Neurology Flashcards
How does brain develop
Myelin sheath
Synapses between dendrites
What can affect the brain
Congenital Neurogenetic Neurometabolic Infection Ischaemia Trauma Tumour Autoimmune
What do you look for in neuro examination (difficult to do full adult in young child)
Observation Appearance / unusual facial features / skin findings Gait Posture Head circumference
What is the most common cancer in children and 2nd most common
Leukaemia
Brain tumour
What can you describe headaches as
X = underlying cause more likely
Isolated acute X
Recurrent acute
Chronic progressive X = worry
Chronic non-progressive
What type of headache is migraine
Acute and recurrent = most common type
Tension = second most common
What do you include in headache history
Is there more than one type of headache Any warning signs Location Severity Duration Frequency
What is a red flag sign in headache
Localised to the back
What do you look for on examination of headache and what does this indicate
Growth - craniopharyngioma OFC - hydrocephalus BP - hypertension Sinuses - sinusitis Visual acuity - vision headache Fundoscopy - papilloedema Visual field - craniopharyngioma Cranial bruit Focal neurological signs Cognitive / emotion
How many tension type headaches do you get and how long do they last
10+
30 mins- 7 days
What are tension headahce
Diffuse and symmetrical Bilateral Band like Present most of the time Constant mild ache No N+V / photo or phonophobia / no aggravation exercise
What suggests raised ICP (need scan)
Worsen bending down / coughing / straining
Woken up from sleep
Morning headache
Vomiting
What suggests analgesic overuse
Headache is back before allowed to use another dose
Common in paracetamol, NSAIDs, cocodamol
What are indications for neuroimaging
Cerebellar dysfunction Features of raised ICP New focal neurological deficit e.g. squint Seizures esp focal Personality change Unexplained deterioration of school work
What are features of cerebellar dysfunction
Dyskinesia Ataxia Nystagmus Inentention tremor Scanning dysarthria Hypotonia Past pointing on finger nose test
How do you manage TTH
Reassure no sinister cause
MDT
Look for physical / psychological causes
Analgesia - paracetamol 15mg /kg or Ibuprofen 10mg / kg
What do you give as prophylaxis
Amitryptilline
Most common type of headache in children
Migraine
How many migraine can you get
5+
4-72 hours
How does migraine present
Hemicranial Uni or bilateral Frontal or temporal Throbbing or pulsatile Abdo pain N+V Pallor Photophobia Focal - visual / parathesia / weakness / aura
What triggers migraine
Fatigue
Stress
Exercise
FH
What relieves migraine
Sleep
Dark
What do you give acutely
Triptans >12 nasal spray
Ibuprofen
How do you prevent migraine
Propranolol = 1st line
Amitryptiline
Sodium valproate
What is the role of the EEG
EEG if not having a seizure is not sensitive (30-60%)
May have false +ve findings on EEG
Useful if catch during a seizure
Useful to find out seizure type, syndrome and cause rather than Dx
What is cerebral palsy
Non-progessive lesion of motor pathway in developing brain
More at risk if pre-term
What causes
Antenatal - Rubella / toxoplasmosis / CMV Bith asphyxia Pre-term IVH Meningitis Severe jaundice Head injury / trauma
What types of cerebral palsy
Spastic due to damage to UMN
Dyskinetic due to damage to basal ganglia
Ataxic due to damage to cerebellum
How does cerebral palsy present
Hypertonia Clonus Brisk reflex LImb weakness Spastic Delayed motor Abnormal gait Poor feeding
How do you treat cerebral palsy
MDT Physio OT SALT - may need NG or PEG Dietician Orthopaedic surgeon Spasticity - baclofen / diazepam / botox Anti-convulsant for epilepsy Analgesia
Complications
LD Epilepsy Squint Hearing and visual GORD Muscle contractures
Most common cause of death in children
Head injury
Indications for ED / observation
GCS <15 Post trauma seizure Focal neuro Fracture sign LOC Severe + persistent headache Repeat vomit >1 Amnesia >5 Retrograde >3 High risk mechanism Coagulopathy
How do you examine
AVPU GCS Pupils Vital signs Palpate skull Battle sign Examine TM - CSF / blood in ears Temp / blood glucose - other causes of seizure / LOC
Indications for immediate head CT
GCS <13/14 or 15 if <1 Basal skull HIgh speed RTA LOC >30 mins Focal neuro Open or depressed skull or tense fontanelle Coagulopathy
Head CT within 8 hours
Bruising Laceration >5cm Amnesia >5 minutes + retrograde >3 Seizure Repeated vomitng >1 Drowsy within 8 hours NAI
How do you image C-spine
X-ray <10
CT >10
When do you image C-spine
Severe head or cord injury signs e.g. weakness
When do you admit to the ward
CT needed NAI Co-morbid Can't make full assessment Social
When do you discharge with follow up
Consciousness recovered E+D No vomit Neuro resolved Imaging reviewed
What is hydrocephalus
Impaired cerebrospinal flow
Resorption or eccess production
What causes hydrocephalus
Most commonly genetically acquired outflow obstruction at cerebral aqueduct
Aqueductal stenosis that connects 3rd and 4th ventricle
Arachnoid cyst
Arnold chair
What are the clinical features of hydrocephalus
Increase in head circumgerence Bulding anterior fontanelle Vomiting Droswy Irritbale Poor tone Sunsetting eyes - downward Seizures Blurred vision Headaches
How do you treat hydrocephalus and complications
VP shunt
Infection
Blockage
IVH during surgery
Return of Sx due to outgrowing
What is common cause of neonatal death
Hypoglycaemia
Meningitis
Head trauma
What suggests basal skull fracture
Battle sign
Panda eyes
Blood or CSF out of ear or nose
What is important in the history of head injury
Mechanism LOC Vomiting Headache VIsual Drowsy Were they well prior
What should you do if sending home
Safety net worsening symptoms
What is craniosyntosis and complications
Skull sutures close prematurely resulting in abnormal head shape Small in proportion to body Will eventually lead to raised ICP Developmental delay Cognitive impairment Vomiting Irritable Visual Seizure
How do you Dx
Refer specialist
Skull X-ray = 1st line
CT to confrim
How do you Rx
Surgical reconstruction
What is other causes of abnormal head
Plagiocephaly
Brachycecphaly
What causes
Babies resting head at particular point
Results in bone and sutures moulding
How do you manage
Exclude craniosyntosis
Reassurance
Supervised tummy time
