Neurology Flashcards
Why is child neurology considered dynamic?
- Brain continues to grow and function evolves
- Static lesions produce evolving features
Give examples of types of pathology that can affect children?
- Congenital anomalies
- Neurogenetic diseases and syndromes
- Neurometabolic diseases and syndromes
- Acquired: infection, ischaemia, trauma, tumour
What is included in the neurological consultation in childhood?
- History taking interactive
- Avoid medical jargon
- Time course of symptoms
- Distinguishing static from slowly progressive symptoms can be challenging
- Perinatal, developmental, family history
What is assessed in a developmental history?
- Motor milestones: gross and fine motor skills
- Speech and language development
- Early cognitive development
- Play esp. symbolic play and social behaviour
- Self-help skills
- Vision and Hearing assessment
What is looked at in a paediatric neurological examination?
- Opportunistic approach and observation skills
- Appearance
- Gait
- Head size
- Skin findings
- Real world examination (depends on age)
- Synthesis of history and clinical findings into a differential diagnosis and investigation plan
How common are neurological problems?
- 10% of primary care consultations for children
- 25% of hospitalised children
- Migraine 7.7% of children 10-17
- Traumatic Brain Injury: 180-300/ 100,000 children
- Tourette syndrome: 1% of all children with high frequency in ADHD and OCD
- Epilepsy: 0.7% of all children, 1/3 will have intractable epilepsy
- Brain tumours: second most common cancer in children
What is the epidemiology of headache disorders?
- 40% of children by age 7
- 75% of children by age 15
What are the 4 classifications of headache?
- Isolated acute
- Recurrent acute
- Chronic progressive
- Chronic non-progressive
What do you want to know about the typical episode of chronic headache?
- Any warning?
- Location?
- Severity?
- Duration?
- Frequency?
What should you look at when examining a child due to headache?
- Growth parameters, OFC, BP
- Sinuses, teeth, visual acuity
- Fundoscopy
- Visual fields (craniopharyngioma)
- Cranial bruit
- Focal neurological signs
- Cognitive and emotional status
The diagnosis of headache aetiology is clinical
What features would suggest childhood migraine?
- Associated abdominal pain, nausea, vomiting
- Focal symptoms/ signs before, during, after attack: Visual disturbance, paresthesia, weakness
- ‘Pallor’
- Aggravated by bright light/ noise
- Relation to fatigue/ stress
- Helped by sleep/ rest/ dark, quiet room
- Family history often positive
What is the typical presentation of migraine?
- Hemicranial pain
- Throbbing/ pulsatile
- Abdo pain, nausea, vomiting
- Relieved by rest
- Photophobia/ phonophobia
- Visual, sensory, motor aura
- Positive family history
What is the typical presentation of tension headache?
- Diffuse, symmetrical
- Band-like distribution
- Present most of the time (but there may be symptom free periods)
- “Constant ache”
What type of headache would suggest raised intracranial pressure?
- Aggravated by activities that raise ICP eg. Coughing, straining at stool, bending
- Woken from sleep with headache
What type of headache would suggest analgesic overuse headache?
- Headache is back before allowed to use another dose
- Paracetamol/ NSAIDs
- Particular problem with compound analgesics eg. Cocodamol
What are the indications for neuroimaging in headache?
- Features of cerebellar dysfunction
- Features of raised intracranial pressure
- New focal neurological deficit eg. new squint
- Seizures, esp focal
- Personality change
- Unexplained deterioration of school work
How is acute migraine treated in children?
Effective pain relief and triptans
What is the preventative treatment for migraines in children?
- Pizotifen
- Propranolol
- Amitryptiline
- Topiramate
- Valproate
How are tension type headaches treated in children?
- Aim at reassurance: no sinister cause
- Multidisciplinary management
- Attention to underlying chronic physical, psychological or emotional problems
- Acute attacks: simple analgesia
- Prevention: Amitryptiline
- Discourage analgesics in chronic TTH
Seizure/fit
Any sudden attack from whatever cause
Syncope
Faint ( a neuro-cardiogenic mechanism)
Convulsion
Seizure where there is prominent motor activity
What is a an epileptic seizure due to?
An electrical phenomenon coming form the brain
What does presentation of an epileptic seizure depend on?
- Seizure location
- Degree of anatomical spread over cortex
- Duration
What is epilepsy?
- A tendency to recurrent, unprovoked (spontaneous) epileptic seizures
- A question that must be answered clinically with resource to EEG only supportive evidence
What non-epileptic seizures and mimics can occur in children?
- Acute symptomatic seizures: due to acute insults eg. Hypoxia-ischaemia, hypoglycemia, infection, trauma
- Reflex anoxic seizure: common in toddlers
- Syncope
- Parasomnias eg. night terrors
- Behavioural stereotypies
- Psychogenic seizures (NEAD: Non-epileptic attack disorder)
What is the commonest cause of acute symptomatic seizure in childhood
Febrile convulsion
What is a febrile convulsion?
An event occurring in infancy/childhood usually between 3 months and 5 years of age, associated with fever but without evidence of intracranial infection or defined cause for the seizure
What are the different seizure types?
- Jerk/ shake: clonic, myoclonic, spasms
- Stiff: usually a tonic seizure
- Fall: Atonic/ tonic/ myoclonic
- Vacant attack: absence, complex partial seizure
