Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Paediatrics > Neurology > Flashcards

Neurology Flashcards

1
Q

Define cerebral palsy

A

Permanent disorder of movement and/or posture and motor function due to non-progressive abnormality of developing brain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Causes of cerebral palsy

A

80% antenatal - prematurity, genetic, infection
10% intrapartum - hypoxic-ischaemic encephalopathy
10% postnatal - infection, trauma, hyperbilirubinaemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What are the early clinical features of CP

A

Abnormal posture and tone, delayed motor milestones
Feeding difficulties
Abnormal fair
Asymmetric hand function before 12 months

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What are the types of CP

A

Spastic: unilateral, bilateral Diplegia, bilateral quadriplegia
Dyskinetic
Ataxic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Cause of spastic CP

A

UMN lesions
Unilateral - perinatal MCA infarct
Bilateral diplegic - damage to periventricular areas
Bilateral quadriplegic - extensive damage to periventricular areas

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What are clinical features of spastic CP

A

Unilateral
spastic or dystonic tone,
arm > leg,
walks w or wo aid (GSM 1-2)

Biplegic
legs > arms
young child - walk on toes + scissoring,
older - crouch gait

Quadriplegic 
Learning difficulty 
Feeding difficulty 
Problems with speech, vision, hearing 
Seizures 
Requires powered mobility 
Dependent for ADLs
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Clinical features of dyskinetic CP

A 
Floppiness
Delayed motor development 
Poor trunk control 
Abnormal movements - dystonia, chorea, athetosis 
Feeding difficulty 
Dependent on ADLs
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What causes dyskinetic CP

A

Hypoxic-ischaemic encephalopathy at term

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Define chorea, athetosis, dystonia

A

Chorea: irregular, sudden, non-repetitive movements
Athetosis: slow writhing movements occurring more dismally
Dystonia: twisting movements due to simultaneous contraction of agonist and antagonist muscles

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What causes Ataxic CP

A

Genetic

Acquired - cerebellar injury

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Clinical features of ataxic CP

A 
Hypotonia 
Poor balance
Delayed motor development 
Incoordination
Intention tremor
Ataxic gait
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

CP investigations

A

History - for static neurological insult

MRI brain - periventricular leukomalacia in prematurity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

CP management

A 
Complex multidisciplinary input 
Stretching exercises 
Orthoses, wheelchair, sleeping and standing systems 
Botulinum toxin injection 
Speech therapy 
Learning support
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Floppy infant - causes?

A 
Floppy strong (CNS) 
Prematurity 
Hypoxic-ischaemic encephalopathy 
Trisomy 21 / chromosomal 
In-born errors of metabolism 
Hypoglycaemia
Hypothyroidism 
Sepsis 
Floppy weak (PNS, NMJ, muscle disease) 
Spinal muscular atrophy
Myasthenia gravis
Congenital myotonic dystrophy 
Congenital muscular dystrophy 
Metabolic myopathies 
Congenital myopathies 
Peripheral neuropathies
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Floppy infant - clinical features

A 
All:
Generalised hypotonia
Frog-leg posture
Respiratory failure 
Hx obstetric complications - polyhydramnios, breech

Central:
Encephalopathy
Reasonable muscle strength
Increased tendon reflexes

Peripheral: 
Muscle - weakness, myotonia, fasciculations, fatiguing 
Reduced tendon reflexes 
Little facial expression 
Ptosis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Floppy infant - investigations

A 
Exclude severe systemic illness
O2 + ventilatory support (for Resp failure) 
Family, antenatal Hx
Exam (to distinguish cause) 
Central: 
glucose, U+E, Ca, Mg, septic screen,  CRP,  TFT, Karyotype, IEM screen 
cranial uss, MRI, EEG 
Peripheral: 
Muscle USS 
EMG, nerve conduction studies
Muscle or Surat nerve biopsy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Classification of headaches

A

Primary:
Tension
Migraine
Cluster

Secondary: 
Medication overuse
Medication withdrawal 
Intracranial haemorrhage, Vascular malformation 
Head/neck trauma
Meningitis/encephalitis 
Acute sinusitis, acute glaucoma 
HTN, hypercapnia

Cranial neuralgias, central facial pain:
Trigeminal neuralgia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Uncommon forms of migraine

A

Familial hemiplegic migraine
Sporadic hemiplegic migraine
Basilar-type migraine: vomiting, nystagmus, cerebellar signs
Periodic syndromes:
Cyclical vomiting - recurrent episodes of N+V
Abdominal migraine - recurrent episodes of midline abdo pain
Benign paroxysmal vertigo of childhood - recurrent episodes of vertigo

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Management of headaches

A

Rescue:
Analgesics - NSAIDs, paracetamol
Antiemetic
Triptan (serotonin agonist)

Preventative: 
Topiramate (Na channel blockers) 
Propranolol 
Tricyclists (pizotifen, amitriptyline) 
Acupuncture 
Supportive:
Lifestyle changes 
cold compress, warm pads 
psychological support 
relaxation techniques
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Define febrile seizure

A

Epileptic seizure accompanied by pyrexia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Epidemiology of febrile seizure

A

5%

6 months - 6yrs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Risk factors for febrile seizures

A

Family Hx

Viral illness - rapid rise in temperature

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Clinical features of febrile seizure

A

Generalised tonic clonic seizure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Prognosis of febrile seizure

A

Self resolving, within 5 minutes
Not associated with brain damage
Not associated with increased risk of epilepsy
Increased risk of epilepsy if complicated - prolonged, focal, recurrent

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Management of febrile seizure

A

Reassurance and education

Buccal midazolam If Hx of prolonged seizures

26
Q

Define seizure

A

Paroxysmal abnormality in motor/sensory/autonomic/cognitive function due to transient brain dysfunction

27
Q

What is epileptic seizure

A

Seizure due to excessive and hypersynchronous electrical activity

28
Q

What is epilepsy

A

Brain disorder that predisposes patient to have unprovoked epileptic seizures

29
Q

What is convulsion

A

Seizure with motor components - tonic, clonic, myoclonic, spams, hypermotor

30
Q

Causes of seizures

A

Epilepsy
Acute symptomatic seizures
Febrile seizures

Non-epileptic seizures:
Syncope
Sudden rise in ICP
Sleep disorders
Functional/behavioural
31
Q

What is acute symptomatic epileptic seizures

A

Provoked epileptic seizure due to brain injury

E.g. stroke, traumatic brain injury, intracranial infection, hypoglycaemia, electrolyte disturbance, toxins

32
Q

What are paroxysmal disorders

A

Funny turns

Recurrent movement disorders with acute onset and ending

33
Q

Causes of paroxysmal disorders

A 
Epilepsy 
Blue breath holding spells 
Reflex asystolic syncope 
Syncope 
Migraine 
Long QT Syndrome 
Self gratification 
Non-epileptic attack disorder 
Induced illness 
GORD 
Paroxysmal movement disorders - tics
34
Q

Clinical features of non-epileptic attack disorder

A 
Provoked by emotional precipitants
Do not occur during sleep
Intractable despite medicine
Onset gradual 
Injury during fall fare 
No post-ictal phase or amnesia
Hx of abuse
35
Q

Clinical features of breath holding spells

A

Precipitated by anger
Vigorous cry followed by period of blocked respiration
Resulting in cyanosis, loss of consciousness
Sometimes opisthotonos posturing - muscle spasm leading to pronounced hyper-extension with head and lower limbs bend backwards and trunk arched forward)

36
Q

Clinical features of reflex asystolic seizure

A

Precipitated by mild injury - cold food, head trauma, fever
Becomes pale and loss of consciousness
Cerebral hypoxia may lead to opisthotonic posturing and brief clonic movements

37
Q

Clinical features of syncope

A

Happens in standing position
Accompanied by pallor and seating
Quick recovery and no post-ictal phase

38
Q

Clinical features of parasomnia

A

Occur in first few hours of sleep
Not repetitive in same night
Normal EEG during event

39
Q

Clinical features of GORD

A

Infant gasping and becoming apnoeic and stiff
Change in skin colour
Sandifer Syndrome - spastic torticollis, dystonic movements
Occurs within 1 hour of feed

40
Q

Aetiological Classification of epilepsy with generalised seizures

A 
Genetic
Structural
Metabolic
Infectious
Immune 
Unknown
41
Q

Pathophysiology of epilepsy

A

Increased neuronal excitability and synchronicity

Abnormal neuronal activity Originate at single point within brain and rapidly engage bilaterally distributed networks

42
Q

Classification of epilepsy type

A

Focal:
Originate in networks limited to one hemisphere

Generalised:
Originate in bilaterally distributed networks
Loss of consciousness >3 seconds

43
Q

Differences bw clonic and Myoclonic movements

A

Tonic: rhythmic muscular jerking movements
Myoclonic: arrhythmic muscular jerking movements

44
Q

Classification by seizure type of focal epilepsy

A 
Focal Aware / Focal Impaired awareness 
Motor onset:
Automatism
Atonic
Clonic
Epileptic spasms
Hyperkinetic
Myoclonic
Tonic 
Non-motor onset: 
Autonomic
Behaviour arrest
Cognitive
Emotional
Sensory
45
Q

Classification of generalised epilepsy by seizure type

A 
Non-motor/absence: 
Typical 
Atypical
Myoclonic
Eyelid myoclonia
Motor:
Tonic clonic
Tonic
Clonic
Myoclonic
Myoclonic tonic clonic
Myoclonic atonic
Atonic
Epileptic spasms
46
Q

What causes genetic generalised epilepsy, what syndromes does it cover

A

Caused by genetic mutations at several loci, thus complex inheritance and de novo mutations
Childhood absence epilepsy, Juvenile absence epilepsy, juvenile myoclonic epilepsy, generalised tonic clonic seizures

47
Q

Clinical features of infantile spasms

A

<1 years (excluding neonates)
Violent flexor spasms of head, trunk, limbs
Lasts 1-2 seconds, in multiple bursts of 20-30 seconds
Child distressed
Social interaction deteriorates
EEG: hysparrhythmia - chaotic background with slow-wave activity

48
Q

Clinical features of Lennox-Gastaut syndrome

A

Early childhood: 1-6
Multiple seizure types: Atonic, atypical absence, tonic clonic, myoclonic
Associated with: Neurodevelopmental arrest, regression, behaviour disorder

Poor prognosis

49
Q

Clinical features of panayiotopoulos syndrome

A

Early childhood: 1-6
Autonomic features, vomiting
Unresponsive staring in sleep
Head and eye deviation

EEG: occipital discharges when eyes shut

50
Q

Clinical features of childhood absence epilepsy

A 
Middle childhood: 6-10
Momentary unresponsive stare with motor arrest
May twitch eyelids, hands, mouth 
Sudden onset, lasts <30 seconds 
Child has no recall
Developmentally normal

Induced by hyperventilation
Good prognosis - 80% remission

51
Q

Clinical features of benign rolandic epilepsy

A

Middle childhood: 6-10
Tonic clonic seizures in sleep or Focal aware seizures with abnormal sensation in tongue and distortion of face (rolandic area of brain)

EEG: Focal sharp waves in rolandic area
Remits in adolescence
Does not require AEDs

52
Q

Clinical features of juvenile absence epilepsy

A

Adolescence: 10-14
Absences and generalised tonic clonic seizures
Often photosensitivity

53
Q

Clinical features of Juvenile myoclonic epilepsy

A

Adolescent: 10-14
Myoclonic seizures, Generalised tonic clonic seizures, Absences
Often after waking - throwing cereal in morning

54
Q

Risk factors for epilepsy

A 
Genetic: family history,  Fragile X syndrome, Angelman syndrome 
Perinatal asphyxia 
Metabolic disorders
Neurodegenerative disorders
Head trauma
Structural abnormalities of CNS
55
Q

Clinical features of epileptic seizures

A

Incontinence
Tongue biting
Post-ictal phenomena: sleepiness, headaches, amnesia, confusion
Precipitated by fatigue of lack of sleep
Precipitated by light or noise
Developmental delay - Lennox gastaut Syndrome, myoclonic absence
Intercurrent illness

56
Q

Clinical features of absence seizure

A

Staring spells or inattention
+/- Motor arrest or stereotyped movements
Typical: behavioural arrest or staring, lasting 5-10 seconds, interrupting normal activity, can be hyperventilation induced
Atypical: less distinct beginning and end, not precipitated by hyperventilation

57
Q

Clinical features of tonic clonic seizures

A

Tonic phase - fall unconscious and extension/flexion of extremities
Clonic phase - violent muscle contractions
Associated with: eyes roll back in head, tongue biting, incontinence
May be preceded by aura
Followed by post ictal phenomena

58
Q

Investigations for epilepsy

A

EEG: inter-ictal recording shows abnormal rhythms specific to epilepsy syndrome, can be provoked by sleep deprivation, hyperventilation, photic stimulation

ECG: exclude cardiac cause

FBC
Blood glucose
Metabolic panel: exclude metabolic and electrolyte abnormalities
Genetic tests: if developmental delay

MRI brain: if structural cause suspected

59
Q

Management of epileptic spasms

A

Vigabatrin + ACTH/corticosteroid

60
Q

Management of Lennox gastaut Syndrome

A

Sodium valproate / clonazepam

61
Q

Treatment for other generalised epilepsy syndromes

A

Sodium valproate / Lamotrigine / Levetiracetam

62
Q

Treatment for focal epilepsy

A

Carbamazepine

Paediatrics (15 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions