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Laura Paediatrics > Neurology > Flashcards

Neurology Flashcards

1
Q

What is a febrile seizure?

A

An epileptic seizure accompanied by a fever in the absence of intracranial infection
They usually occur early in a viral infection as the temperature rises rapidly

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2
Q

What is an epileptic seizure?

A

The nature of the underlying electrical activity in the brain
Excessive and hypersynchronous electrical activity

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3
Q

When do febrile seizures usually occur?

  • With regards to age group of the child
  • With regards to viral infection
A

In children between the ages of 6 months to 6 years
They usually occur early in a viral infection when the temperature is rising rapidly
Increased risk (10%) if the child has a first degree relative with febrile seizures

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4
Q

What advice should parents of a child with febrile seizures be given?

A

If a febrile convulsion lasts >5 minutes they should call an ambulance
If the parents want to treat the fever at home (for reduction of the child’s anxiety) they should not carry out ‘active cooling’ - e.g putting in a cold bath but they could carry out cooling in the form of removing the child’s clothing, giving fluids and giving anti-pyretics
Reducing the child’s temperature, however, does not prevent febrile seizures from re-occuring

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5
Q

How common are febrile convulsions?

A

They are seen in around 3% of children

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6
Q

What features are considered to be a ‘complex’ febrile seizure?

A

15-30 minutes in duration
Focal seizure
May have repeat seizures in 24 hours

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7
Q

What features are considered to be a ‘simple’ febrile seizure?

A

Less than 15 minutes in duration
Generalised (most commonly tonic clonic)Typically no recurrence within 24 hours
Should be complete recovery within an hour

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8
Q

What is cerebral palsy?

A

It is an umbrella term for a permanent disorder of movement and/or posture and of motor function due to a non-progressive abnormality in the developing brain.

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9
Q

What are some of the different causes of cerebral palsy?

Up to what age is brain damage called cerebral palsy? After that age what is it then known as?

A

Causes:

  1. Antenatal (80%)- cerebral malformation and congenital infection (rubella, toxoplasmosis, CMV)
  2. Intrapartum (10%) - birth asphyxia/trauma
  3. Post natal (10%) - intraventricular haemorrhage, meningitis, head-trauma

After the age of 2 the brain injury is diagnosed as acquired brain injury.

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10
Q

What are the different types of cerebral palsy?

A
  1. Spastic - cerebral cortex affected - stiff muscles
    Spastic can be hemiplegia, diplegia or quadriplegia
  2. Dyskinetic - damage to the basal ganglia - uncontrollable movements
  3. Ataxic - cerebellum affected - poor balance and co-ordination
  4. Mixed
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11
Q

What are reasons for involvement of medics with patients with cerebral palsy (e.g describe management of cerebral palsy)

A 
Medicine for muscle tightness 
Surgery to reduce muscle tightness 
Orthopaedic surgery 
Surgery to correct spinal deformity 
Medication to reduce muscles spasticity 
Management of associated conditions
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12
Q

What are some of the (non-motor) complications associated with cerebral palsy?

A

Learning difficulties
Epilepsy
Squints
Hearing impairment

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13
Q

What treatments may people with cerebral palsy be given for muscle spasticity/tightness?

A

Oral diazepam
Oral and intrathecal baclofen
Botulinum toxin type A
Orthopaedic surgery and selective dorsal rhizotomy

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14
Q

What are some early features of cerebral palsy?

A
  • Abnormal limb and/or trunk posture and tone
  • Delayed motor milestones
  • Feeding difficulties (with oromotor inco-ordination, slow feeding, gagging and vomiting)
  • Abnormal gait once walking is achieved
  • Asymmetric hand function before 12 months
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15
Q

What pathway is damaged in spastic cerebral palsy?

What are the 3 main types of spastic cerebral palsy? What is affected in each?

A

Pyramidal and corticospinal tract

  • Hemiplegia (one half) where the arm is usually affected more than the leg
  • Diplegia - all 4 limbs are affected by the legs are affected more than the arms. Hand function may appear relatively normal and difficulties are most apparent with functional use of the hands
  • Quadriplegia - all 4 limbs are affected, often severely.
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16
Q

Which type of cerebral palsy is most common in premature babies?
Which type of cerebral palsy is often associated with seizures, micro-encephalopathy and moderate or severe intellectual impairment?

A

Diplegia is one of the patterns associated with preterm birth

Quadriplegia can be associated with seizures, micro-encephalopathy and moderate or severe intellectual impairment

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17
Q

What is dorsal rhizotomy?

Who is it suitable for?

A

When a proportion of the nerve roots in the spinal cord are selectively cut to reduce spasticity

Children with a gross motor function of 2 or 3

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18
Q

At what age does childhood absence epilepsy usually present at?

A

4-12 years

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19
Q

What is the difference between a primary headache and a secondary headache?

A

A primary headache is thought to be due to a primary malfunction of neurons and their networks. A secondary headache is symptomatic of some underlying pathology e.g from raised intracranial pressure or space-occupying lesions.

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20
Q

Given some examples of primary headaches

A

Migraine
Tension-type headache
Cluster headache
Trigeminal neuralgia

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21
Q

Give some examples of secondary intracranial headaches

A

Meningitis
Temporal arteritis
Intracranial haemorrhage - subarachnoid haemorrhage, subdural, intracerebral
Raised ICP - e.g tumour, benign intracranial HTN
Intracranial venous thrombosis

22
Q

Give some examples of secondary extracranial headaches

A

Glaucoma

Sinusitis

23
Q

Other than the causes for primary and secondary headaches what are some other differentials for a headache?

A

Infections (abscess, encephalitis, meningitis)
Hypoxia/hypercapnia
Malignant hypertension
Viraemia
Cervical spondylosis
Pre-eclampsia
Drugs (e.g nitrates, PPI, caffeine, analgesia overuse, hormones)

24
Q

What are some features (in the Hx) suggestive of a tension headache?

A

Bilateral tight band sensation
Recurrent
Occurs late in the day
Association with stress

25
Q

What are some features (in the Hx) suggestive of a cluster headache?

A

Short painful attacks around one eye
Last between 30 mins - 3 hours
Occur once/twice a day for 1-3 months
May be lacrimation and flushing

26
Q

What are some features (in the Hx) suggestive of a migranous headache?

A

Unilateral pulsating headache in trigeminal nerve distribution
Last between few hours-days
May be aura (usually visual - can also be sensory or motor)
Need to lie down in dark room (photophobia)

27
Q

What are some features (in the Hx) suggestive of a trigeminal neuralgia

A

2 second paroxysms of stabbing pain in unilateral trigeminal nerve distribution
Face screws up with pain

28
Q

What are some features (in the Hx) suggestive of a headache secondary to meningitis?

A

Photophobia
Neck stiffness
Systemic symptoms e.g fever, non blanching rash

29
Q

What are some features (in the Hx) suggestive of a headache secondary to temporal arteritis?

A

Unilateral throbbing pain
Scalp tenderness and jaw claudication
>55 years
May be visual problems

30
Q

What are some features of a headache secondary to subarachnoid haemorrhage?

A

Very sudden onset severe headache
‘Like someone hit me with a brick over my head’
Meningismus

31
Q

What are some features of a headaches secondary to raised ICP?

A

Worse in the morning
Worse on coughing/bending
Vomiting and reduced GCS
May be neurological symptoms and seizures if a tumour

32
Q

What are some features of a headache secondary to glaucoma?

A

Pain around one eye
Swollen red eye
Visual blurring and halos

33
Q

What are some features of a headache secondary to sinusitis?

A

Facial pain exacerbated by leaning head forwards

34
Q

What are some of the unpleasant symptoms that can be associated with migraine?
What may aggravate migraines?

A

Unpleasant gastrointestinal disturbance e.g N&V, abdo pain, photophobia and phonophobia (sensitivity to sounds)
May be aggravated by physical activity and relieved by sleep

35
Q

Describe the visual disturbances which may occur before a migraine

A

Negative phenomena - e.g hemianopia (loss of half the visual field) or scotoma (small areas of visual loss)

Positive phenomena e.g fortification spectra (seeing zigzag lines)

36
Q

What is the definition of status epilepticus? (e.g in books)

A

Continuous seizures lasting >30 minutes OR

Intermittent clinical or EEG seizures lasting >30 minutes without full recovery of consciousness between seizures

37
Q

Why is it crucial to terminate seizures as soon as possible?

A

Because seizures of a longer duration are associated with a worse outcome and can be more treatment resistant

38
Q

When is a seizure considered to be ‘prolonged’?

A

If it last 5 minutes or longer
The aim is to prevent the prolonged seizure from developing into convulsive status epilepticus (this is why parents are advised that if (any) seizure lasts >5 minutes to contact hospital

39
Q

How is GCS assessed?

A

Movements(6), Eyes (4), Verbal (5)
Eyes - 4 Alert 3 Open to voice 2 Open to pain 1 Unresponsive
Verbal - 5 -orientated to time, place and person 4-confused 3-inappropriate words 2-incomprehensible sounds - No response
Movements - 6 - Normal 5 - Localise to pain 4 - Withdraw from pain 3- Decorticate 2- Decerebrate
1 - No response

40
Q

What are some reversible causes of seizures?

A

Hypoglycaemia
Electrolyte disturbances
Infection

41
Q

What drugs can be given in the treatment of status epilepticus?

A

If there is vascular access: LORAZAPAM is given IV/IO

If no vascular access MIDAZOLAM (buccal), DIAZEPAM (rectal)

42
Q

What is a convulsion?

A

A seizure with motor components

43
Q

What is the definition of status epilepticus that is a more practical definition?

A

> 5 minutes of continuous seizure or ≥2 discrete seizures between which there is incomplete
recovery of consciousness

44
Q

If the seizure doesn’t terminate followed administration of medication what should be done?

A

Initial medication can b repeated if there is no termination at 10 minutes

Anaesthetists, PICU and Paeds SpR should be called

Require IV infusion of phenytoin
/Phenobarbitone 
(need cardiac monitoring).
RSI with Propofol/Midazolam/Thiopental.
Transfer to PICU
45
Q

When can epilepsy be diagnosed?

A

Diagnosed when at least 2

unprovoked seizures occur >24 hours apart

46
Q

What are acute symptomatic epileptic seizures?

A

When epileptic seizures are provoked by acute brain injury e.g cortical ischaemia, intracranial infection, hypoglycaemia
They do NOT constitute an epilepsy

47
Q

What should always be considered in a patient having a seizure with a temperature?

Who must you be particularly careful with?

A

Meningitis MUST be excluded. Classical features = photophobia, neck stiffness
Classical features may not be present in children <18 months so infection screen may be necessary

48
Q

What does an infection screen for meningitis entail?

A

Blood cultures
Urine culture
Lumbar puncture for CSF

49
Q

What is the difference between central and peripheral hypotonia on examination?

A

CENTRAL: ‘strong floppy’ - e.g truncal weakness but sustained limb strength, global developmental delay, may have syndromic features e.g trisomy 21
PERIPHERAL - ‘weak floppy’ - weak cry and cough, frog leg position, decreased tendon reflexes, social development may be normal

50
Q

A drowsy child following a FEBRILE convulsion is not consistent if it is longer than what time period?

A

A child still being drowsy after 1 hour is not consistent with a ‘simple’ febrile convulsion.

51
Q

What are some of the size effects of baclofen?

A

Because the drug is not selective is leads to decreased tone of all of the muscles in the body- this can mean threat the central/core muscles that do not have increased tone are more floppy/less functiona

Laura Paediatrics (20 decks)

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