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Paediatrics > Neurology > Flashcards

Neurology Flashcards

1
Q

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

A

2y

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2
Q

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

A

2y

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3
Q

Are babies born with neurological signs?

A

Neurological signs develop as brain develops

These are not necessarily present at birth

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4
Q

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

A

Time course of symptoms

Perinatal, developmental and family history

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5
Q

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

A

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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6
Q

What does a neurological examination in a child involve?

A

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

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7
Q

How common is headache?

A

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

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8
Q

What are the 4 types of headache pattern?

A

Isolated acute
Recurrent acute
Chronic progressive
Chronic non-progressive

Where IA & CP are more likely to be sinister

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9
Q

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

A

Is there more than 1 type of headache?

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

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10
Q

What is involved in headache examination?

A

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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11
Q

What things might make you think migraine?

A 
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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12
Q

How does migraine differ from TTH?

A

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

TTH - diffuse, symmetrical, band like, constant ache

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13
Q

What features are typical of a RICP headache?

A

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

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14
Q

What features are typical of a analgesic overuse headache?

A

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

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15
Q

What are indications for neuroimaging?

A 
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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16
Q

What is Mx for migraine?

A

Acute: pain relief, triptans

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

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17
Q

What is Mx for TTH?

A

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

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18
Q

Define seizure/fit

A

Any sudden attack from whatever cause

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19
Q

Define syncope

A

Faint, usually due to vagal overactivity

20
Q

Define convulsion

A

Seizure where there is prominent motor activity

21
Q

Define epileptic seizure

A

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

22
Q

Define epilepsy

A 
A tendency to recurrent, unprovoked spontaneous epileptic seizures 
CLINICAL diagnosis (EEG supportive)
23
Q

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

A

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)

24
Q

Define febrile convulsion

A

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

25
Q

What is a clonic seizure?

A

One in which there is repeated jerking of the muscles

26
Q

What is a myoclonic seizure?

A

Uncontrolled jerking

27
Q

What is a tonic seizure?

A

Patient goes really stiff

28
Q

What is an aclonic seizure?

A

Patient goes floppy and falls

29
Q

What is an absence seizure?

A

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

30
Q

What is the mechanism of an epileptic fit?

A

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

31
Q

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

A

Generalised - affecting both hemispheres

Partial - affecting 1 hemisphere or 1 lobe

32
Q

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

A

Maj idiopathic and generalised

Seizures can be subtle

33
Q

What is the role of the EEG in diagnosing epilepsy?

A

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

34
Q

What things can help you reach a diagnosis of epilepsy?

A

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

35
Q

How do you Mx epilepsy?

A

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)

36
Q

What are the side effects of anti-epileptics?

A

Drowsiness, effect on learning, cognition & behaviour

Supression of bone marrow

37
Q

When should you suspect a NM disorder?

A 
Floppy baby
Slips from hands
Paucity of limb movements
Alert, but less motor activity
Delayed milestones
Able to walk, but frequent walls
38
Q

What are the signs of NM disorder?

A 
Pelvic waddle due to pelvic weakness
Exaggerated lumbar lordosis (protuberant belly)
Wasting of muscles
Swaying of shoulders
Foot drop 
Poor balance
39
Q

What is Charcot-Marie-Tooth disease?

A

Sensorimotor polyneuropathy where there is calf atrophy and pes cavus

40
Q

What are the conditions affecting the NMJ?

A

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

41
Q

What are the typical features of a myopathy?

A

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

42
Q

What are the typical features of a neuropathy?

A

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

43
Q

What is Duchenne muscular dystrophy caused by?

A

Mutation in Xp21, dystrophin gene

44
Q

What are the typical features of Duchenne muscular dystrophy?

A

Delayed gross motor skills
Symmetrical proximal weakness - waddling gait, calf hypertrophy, Gower’s sign positive

Elevated CK >1000
Cardiomyopathy
Resp involvement in teens

45
Q

What is CK a marker of?

A

Muscle breakdown

Paediatrics (35 decks)

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