Neurology Flashcards
4 patterns of headaches in childhood
isolated acute
recurrent acute
chronic progressive
chronic non-progressive
Typical episode of headache questions
any warning? location? severity? duration? frequency?
headache examination
growth, OFC, bp sinuses, teeth, vision fundoscopy visual fields cranial bruit focal signs
pointers to childhood migraine
associated abdo pain, N&V Focal symptoms before/during/after - tingling aggravated by light/noise relation to fatigue/stress helped by sleep, quiet FH
Migraine vs TTH location
migraine is hemicranial
TTH - diffuse, symmetrical
pointers to raised ICP
aggravated by coughing, bending
woken from sleep
Indications for neuroimaging
cerebellar dysfunction
raised ICP
new focal neurological deficit eg new squint
seizures - esp focal
managing migraine
acute attack - triptans
prevent - amitriptyline, valproate, propanolol
TTH treatment
reassure, MDT, underlying stress
simple analgesia
amitriptyline?
convulsion
fit where there is a prominent motor activity
Epileptic seizure
abnormal excessive hypersynchronous discharge from neurons
Non epileptic seizures
syncope parasomnias psychogenic hypoglycaemia reflex anoxic seizures - preceded by trauma
What is a febrile convulsion?
3 months - 5 years
fever
no intracranial infection or defined cause
commonest cause of acute symptomatic seizure in childhood
febrile convulsion
jerk/shake seizure types
myoclonic, clonic, spasm
stiff seizure type
tonic
fall seizure type
atonic/tonic/myoclonic
chemical trigger of epileptic fit
decreased inhibition - GABA
Excessive excitation - glutamate
excess Na and Ca influx
Child epilepsies vs adult epilepsies
idiopathic
most generalised
can be subtle
Role of EEG
interictal has limited value
seizure type, aetiology
Diagnosing epilepsy
history video recording EEG in seizure MRI brain genetics eg tuberous sclerosis metabolic tests
Epilepsy drug treatment
sodium valproate - generalised (not girls) carbamazepine - focal lamotrigine, steroids, immunoglobulins VNS Surgery
When to suspect NM disorder
baby floppy from birth slips from hands alert but less motor activity delayed milestones able to walk but frequent falls
Sign which indicates pelvic girdle weakness
Gower’s
