Neurology Flashcards
Features of TTH
Diffuse, bilateral
“Band like”
Present most of the time
Constant ache with little variation
Features of migraine
Hemi cranial pain Throbbing Pulsatile Abdo. pain Vomiting Releived by rest/dark/ quiet room Photophobia/ phonophobia Visual, sensory, motor aura \+ve FH
Pointers to increased intracranial pressure
Aggravated by activities that raise ICP
e.g coughing, bending straining
Woken from sleep with headache/vomiting
Papilloedema
Pointers to analgesic overused headaches
Particularly relevant to TTH Vicious cycle Back before allowed to use another dose Paracetamol/NSAIDs Particular problem with compound analgesics e/g Cocodamol
Indications for neuroimaging
Features cerebellar dysfunction Increased ICP signs New focal neurological deficit Seizures Personality change Unexplained deterioration at schoo,
Rx for TTH
Aim reassurance No sinister cause MDT approach Acute attacks = simple analgesia Prevention = amitriptyline
Rx for medication overuse headaches
Stop analgesics
Acute attack Rx for migraine
Pain relief (triptans)
Preventative Rx for migraine
Pizotifen, Propanolol, Amitryptiline, Topiramate, Valproate
Most common types of primary headaches
TTH
Migraine
Dx criteria for epilepsy
Tendency to recurrent (at least 2), unprovoked (spontaneous) epileptic seizures
2 broad types of epileptic seizures
Generalised
Partial
does a single seizure = epilepsy
no
Causes of epileptic seizures
Often idiopathic Infection Hyponatraemia glc Trauma Metabolic defects Tuberous sclerosis CNS tumour Arrhythmia
Rx for generalised seizures
Sodium Valproate
Who is sodium valproate CI in
F of child bearing age
Rx for focal seizures
Carbamezepine
New AEDs examples
Lamotrigine
Levatiracetam
Perampanel
Gabapentin
Other therapies to Rx epilepsy
Steroids Immunoglobulin Ketogenic diets VNS Surgical
What is the purpose of AEDs
Used to control seizures not cure epilepsy
Types of non-epileptic seizures
Acute Symptomatic seizures Reflex anoxic seizure Syncope Parasomnias e.g night terrors Behavioural stereotypies Psychogenic seizures
What is the commonest cause of acute symptomatic seizure in childhood
Febrile convulsion
What is a febrile convulsion
Convulsion that occurs in 3mnths-5yrs
Associated with fever
But without evidence of intracranial infection or defined cause for seizure
Ix for epilepsy
Hx Video recording EEG (convulsive seizures) MRI brain Genetics (e.g tuberous sclerosis) Metabolic tests
What is a generalised seizure
Affects both lobes of the brain
Generalised
What is a focal seizure
Affects only one part of the brain
Types of Childhood epilepsy syndromes
Infantile Spasms (West Syndrome)
Benign Rolandic Epilepsy (BRE)
Juvenile Myoclonic Epilepsy (JME)
Lennox-Gastaut Syndrome (LGS)
Childhood Absence Epilepsy
Inheritance mode of Duchenne Muscular Dystrophy
X-linked recessive pattern
Which gender are affected by Duchenne Muscular dystrophy
Male
How many muscular dystrophies are there
9
What is the milder form of Duchennes known as
Becker
Clinical features of Duchennes
Symmetrical proximal weakness
Bulky calf muscles
Gowers Sign +ve
Waddling gait
Scoliosis
Cardiomyopathy
Resp. involvement in teens
Ix for Duchennes
Elevated Creatinine Kinase
Muscle biopsy
EMG
Why is Benign Rolandic Epilepsy called benign
Because many children outgrow it by adolescents
Describe benign rolandic epilepsy syndrome
Simple partial seizures Often nocturnal Prodrome: Tingling feeling in mouth Speech can be affected Jerking of the mouth
Name some childhood epilepsy syndromes
Benign Rolandic Epilepsy Childhood absence seizures Juvenile Myoclonic Epilepsy Lennox Gastaut Syndrome Infantiles Spasms (West Syndrome)
Explain Childhood absence seizures syndrome
Seizures occur frequently V. brief (few scs) Often go unnoticed Look bland or stare Eyelids may flutter Unresponsive to surroundings Abrupt onset Abrupt offset
Rx for absence seizures
Ethosuximide
What 3 types of seizures occur in juvenile myoclonic epilepsy
Myoclonic
Tonic cloni
Absence
What is the trigger for seizures in 40% juvenile myoclonic epilepsy
Photosensitivity
Flashing/flickering lights
What types of seizures can occur in Lennox Gastaut Syndrome
Tonic Atonic Myoclonic Tonic clonic Atypical absences ‘drop attacks’
Rx for Lennox Gastaut Syndrome
Difficult to treat
Sodium valproate 1st line generally
Describe seizures in infantile spasms (west syndrome)
Brief spasms or jerks
Involving head, trunk, extremities
Happen in clusters (episodes 1-2 secs)
Typically occur before sleep, after waking
When does infantile spasm syndrome typically begin
First year of life
What does EEG show in infantile spasm
Hypsarrhythmia
Rx for infantile spasms
Vigabatrin
Ketogenic diet
Prednisolone
What can infantile spasms develop into/
Lennox Gastaut syndrome
What do many children with Lennox-Gastaut syndrome
Learning difficulties
Behavioural problems
when does Juvenile Myoclonic Epilepsy occur
Adolescents
Typically 12-18yrs
