Neurology Flashcards
What percentage of infants experience at least one febrile seizure?
0.5-1%
What proportion of infants who have had a febrile seizure have an additional seizure?
30%
RIsk is higher the younger the child
What is the risk of developing epilepsy following febrile seizures?
Only slightly greater than the rest of the population
What type of seizure does not occur in newborns and very rarely occurs in children < 2
Generalised tonic-clonic
What is the most common seizure type seen in Lennox-Gastaut syndrome?
Astatic seizures (drop attacks)
Also tonic-clonic and atypical absence
How can absence seizures be induced?
Hyperventilation
Ask the child to blow on a piece of paper or windmill for 2-3 minutes
What is the treatment for absence seizures?
Ethosuximide
What is the definition of a simple febrile convulsion?
A generalised tonic-clonic seizure lasting < 15 minutes that does not recur within the same febrile illness
What are the features of a complex febrile convulsion?
- Focal features at onset or during the seizure
- Duration of more than 15 minutes
- Recurrence within the same febrile illness
- Incomplete recovery within 1 hour
What role does paracetamol play in febrile convulsions?
Does NOT reduce the risk of further febrile convulsions
What EEG pattern is seen in absence seizure
3Hz spike and wave
What is the first line treatment for focal epiliepsy (including with secondary generalisation)?
Carbamazepine
What is the earliest sign of dose-related toxicity with carbamazepine use?
Diplopia, starting 30-60 minutes after the morning dose
What allele should be screened for in patients with Asian origin before starting carbamazepine?
HLA-B*1502
Risk of SJS
How can temporal lobe epilepsy associated with hippocampal sclerosis be treated surgically?
Temporal lobectomy
Up to 80% of patients have long term control
How are neonatal seizures treated?
Phenobarbitone IM/IV immediately
Stopping the seizure immediately is critical
When and how does intervention occur during a febrile seizure?
After 5 minutes - midazolam
After another 5 minutes - midazolam
After another 5 minutes - phenytoin/phenobaritone
Within what age group do febrile seizures occur?
6 months - 5 years
Mostly 12-18 months
Why is magnesium sulfate given to mothers at risk of preterm delivery?
Prevention of cerebral palsy
What are the most common delayed motor milestones in children with cerebral palsy?
Not sitting by eight months (corrected for gestational age [GA])
Not walking by 18 months (corrected for GA)
Early asymmetry of hand function (hand preference) before one year (corrected for GA)
Which type of cerebral palsy is most common in preterm infants?
Spastic diplegia
What is the most common type of cerebral palsy?
Spastic (70-80%)
Which region of the brain is involved in spastic cerebral palsy?
UMN of pyramidal tract
Which region of the brain is affected in athetoid/dyskinetic cerebral palsy?
Basal gangia
Which region of the brain is affected in ataxic cerebral palsy?
Cerebellum
Kernicterus is most associated with which type of cerebral palsy?
Dyskinetic
Periventricular leukomalacia is most commonly associated with which type of cerebral palsy?
Spastic diplegia
How are the two genders affected differently by muscular dystrophy?
Duchenne and Becker’s only affect males (x-linked recessive)
When do clinical features of muscular dystrophy appear?
Duchenne: 2-5 years
Becker: no earlier than 15
Where does muscular weakness begin in muscular dystrophy?
Proximal lower limbs
Then spreads to upper body and distal areas
Epilepsy is most likely to occur in which type of cerebral palsy?
Spastic quadriplegia
How is a diagnosis of Hirschprung’s disease confirmed?
Full-thickness rectal biopsy
What are 3 antispasmodics which can be used for cerebral palsy?
Botulinum toxin
Baclofen
Dantrolene
Benzodiazepines
What is the mechanism of baclofen?
GABA analogue
What is athetosis?
Abnormal muscle contraction causes involuntary writhing movements
Seen commonly in cerebral palsy
What is dystonia?
Sustained or repetitive muscle contractions result in twisting and repetitive movements or abnormal fixed postures
How can glucose on CSF help distinguish viral from bacterial meningitis?
Bacterial: low
Viral: normal
How can CSF protein levels help distinguish viral from bacterial meningitis?
Viral: slightly elevated
Bacterial: high
How can the CSF:blood glucose ratio on CSF help distinguish viral from bacterial meningitis?
Viral: normal
Bacteria: low (decreased CSF glucose)
What is the triad of rasied ICP (Cushing’s)?
- Systemic hypertension
- Bradycardia
- Respiratory depression
What is craniosynostosis?
The premature fusion of one or more cranial sutures
Surgically managed
What are the CSF findings in Guillain-Barre syndrome?
Elevated protein (increased permeability of the blood-nerve-barrier)
Normal cell counts
Albuminocytologic dissociation
What is spinal muscular atrophy?
A group of autosomal recessive motor neuron diseases
Caused by apoptosis of lower motor neurons
Which supplement is often used for migraine prevention?
Riboflavin (B2)
What are the main types of CP?
- Spastic
- Ataxic
- Dyskinetic
When in the course of acute rheumatic fever does Sydenham’s chorea occur?
1-8 months after inciting infection
Antibody cross-reaction with the basal ganglia and cortical structures
How long do symptoms of Sydenham’s chorea persist?
3-4 months, sometimes persisting up to 2 years
What type of CP is associated with chronic bilirubin encephalopathy?
What is the specific movement pattern?
Dyskinetic
Choreoathetoid
Chorea (irregular migrating contractions) and athetosis (twisting and writhing)
What is the most common feature of chronic bilirubin encephalopathy?
High-frequency sensorioneural deafness
A “milk maid’s grip” is characteristic of which encephalopathy?
Sydenham’s chorea
What is a decorticate posture?
What is a decerebrate posture?
What is spina bifida occulta?
Failure of one or more vertebrae to close completely
The spinal cord, meninges and overlying skin remain intact
What is a meningocele?
A neural tube defect
The meninges protrude through the gap made by failed of the closure of a vertebrae
What is a myelomeningocele?
A neural tube defect
The meninges and spinal cord protrude through the gap made by failed of the closure of a vertebrae
What is the most common cause of meningitis in children and teens?
Neisseria meningitidis
What is the empirical treatment for meningitis in neonates and children < 2 months?
Cefotaxime + benzylpenicillin/amoxycillin
Add acyclivir if encephalitis is suspected
What is the empirical treatment for meningitis in infants and children > 2 months?
Ceftriaxone + dexamethasone
Add acyclivir if encephalitis is suspected
