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Neurology Flashcards

1
Q

Define cerebral palsy

A

An umbrella term for a permanent disorder of movement and/or posture and of motor function due to a non-progressive abnormality in the developing brain

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2
Q

What is the incidence of cerebral palsy?

A

2 in 1000

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3
Q

How do we categorise the causes of cerebral palsy?

A

Antenatal
Before/during delivery
Postnatal

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4
Q

What are the most common causes of cerebral palsy?

A

Antenatal:
CVA
Cortical migration disorders
Structural maldevelopment

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5
Q

What percentage of CP is caused by hypoxic-ischaemic injury at delivery?

A

10%

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6
Q

Give some causes of post-natal CP

A 
Meningitis/encephalitis 
Head trauma
Symptomatic hypoglycaemia
Hydrocephalus
Hyperbilirubinaemia
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7
Q

What are the early features of CP?

A 
Abnormal limb or trunk posture and tone
Delayed motor milestones
Feeding difficulties
Abnormal gait
Asymmetric hand function before 12 months
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8
Q

What are the types of CP and which is most common?

A

Spastic - most common
Dyskinetic
Ataxic
Other/mixed

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9
Q

Describe the findings in a patient with spastic CP

A 
Damage to UMN:
Hypertonia
Hyperreflexia 
Babinski positive 
Clap knife - increased tone may suddenly yield under pressure 
Unilateral or bilateral
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10
Q

What is the management of CP?

A

Parental education
Careful follow up as more likely to have a wide range of associated medical/psychological problems
MDT
Treat hypertonia - botulinum toxin IM, intrathecal baclofen

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11
Q

Describe the rooting reflex

A

Head turns to stimulus when touched near mouth

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12
Q

Describe the primitive stepping response

A

Stepping movements when held vertically and dorsum of foot touches a surface

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13
Q

Describe the asymmetrical tonic neck reflex

A

When lying supine the infant adopts an outstretched arms to the side the head is turned

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14
Q

Describe sucking reflex

A

Child sucks when nipple is placed in mouth

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15
Q

Describe the parachute reflex

A

When suspended face down the baby’s arms extend

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16
Q

What is Tourette’s syndrome?

A

A neuropsychiatric disorder characterised by motor and vocal tics
Runs a fluctuating course

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17
Q

When is the typical onset of Tourette’s?

A

3-6 years

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18
Q

What is the ratio male to female of Tourette’s?

A

M:F 3:1

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19
Q

What are tics?

A

Sudden, purposeless, repetitive, non-rhythmic, stereotyped movements or vocalisations

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20
Q

What is the criteria for diagnosing Tourette’s?

A

Multiple motor tics and one or more vocal tics <18 years
Present for >1 year
Leads to significant impairment of function
Not due to substance abuse or secondary causes

21
Q

What is the management of Tourette’s?

A 
Education
Treat any co-morbidities
Counselling or psychotherapy
Habit reversal training
Atypical antipsychotics- risperidone
22
Q

Define epilepsy

A

Recurrent seizures resulting from involuntary disturbances in brain function
Unrelated to fever or acute insults

23
Q

Most children are started on one of which 2 AEDs?

A

Sodium valproate

Carbamazepine

24
Q

Ethosuximide can be used in children for which seizures?

A

Absence only

25
What are the features of neurofibromatosis 1?
Cafe au lait spots >1 neurofibroma Axillary freckling Optic glioma
26
What is the pattern of inheritance of the neurofibromatosis types?
Autosomal dominant
27
What are the features of NF type 2?
Bilateral acoustic neuromas | - deafness or cerebellopontine syndrome
28
Both NF 1 and 2 are associated with ....
MEN syndromes
29
List some viruses that cause meningitis in children
``` Mumps Coxsackie Echovirus Herpes simplex Poliomyelitis ```
30
List some bacterial causes a meningitis in children
Neisseria meningitidis Strep pneumoniae HiB Group B strep, E-coli and listeria (newborn)
31
What is found in an LP to confirm meningitis?
``` Cloudy Leukocytosis High protein Low glucose Cultured organism ```
32
What are the most common causes of encephalitis in children?
Herpes simplex virus | Mycoplasma pneumoniae
33
Describe the pathophysiology of generalised seizures
Synchronous discharge of electrical activity from a number of neurones, usually with loss of consciousness and abnormal movements
34
What percentage of epilepsy develops in childhood?
60%
35
Between what ages are febrile convulsions most likely to occur?
6 months - 5 years
36
At what concentration does paracetamol become hazardous?
150 mg/kg +
37
How long after paracetamol ingestion can hepatic necrosis occur?
3-4 days later
38
Give some differentials for a headache
``` Tension Raised ICP Infection Eye strain Migraine Analgesia Sinusitis Dental caries HTN ```
39
What criteria make it likely for a headache to be a migraine?
``` Episodic occurrence of headache Completely well between attacks Aura N+V Throbbing head aching, sometimes unilateral Positive family history Impairment of normal function Attack last 1-72 hrs ```
40
What is the management of migraines?
Rest and simple analgesia Combo therapy paracetamol and anti-emetic Migraine diary to identify triggers Prophylaxis - beta blockers or pizotifen Triptans in adolescents
41
How do we manage cluster headaches?
SC/nasal triptans - serotonin agonists | Calcium channel blockers for recurrence
42
What features make raised ICP the likely cause of headache?
``` Worse laying down Worse in morning Vomiting Blurred vision increased BP/decreased HR Focal nerve palsies ```
43
What is the medical management of idiopathic intracranial hypertension?
Acetazolamide
44
What is the second most common type of cancer in children?
Brain tumours
45
Where are most brain tumours located in children?
Posterior fossa | Brainstem or cerebellum
46
What age group tend to get neuroblastomas?
Children under five years old
47
Where does a neuroblastoma come from?
Arises in the neural crest tissue | Adrenal medulla or sympathetic nervous system
48
How does neuroblastoma present?
Abdominal mass Skin nodules Periorbital bruising
49
How do we diagnose a neuroblastoma?
Increased urinary catecholamine metabolites

Paediatrics (8 decks)

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