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Paediatrics > Neurology > Flashcards

Neurology Flashcards

1
Q

What are the causes of meningitis?

A

Child: Strep Pneumoniae, N. meningitidis
>6yo: N. Meningitidis, Strep pneumoniae
Hib
Neonate: E.Coli, Listeria, Strep B/Pneumoniae, TB, Entero

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2
Q

What is the pathophysiology of meningitis?

A

Colonises in the nasopharyngeal epithelium
Invades the blood stream & spreads to the meninges
Inflammation leads to protein leak and cerebral oedema
Change in blood flow and metabolism - cerebral vasculitis

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3
Q

What are the signs & symptoms of meningitis?

A 
INFANTS DONT GET MENINGISM- low threshold for LP
Headache
Decreased consciousness
Vomiting 
Visual disturbance (papilloedema)
Bradycardia 
Hypertension
(above) 12-24hrs into the illness for older children 
Fever 
Neck stiffness
Photophobia
Irritable
Seizure 30%
Bulging Fontanelle
Focal neuro deficit
Kernig's sign: Hip flexed at 90 cannot fully extend knee
Brudzinski's sign: Passive flexion of neck= flexion of both legs & thighs
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4
Q

How is meningitis investigated?

A

LP
Bloods: FBC, Clotting, U&E, LFT, Blood Culture
Whole blood PCR: N.Meningitidis
Ziehl-Neelsen Stain: TB

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5
Q

When is an LP contraindicated?

A

Raised ICP: Focal neuro signs, papilloedema, bulging fontanelle, signs of cerebral herniation
Skin infection over site
Coagulopathy: DIC or thrombocytopenia
CV instability

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6
Q

How do the results of an LP differ depending on the cause of meningitis?

A

Bacterial: High opening pressure, Cloudy & turbid, raised neutrophils & WCC, raised protein, low glucose
Viral: Normal/high opening pressure, Normal appearance, raised lymphocytes, normal protein & glucose
Partial Tx bacterial: WCC slightly raised, high neutrophils & protein, normal glucose

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7
Q

How is meningitis managed?

A

GP Abx: BenzylPenicillin STAT (<1yr 300mg, 1-9 600mg, >10 1200mg) on transfer to hospital
Hospital admission:
<3m: IV Amoxicillin & Cefotaxime 14d
>3m: IV Cefotaxime
Steroids (>1m): IV Dexamethasone 150micro/kg for 4days
Public health notification
IV Aciclovir if seizure, focal neuro or HSV exposure
Prophylaxis for contacts: Ciprofloxacin (Rifampicin for haemophilus)

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8
Q

What are the complications of meningitis?

A 
Cerebral Palsy
Deafness
Visual problems
Epilepsy
Cognitive impairment
Motor deficits
Hydrocephalus
Cerebral abscess/ cerebral infarcts
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9
Q

What are the causes of cerebral palsy?

A 
Static injury to the developing brain
80% Antenatal
10% Postnatal
10% Hypoxic birth
Meningitis
Teratogenic
Vascular
Prematurity
Genetics
Metabolic issues
Congenital infection
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10
Q

What are the types of cerebral palsy?

A

Spasticity
Choreoathatosis
Ataxia

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11
Q

Describe Spastic cerebral palsy

A 
Most common
Hemi/di/quadriplegic
Spasticity: Disruption to spinal reflex arc by upper motor neuron 
Affects all skeletal muscles
Inc tone &amp; reflexes
Clasp knife phenomenon
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12
Q

What is the definition of cerebral palsy?

A

Chronic disorder of movement +/- posture

Presents early <2yr and continues throughout life

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13
Q

Describe Choreoathetosis

A

4 limb disorder
Greatly inc tone when awake
No stretch related response
Fixed RoM

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14
Q

Describe ataxic cerebral palsy

A

Extremely rare
Congenital ataxia- striking loss of balance in early years
Mild diplegia

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15
Q

How is cerebral palsy investigated?

A

MRI (esp pyramidal tracts)

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16
Q

How is cerebral palsy managed?

A 
OT/Speech therapist
Adaptive equipment
Baclofen: Muscle spasm
Botox: Contractures
Surgery: Tendon lengthening
Mobility aids
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17
Q

What are the different levels in the GMFCS?

A

Gross Motor Function Classification System
6-12years
Level 1: Able to walk, climb stairs independently, perform gross motor skills, speed & balance & coord limited
Level 2: Walk in most settings, difficulty with long distances, physical assistance/mobility device used, minimal gross motor skills
Level 3: Walk w/ hand-held device, climb stairs w/rail, wheelchair for long distances
Level 4: Require physical assistance/ powered mobility in most settings, walk short distances at home w/assistance
Level 5: Manual wheelchair in all settings, limited ability to maintain antigravity head & trunk postures & control leg & arm movements

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18
Q

What is a febrile seizure?

A 
Must fulfil criteria:
Temp >38
Developmentally a normal child
3m-5yr OR <6yr
No evidence on intracranial infection/inflammation
No prev afebrile seizure
No acute metabolic disturbance
19
Q

What are the signs & symptoms of a febrile seizure?

A 
Tonic-Clonic 
<15mins
Incontinence
Rousable afterwards
Post-seizure fatigue
20
Q

What are the causes of a febrile seizure?

A

Infection: Otitis media, Rhinitis, Tonsilitis, Pneumonia, UTI, Meningitis, Septicaemia

21
Q

What are the red flag signs for a febrile seizure?

A 
>15mins
Repeated
Focal signs
Incomplete recovery within 1hour
<12m or >5yrs
22
Q

How is a febrile seizure investigated?

A 
Temp
Bloods
Urinalysis
EEG
LP
CXR
CT if no cause found
23
Q

How is a febrile seizure managed?

A

Antipyretic: Ibuprofen/Paracetamol
Recovery position afterwards
>5mins: Rectal Diazepam: <1m= 2.35-3.5mg <11yr= 5-10mg
Observe on CAT for 6hrs
Parents worried about recurrence: Don’t routinely offer antipyretics

24
Q

What are the causes of hypoxic ischaemic encephalopathy?

A 
PERINATAL CEREBRAL HYPOXIA
Reduced umbilical flow: Prolapse
Reduced placental gas exchange: Abruption
Maternal hypoperfusion
Maternal hypoxia
Shoulder dystocia
Inadequate postnatal circulation
25
Q

What are the grades of presentation of hypoxic ischaemic encephalopathy?

A

Grade 1: hyperalert, normal tone, brisk reflexes, weak suck, strong moro, tachy
Grade 2:lethargic, hypertonic, overactive reflexes, weak suck& moro, brady, seizures
Grade 3: stuporous baby, flaccid, intermittent decerebration, absent reflexes, absent suck, absent moro, variable hr, difficult seizures.

26
Q

How is hypoxic ischaemic encephalopathy treated?

A 
Resus at birth
Assess: Tone, breathing, HR
Gasping/ not breathing: 5 inflation breaths
ABOVE WITHIN 60s
Re-assess
HR slow <60: Ventilate for 30s
Re-assess
HR still <60: Chest compressions 3:1
Re-assess every 30s
Consider: IV &amp; arterial lines &amp; IV drugs
BP: Maintain at >30
Fluids: 40ml/kg/day 10% Dextrose
27
Q

How is hypoxic ischaemic encephalopathy investigated?

A 
Defects depend on area affected 
IMMEDIATE 
Resus
Bloods: U&amp;E, Ca, Glucose, Hb, Coag
ABG
Daily cranial USS
Doppler MCA/ACA after 24hours
MRI/CT 2nd week
Sever: EEG >6hours
28
Q

What are tics thought to be related to?

A

Some genetic component

Related to dopamine

29
Q

What signs are seen in someone with a tic?

A

Sudden, purposeless, repetitive, non-rhythmic movements or vocalisations
Eye blinking
Twitching
Grunting/ throat clearing
Can be suppressed to some extent
Worse: Anxiety, stress, fatigue, excitement

30
Q

What are tics associated with?

A 
ADHD
OCD
Learning difficulties
Behavioural problems
Tourettes
31
Q

What are the different types of tics?

A

Chronic: No tick free period of longer than 3m in 1year
Transient: Nearly every day no longer than 18m
Tourettes: Mixed phonic, motor & chronic

32
Q

Who is affected by tics?

A

Boys

8-11years

33
Q

How are tics managed?

A

Reassurance
Education to avoid triggers
Ignore tics

34
Q

How common are brain tumours in children?

A

Most common solid tumour

25% of all childhood malignancies

35
Q

How are CNS tumours classified?

A

Infratentorial: >50%
Supratentorial
Primary Spinal
CNS mets

36
Q

What are the signs & symptoms of a brain tumour?

A 
Raised ICP
Headache/Migraine
Vomiting
Seizures
Blurred vision
Abnormal eye movements
Papilloedema
Fatigue
Balance problems
Cerebellar ataxia
Unilateral weakness
37
Q

How are brain tumours investigated?

A 
Opthalmoscope:Papilloedema
MRI/CT
Brain angiogram
LP
Bloods/biopsy
38
Q

How are brain tumours managed?

A

Diagnostic imaging: CT, MRI, Spinal imaging for staging
Raised ICP: Referral & transfer, Dexamethasone, Surgery- CSF drainage
Anticonvulsants
RT/Chemo

39
Q

What are the RFs for a brain tumour?

A 
FHx
Leukaemia
Cranial irradiation
Neurofibromatosis
Li-Fraumeni Syndrome
40
Q

What are the types of brain tumours?

A

Ependymoma: Periventricular, Obstructive hydrocephalus, Chemo
CNS Germ Cell: Rare, teens, raised AFP & hCG, surgery
Craniopharyingioma: Slow-growing, Rathke’s pouch, Complete resection
Retinoblastoma: Sporadic/familial, bilateral/unilateral disease, absent/abnormal light reflex, squint, surgery, Chemo
Gliomas: Low grade-1, high grade-3,4, brainstem
Medulloblastoma: Cerebellum

41
Q

What are the complications of brain tumours?

A

Delayed growth
Endocrine: Hypothalamic-Pituitary damage
Educational/behavioural issues

42
Q

What are the red flags signs in a headache?

A 
Neck stiffness
Photophobia
Papilloedema &amp; vomiting
Morning headaches
Posture related headache
Trauma
Neurological impairment 
SOL: visual defects, CN abnormalities, abnormal gait, torticollis, growth failure
43
Q

Name the causes of primary & secondary headaches

A

1: Migraine, tension, cluster, paroxysmal hemicranias, trigeminal, post-hepatic
2: Head & neck trauma, raised ICP, space occupying lesion, abscess, meningitis, encephalitis, sinusitis, stroke, GCA

44
Q

What are the signs & symptoms of a chronic headache?

A

Regular
Often Frontal
NO: Vomiting, paraesthesia, visual disturbance, abnormal exam

Paediatrics (26 decks)

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