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Peadiatrics > Neurology > Flashcards

Neurology Flashcards

1
Q

Sodium valproate: indications and side effects?

A

Use: (Think ‘generalised’)

  1. Generalised tonic clonic
  2. Absence
  3. Atypical absence
  4. Myoclonic

Side effect:

  1. Teratogen (neural tube)
  2. Hyperammonaemia
  3. Thrombocytopenia (dose-related)
  4. Weight gain
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2
Q

Carbamazepine: indications and side effects?

A

Use:
1. Focal seizures +/-secondary generalised

Side effect:

  1. Leukopenia
  2. Hepatotoxicity
  3. SIADH -> hyponatraemia
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3
Q

Phenytoin: indications and side effects?

A

Use:

  1. Status epilepticus
  2. Focal seizures +/- secondary generalised

Side effects:

  1. P450 induction
  2. Hirsutism
  3. Gum enlargement
  4. Teratogen (hydantoin syndrome)
  5. Ataxia, rash
  6. Steven Johnson syndrome
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4
Q

Ethosuximide: indications and side effect?

A

Use:
1. Absence seizures

Side effect:

  1. (F)atigue
  2. (G)I upset
  3. (H)eadache
  4. (I)tching
  5. Steven (J)ohnson
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5
Q

Phenobarbitol: indications and side effect?

A

Use: (only in infants i.e. ‘phenoBABYtol’)

  1. Generalised tonic-clonic
  2. Focal seizure

Side effect:

  1. Severe behavioural changes
  2. Impaired cognition
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6
Q

Lamotrigine: indications and side effect?

A

Use:

  1. Lennox-Gastaut
  2. Focal seizures

Side effect:

  1. Steven Johnson syndrome
  2. Haemophagocytic lymphohistiocytosis
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7
Q

Levetiracetam: indications and side effect?

A

Use:

  1. Focal seizures (with impaired consciousness >4 years)
  2. Generalised tonic-clonic (>6 years)
  3. Juvenile myoclonic epilepsy (>12 years)

Side effect:
1. Behavioural (irritability, aggression)

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8
Q

Topiramate: indications and side effect?

A

Use:

  1. Focal seizure
  2. Generalised seizure

Side effect:

  1. Kidney (s)tone
  2. (S)low cognition
  3. (S)kinny (weight loss)
  4. (S)ight threatened (glaucoma)
  5. (S)peech difficulties (word finding)
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9
Q

Oxcarbazepine: indications and treatment?

A

Use:
1. Benign Rolandic epilepsy of childhood (centrotemporal spikes)

Side effect:

  1. Ataxia
  2. Nystagmus
  3. Hyponatraemia
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10
Q

Which areas of the brain correspond to motor, adversive, somatosensory or emotional changes?

A

Focal motor = precentral gyrus

Focal adversive (forceful turning to one side) = mesial frontal lobe

Focal somatosensory = parietal

Emotional/hallucinatory = temporal

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11
Q

What is the treatment of choice for focal seizures?

A

Carbamazepine
Oxcarbazepine
Phenytoin

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12
Q

What is the treatment of infantile spasms?

A

ACTH
Vigabatrin

ACTH side effect = HTN, irritability, ionfection

Vigabatrin side effect = Vision (permanent blindness)
-> best to use with coexistant tuberous sclerosis

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13
Q

What is West syndrome?

A 
Triad of: 
1. Infantile spasm 
2. Intellectual disability 
3. Hypsarrhythmia
= high voltage, irregular, slow waves
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14
Q

What is the EEG with Lennox Gastaut syndrome?

A

Generalised, bilaterally synchronous, sharp- and slow-wave complexes, occurring in repetitive fashion in long runs

a.k.a. ‘slow spike and wave’

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15
Q

What neurocutaneous syndrome is infantile spasms associated with?

A

Tuberous sclerosis

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16
Q

What neurocutaneous disease causes focal seizures contralateral to affected area?

A

Sturge-Weber
= IPSIlateral leptomeningeal angioma causing CONTRAlateral focal seizure

Triad:

  1. Port-wine stain
  2. Leptomeningeal angioma
  3. Glaucoma
17
Q

Why is spinal muscular atrophy (SMA) a disease of motor, not sensory, deficit?

A

= ANTERIOR horn disease (degeneration)

Anterior horn = motor
Posterior horn = sensory

Lethal AR disorder (chromosome 5q)

18
Q

Elevated CK is seen with what neuromuscular disease?

A

Duchenne and Becker

NOT elevated with SMA

19
Q

Which is more severe - Duchenne or Becker?

A

Duchenne
= absent or deficient dystrophin protein

‘BECKER is BETTER’
= defective but not total absence of protein

20
Q

What is the difference in myasthenia gravis vs. Lambert Eaton vs botulism?

A

MG = POST-synaptic (AChR destroyed)

LES = PRE-synaptic (voltage-gated calcium channel not releasing ACh; attacked by antibodies)

Botulism = PRE-synaptic (botulinum toxin inhibits ACh release)

21
Q

What are the types of myasthenia gravis in children?

A
  1. Transient neonatal
  2. Congenital
  3. Juvenile
22
Q

What is used to help diagnose myasthenia gravis?

A

ACh-receptor antibodies (AChR-Ab)

Muscle-specific receptor tyrosine kinase (MuSK) antibodies

EMG demonstrating electrodecrement

23
Q

What is the most common myositis in children?

A

Juvenile dermatomyositis

24
Q

What serum abnormality is seen in ataxia telangiectasia?

A

Elevated alpha fetoprotein

Decreased serum IgA

25
What is the difference between vestibular neuritis vs. labarynthitis?
Both due to viral/postviral inflammatory disorder of vestibular portion of CN VIII Vestibular neuritis = auditory function preserved Labarynthitis = unilateral hearing loss
26
What are the key physical findings in vestibular neuritis?
Nystagmus - horizontal or rotational Positive head thrust (rapid turning of head toward lesion side -> patient unable to maintain visual fixation) Gait instability = fall toward affected side
27
Where is the most common location for brain tumours in children?
Posterior
28
Describe the flow of CSF and their channels
CSF produced by choroid plexus in lateral, third and fourth ventricles Lateral -> (foramen of Munro) -> third ventricle -> (aqueduct of Sylvius) -> fourth ventricle -> (foramina of Magendie (medial) and Luschka (lateral)) -> subarachnoid space Absorbed by arachnoid granulatoions to dural venous sinus
29
What is a communicating hydrocephalus?
= impairment of CSF flow within the SUBARACHNOID SPACE or impairment of ABSORPTION (at villi) A misnomer Think of it as EXTERNAL hydrocephalus
30
How are the clinical symptoms of hydrocephalus related to anatomy?
Symptoms due to (1) ventricular distension; (2) increased ICP Lateral ventricle dilation = ataxia + spasticity (lower >> upper as leg fibers closest to ventricles) Third ventricle dilation = endocrine dysfunction (hypothalamic region) + visual dysfunction (proximity to anterior of third ventricle) Cerebral aqueduct dilation = sun-setting eyes (compress periaqueductal vertical gaze center)
31
What type of sensory information does the dorsal column-medial lemniscus vs. anterolateral spinothalamic tract?
DCML 1. Proprioception 2. Fine touch SPINOTHALAMIC (Lateral) 1. Pain 2. Temperature (Anterior) 1. Crude touch 2. Pressure
32
What vitamin deficiency causes treatment-resistant neonatal seizures?
Vitamin B6 (pyridoxine) Required for synthesis of y-amniobutyric acid (GABA), which is the principle inhibitory neurotransmitter
33
What is elevated in the serum after a seizure?
Prolactin But not routinely measured as per NICE
34
What is the most common aura pre-seizure?
Epigastric pain | Feeling of fear
35
What two antiepileptics are renally cleared?
Levetiracetam | Phenobarbitol (25%)
36
What is the most common posterior fossa tumour of childhood?
Cerebellar astrocytoma
37
What is Macewen's sign
Percussion of skull -> cracked pot sound Positive test = separation of sutures -> seen in hydrocephalus, brain abscess
38
What is the familial cause of hydrocephalus due to?
Aqueductal stenosis X-linked Note: NF-1 can also cause aqueductal stenosis (rare association)
39
What is gene is involved in Dravet syndrome?
SCN1A

Peadiatrics (13 decks)

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