?

A

Moves it down and out (always in doubt)

36
Q

What movements does the superior oblique muscle do to the eye?

A

Moves it up and in

37
Q

What’s a cover test?

A

When there is a squint, cover the normal eye with card.

The abnormal eye will move to the centre (will not be squinting anymore)

This shows its not a paralytic squint

38
Q

What nerve supplies the lateral rectus?

A

6

LR6

39
Q

What nerve supplies the superior oblique?

A

4

SO4

Child Health (17 decks)

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