Neurology Flashcards
Risk factors for developing cerebral palsy (CP)
- Breech
- Maternal infection during pregnancy e.g. toxoplasmosis
- Meningitis
- Encephalitis
- Severe untreated jaundice
- Signs of resp/cardio distress during labour
- Low birth weight
- Premature
- Multiple babies
- Rh incompatibility
List and describe types of CP
Spastic - damage to upper motor neuron, incr tone + brisk relfexes. Tone is velocity dependant -> faster you move the muscle the more its tone. This leads to hallmark dynamic catch where the mm contracts intensly. Divided into limb involvement: hemiplegia (1 side affected), quadriplegia (all limbs affected), diplegia (all limbs legs>arms)
Dyskinetic - involuntary movements, divided into: chorea (irregular, sudden, brief non-repetitive), athetosis (slow, writhing in distal joints e.g. fanning of fingers), dystonia (simultaneous contraction of agonist and antagonst mm proximally usually twisting of trunk)
Ataxic (hypotonic) - usually genetic, early trunk and limb hypotonia, poor balance and delayed motor development. Incoordinate movements, intention tremor and ataxic gate later on.
Treatments of CP and when to use them
Therapy - All sorts available depends on problems examples: physio, speech and language, occupational, recreational.
Antispadmodic drugs - Whihc one depends on type of and extent of spasticity. Examples include botox injections (isolated spasticity), for more general diazepam, baclofen may be used in pump
Orthopaedic surgery - May be required to put bones in correct position to improve mobility. In severe cases nerves may be cut to prevent them stimulating affected mms.
Baclofen pumps - Antispadmodic drug given for generalised via pump in skin of abdo
Common types of childhood epilepsies/convulsions/fits and how they differ
Febrile convulsions
- 6 months to 6 years
- Preceeding infection/fever
- Voilent shaking of all 4 limbs
- Self resolving
- Complete recovery
Focal tonic-clonic with secondary generalisation
- 2-12 years peak 8-9 yrs
- Preceeded by stress inducing event e.g. emotional/illness/lack of sleep
- Starts in one area then spreads everywhere, eyes deviate to right and lip smacking
- EEG shows abnormal features in one area
Absence
- 4-8 years peaking 6-7 yrs
- No trigger
- Unresponsive, stares into distance, last a few seconds, worse when tired, immediate recovery
- EEG shows 3 sec spike/wave pattern
Infantile spasms/West syndrome - choas eeg?
- Presents 4months age
- No trigger
- Sudden cry, stiffening of upper body, flexion of head and neck, arms thrown out, occur in clusters, lasts 1-2 seconds
- Losing skills
- Unsettled for few minutes after otherwise fine
- EEG shows hypsarrhythmia (choas eeg)
Relfex anoxic seizure/reflex asystolic syncope
- Brief stoppage of the heart through excessive activity of the vagus nerve
- Preceeded by bump on head
- 0-6 years but can occur at any age
- Loss of consciossness pale and stiff
- Full recovery
Syncope/faint
- Hx that may suggest stress getting blood to brain, e.g. exercise, heat, long period of standing
- Usually teenager
- No convulsions, may tremor
- Other sx feeling hot nauseous, light headidness
- Short lived and fully recovers
Expiratory apnoea syncope/blue breath holding
- Usually cry and fail to breath in and go blue and faint
- Will then start breathing again
Describe what an EEG shows
Electroencephalogram
- Sensors attached to head that detect electrical activity
- Mainly used to investigate epilepsy
- Can help identify seizure type, triggering factors and best treatment
Describe what an MRI shows
Magnetic resonance imaging
- Uses magnetic resonance to generate detailed images
- Claustrophobic warning
Initial investigations into seizures and treatment options
Initial investigations
- EEG
- MRI
- Bloods: U+E, glucose, calcium
- ECG
- Urine dip
- LP
- Temp
Treatment
- Pharmalogical - AED e.g. sodium valproate (contraindicated in women of child bearing age)
- CBT and psychological therapy
- Ketogenic diet
*
Common AEDs and their side effects
Carbamazepine - Blurry vision, dizziness, rashes, unsteadiness, birth defects, induces metabolism therefore interacts w/ lots of drugs
Valproate - sedation, weight gain, tremor, CONTRAINDICATED IN PREGNANCY
Lamotrigine - bone marrow toxicity, stop if flu or rash ensues
Levetiracetam - GI sx
Ethosuximde - GI sx
Phenytoin - increased gum growth, nystagmus, birth defects
What is SUDEP and what safety information should you give
SUDEP - Sudden unexpected death in epilepsy
Safety advice
- Minimise the number of seizures you experience
- There are safety devices you can get
- There’s a good website on SUDEP contains lots of good information
Explain febrile convultions to parents, their prevalence and how to offer basic first aid
Explanation
- We all have a threshold of brain activity when we get above it we have a seizure
- A quick change in body temperature can put us above this threshold
- Childrens’ threshold is lower than adults because their brains aren’t fully developed
- Children are very good at rapidly increasing their body temperature
Prevalence
- 1 in 30 children will have a febrile convulsion
- If they have 1 they are 3x more likely to have another
- If one of their sibilings has had one they have a 30% chance of having 1
Basic safety info
- If convulsion lasts more than 5 mins call 999
- Stay calm put them in a soft place, don’t put anything in their mouth or restrain them
- When your child gets a fever give them paracetamol asap and regularly
Common causes of ataxia and their investigations
Ataxia - loss of control of bodily movement
Causes
- Infection
- Toxin
- Tumour
- Hydrocephalus
- CP
- Trauma
- Hereditary
Investigations
- Infection screen - bloods and LP
- Toxin screen
- MRI head
- Hereditary/genetic screen
Presenting features of brain tumour
- Raised ICP
- Headache
- Nausea vomiting
- Inc BP
- Confusion
- Double vision
- Focal neuro signs
- Weight loss
- Night sweats
What are the common causes of development regression
Battens Disease
Retts syndrome
Leukodystrophies
Wilson’s
SSPE (Subacute sclerosing panencephalitis)
Infantile spasm (west syndrome)
What’s the difference between obstructive, communicating and external hydrocephalus
Obstructive - obstruction stops CSF flowing through ventricles
Communicating - impairment of CSF reabsorption w/out obstruction
External - Widening subarachnoid space w/out ventricular enlargement
Common causes of macrocephaly
- Hydrocephalus
- Tall stature
- Familial macrocephaly
- Tumour
- Intracranial bleeding
- Hurlers syndrome
Common causes of microcephaly
- Familial (presenting from birth)
- Autosomal recessive condition when associated w/ developmental delay
- Congenital infection
- Brain injury e.g. perinatal hypoxia
Pathophysiology and presenting features of craniosynostosis
Craniosynostosis - sutures of skull start to fuse during infancy and finish in late childhood
Can be causes by some syndromes
- Apert syndrome
- Pfeiffer syndrome
- Crouzon syndrome
Presenting features
- Distorted head shape
- Raised ICP
- Syndrome features
How do you differentiate tension type and secondary headaches?
- Systemic S&S: fever, wght loss, this could point to meningitis, cancer
- Abnormal neurologic point to secondary cause rather than simple tension type headaches
- Onset: sudden = possible secondary (aneurysm, meningitis) >6months = reassuring of benign headache
- Age of onset if <5 yrs or >50 yrs w/ new onset headache, shoul be investigated.
- Insidious? if headache is getting progressively worse, check for secondary causes
Management of a seizure > 15 mins
- Buccal midazolam (benzo)
- O2
- IV paracetamol
- Bloods: culture, U+E, FBC, glucose
10 more minutes fitting
- 2nd buccal midazolam
- IV lorazepam (benzo)
10 more minutes fitting
- IV phenytoin
10 more minutes
- Induce medical coma
- Ventilate + intubate
What is Todd’s paresis and what is the prognosis
Definition: Focal weakness after seizure
Usually resolves in 48 hrs
How can an absence seizure be induced
Hypoventilation
1st line in focal seizures
Carbamazepine
1st line in absence seizures
Ethosuximide
1st line in absence with generalised tonic clonic seizures
Valproate if teenage girl lamotrogine
Features of Duschennes Muscular Dystrophy
- Gait instability
- Growers manouver
- Single palmar crease
- Calf pseudohypertrophy
- Inc creatinine kinase
