Neurology Flashcards by Aimee Love

By which age is most of the brain/head growth complete?

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Any head injury before what age may lead to serious impact on brain function?

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Are babies born with neurological signs?

Neurological signs develop as brain develops

These are not necessarily present at birth

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What things do you want to ensure to ask about in the history of a patient with a suspected neurological deficit?

Time course of symptoms

Perinatal, developmental and family history

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What do you want to ask about in the developmental history?

Gross and fine motor skills - have they met the milestones?
Speech and language and eaerly cognitive development
Play esp. symbolic play/copying/social behaviour
Self help skills
Vision and hearing

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What does a neurological examination in a child involve?

Appearance, e.g. facial features
Gait - walking normally? Sitting? Posture?
Head size
Skin findings, e.g. café au lait spots

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How common is headache?

40% have had one by age 7, 75% by age 15

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What are the 4 types of headache pattern?

Isolated acute
Recurrent acute
Chronic progressive
Chronic non-progressive

Where IA & CP are more likely to be sinister

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What things do you want to ask in a headache history?

Is there more than 1 type of headache?

Typical episode duration? warning? frequency? severity? location?

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What is involved in headache examination?

Growth parameters, OFC, BP (e.g. craniopharyngioma may affect only growth & give headache, OFC for hydrocephalus, BP for HTN encephalopathy)
Fundoscopy (RICP)
Visual fields (craniopharyngioma)
Cranial bruit (AV fistula, aneurysm)
Focal neurological signs, e.g. nystagmus
Emotional/cognitive status

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What things might make you think migraine?

Ab pain, N/V
Visual disturbance, paraesthesia, weakness 
Phono/photophobia
Relation to stress/fatigue 
Helped by sleep/rest/dark quiet room 
FH often +ve

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How does migraine differ from TTH?

Migraine - hemicranial, throbbing/pulsatile, abdo pain, NV, other features prev mentioned

TTH - diffuse, symmetrical, band like, constant ache

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What features are typical of a RICP headache?

Made worse by activities that raise ICP, e.g. coughing, straining at stool, bending
Woken with headache

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What features are typical of a analgesic overuse headache?

Headache back before next dose
Paracetamol/NSAIDs
Particular problem with compound analgesics

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What are indications for neuroimaging?

Features of cerebellar dysfunction/RICP
New neurological deficit, e.g. new squint 
Seizures, esp focal 
Personality change
Unexplained deterioration n school work

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What is Mx for migraine?

Acute: pain relief, triptans

Preventative (if 1+/wk): pizotifen, propranolol, amitriptyline, topiramate, valprotate

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What is Mx for TTH?

Reassurance, consider physical/psychological/emotional problems
Acute attack: analgesia
Prevention: amitryptilline

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Define seizure/fit

Any sudden attack from whatever cause

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Define syncope

Faint, usually due to vagal overactivity

Define convulsion

Seizure where there is prominent motor activity

Define epileptic seizure

Abnormal excessive hyper synchronous discharge from a group of cortical neurons –> paroxysmal changes in motor/sensory/cognitive function, depending on site of discharge

Define epilepsy

A tendency to recurrent, unprovoked spontaneous epileptic seizures 
CLINICAL diagnosis (EEG supportive)

What are non-epileptic seizures that mimic epilepsy in children?

Acute symptomatic seizures - due to acute insults, e.g. hypoxia/ischaemia, hypoglycaemia, infection, trauma
Reflex anoxic seizure (vagal mediated brachycardia due to painful stimulus)
Syncope
Parasomnias, e.g. night terrors
Behavioural stereotypies, e.g. rocking
Psychogenic seizures (NEAD)

Define febrile convulsion

An event occurring usually between 3m-5y, assoc with fever but without evidence of intracranial infection/defined cause for seizure

What is a clonic seizure?

One in which there is repeated jerking of the muscles

What is a myoclonic seizure?

Uncontrolled jerking

What is a tonic seizure?

Patient goes really stiff

What is an aclonic seizure?

Patient goes floppy and falls

What is an absence seizure?

Patient loses awareness, may be assoc with eye flickering, upward gaze of eyes etc.

What is the mechanism of an epileptic fit?

Decreased inhibitory NTs (e.g. GABA), increased excitatory NTs (e.g. glutamate & aspartate) --> xs influx of Na and Ca ions --> uncontrolled firing of neurons This can be picked up on EEG

What is the difference between a partial and a generalised seizure?

Generalised - affecting both hemispheres | Partial - affecting 1 hemisphere or 1 lobe

What are the main differences between childhood and adult onset epilepsies?

Maj idiopathic and generalised | Seizures can be subtle

What is the role of the EEG in diagnosing epilepsy?

Supportive - interictal EEG only 30-60% sensitive Also see paroxysmal activity in 30% & frankly epileptiform activity in 5% of normal children But may help in finding the underlying cause & seizure type/syndrome

What things can help you reach a diagnosis of epilepsy?

Hx, EEG during seizure, MRI (?brain malformations/damage) Genetics - idiopathic epilepsies mostly familial & single gene disorders (e.g. tuberous sclerosis) Metabolic tests, esp if assoc with developmental delay/regression

How do you Mx epilepsy?

Only start anti-epileptics if sure of diagnosis & titrate up Sodium valprotate for GE (not in girls) Carbamazepine for focal epilepsy New AEDs with less SEs - levetiracetam lamotrigine, perampanel Resistant epilepsies: ketogenic diet, steroids, Ig Vagal nerve stimulator (disrupts epileptic circuit) Epilepsy surgery (removal of causative part of brain)

What are the side effects of anti-epileptics?

Drowsiness, effect on learning, cognition & behaviour | Supression of bone marrow

When should you suspect a NM disorder?

``` Floppy baby Slips from hands Paucity of limb movements Alert, but less motor activity Delayed milestones Able to walk, but frequent walls ```

What are the signs of NM disorder?

``` Pelvic waddle due to pelvic weakness Exaggerated lumbar lordosis (protuberant belly) Wasting of muscles Swaying of shoulders Foot drop Poor balance ```

What is Charcot-Marie-Tooth disease?

Sensorimotor polyneuropathy where there is calf atrophy and pes cavus

What are the conditions affecting the NMJ?

Muscle: muscular dystrophies, myopathies - congenital & inflammatory, myotonic syndromes NMJ: myasthenic syndromes Nerve: hereditary or acquired neuropathies Anterior horn cell: spinal muscle atrophy

What are the typical features of a myopathy?

Usually proximal, pure motor, reflexes preserved till late, contractures may be present, may have accompanying cardiac dysfunction

What are the typical features of a neuropathy?

Distal weakness, with sensory symptoms, reflexes lost early, fasiculations

What is Duchenne muscular dystrophy caused by?

Mutation in Xp21, dystrophin gene

What are the typical features of Duchenne muscular dystrophy?

Delayed gross motor skills Symmetrical proximal weakness - waddling gait, calf hypertrophy, Gower's sign positive Elevated CK >1000 Cardiomyopathy Resp involvement in teens

What is CK a marker of?

Muscle breakdown