Neurology Flashcards
What is the most common cause of headache in children?
Migraine without aura
What is the best acute management of a migraine in children?
Ibuprofen
Can you use triptans in young people with migraines?
Sumitriptan nasal spra can be used in children over 12.
Oral triptans can only be used in those over 18.
What are the first line treatments for preventing migraines in children>
Pizotifen (Seratonin antagonist)
Propanolol
What is the definition of a febrile convulsion?
- A seizure occuring after one month of age
- Associated with a febrile illness (not causes by an infection of the CNS)
- No previous neonatal seizures or previous unprovoked seizures
- Nor meeting criteria for other symptomatic seizures.
In most situations, what type of seizure is a febrile convulsion?
Usually a tonic clonic seizure
What is the difference between a simple and a complex febrile convulsion?
Simple - Age between 3 months and 6 years - Tonic Clonic - Less than 5 minutes - Isolated event with the febrile illness Complex - Focal onset - More than 10 minutes - Recurrent events suring the same febrile illness
What is the definition of febrile status epilepticus?
Lasts more that 30 minutes
If you have a simple febrile seizure what is the risk that you will go on to develop epilepsy?
2.4%
If you have a simple febrile seizure what is the risk that you will go on to develop epilepsy?
6 - 8%
What first aid measures should be performed if a child has a febrile seizure?
- Protect from injury
- Check airway and clear
- Place in recovery position
- If it lasts over 5 minutes rescue medication should be given
What medication should be given for a febrile seizure that has gone on for longer than 5 minutes?
Buccal midazalam
Rectal diazepam
Do antipyretics reduce the incidence of febrile seizures?
No
If a child has a febrile seizure what is their temperature usually above?
38 degrees
A child has a febrile convulsion. Which red flags would make you think that this was more likely to be meningitis?
- History of irritability, poor feeding or lethargy
- Complex febrile seizure
- Bulging fontaneel, neck stiffness, photophobia, focal neurological signs
- Prolonged postictal altered consciousness or neurological defecit
- Drowsinness
- Previous or current antibiotic treatment
- Incomplete immunisations
Below what level of consciousness (GCS and AVPU) would you want to intubate immediately?
GCS less than 9
Unresponsive
If a child presents with a depressed level of consciousness, low BP and high HR what fluids do you need?
20ml/kg fluid bolus isotonic saline
If a diabetic child presents with a depressed level of consciousness and blood sugar level of 1.2 what fluids do you give?
2ml/kg or 10% dextrose
What signs indicate raised ICP in a child?
Bradycardia with hypertension Abnormal pupils Abnormal breathing pattern Abnormal posture (decerebrate/decorticate) Bulging fontanelle in infants
What are contraindications to doing a lumbar puncture?
- Signs of raised ICP
- GCS below 8 or deteriorating
- Post ictal period following a seizure
- Focal neurological signs
- Signs of circulatory or septic shock
- CT/MRI suggests CSF pathway obstruction, brain swelling or focal mass lesions.