Neurology Flashcards
1
Q
Definition of Cerebral Palsy
A
- Dynamic/changine disorder of posture and movement caused by a non-progressive lesion to the developing barin
- Causes
- Antenatal - toxins, teratogens, inutero infection
- Perinatal - hypoxic insult, sepsis
- Postnatal - meningitis, trauma
- Most causes are antenatal and not related to birth asphyxia
2
Q
Classification of Cerebral Palsy
A
- Neurological
- Spastic (increased tone)
- Dystonic (muscle spasm)
- Choreoathetoid/dyskinetic (increased activity)
- Ataxic (impaired coodrination)
- Mixed
- Topographical
- Tetraplegic (all 4 limbs implies lesion in both hemispheres)
- Hemiplegic (one side of body implies lesion of one hemisphere)
- Diaplegic (lower limbs implies lesion of white matter at back of brain)
3
Q
Definitions in Cerebral Palsy
A
- Plegia = paralysis
- Paresis = weakness
- Spasticity = increased resistance on stretch which is velocity dependant
- Dystonia = a muscle spasm not dependant on stretch, can cause abnormal posture at rest
- Ataxia = incoordination of power, speed, distance for a movement
4
Q
Co-morbidities in Cerebral Palsy
A
- Epilepsy
- Learning disability
- Behaviour problems
- Feeding problems/GORD
- Osteoporosis
5
Q
Management of cerebral palsy
A
- Define underlying pathology
- MDT approach
- Manage co-morbidities (i.e. epilepsy, feeding problems)
- Prevent deformity (physiotherapy, botulinium toxin, surgery in special cases)
6
Q
Definitions of spina bifida/spinal dysraphism/NTDs
A
- In a myelomeningocele there is outpouching of the spinal cord and it’s coverings through a defect in posterior elements of vertebral arches
- Associated problems - mobility, sensation, bowel and bladder function, hydrocephalus, specific learning problems (sometimes)
- In a myelomeningocele cervical cord and brainstem are likely to be affected - the Chiari Malformation
- Review role of folic acid in prevention of NTDs
- In spina bifida there is flaccid weakness of lower limbs, reflexes absent and lack of sensation - also look for evidence of ventriculo-peritoneal shunt
7
Q
Classification of Spina bifida
A
- Community ambulator (L3 level and lower) - can walk for most activities
- Household ambulators (L3 or mid lumbar) - can walk indoors and wheelchair for outdoors
- Nonfunctional ambulators (L1 to L3) - may walk for therapy sessions but wheelchair otherwise
- Nonambulators - wheelchair bound
8
Q
Muscular dystrophy
A
- Duchenne muscular dystrophy and becker dystrophy aer due to mutations in the X-linked dystrophin gene - in Becker there is weakness but still significant amount of dystrophin
- Clinical diagnosis - muscle weakness, Gower’s sign, lumbar lordosis, calf muscle hypertrophy, learning problems (speech common)
- Investigations - elevated CK, DNA testing, monitor cardiac and respiratory function
- Management - genetic counselling, physiotherapy, OT input, surgery, steroids and respiratory support
9
Q
Definition of Epilepsy
A
- An epileptic seizure is a transient occurence of signs and/or symptoms due to abnormal excessive or synchronous neuronal activity in the brain
- Defined by:
- At least 2 unprovoked seizures occurring more than 24 hours apart
- One unprovoked seizure and a probability of further seizures similar to general recurrence risk after 2 unprovoked seizures
- At least 2 seizures in a setting of reflex epilepsy
10
Q
Assessment of epilepsy
A
- Clinical assessment
- EEG
- Imaging
- Other biomarkers (i.e. genes)
11
Q
Causes of epilepsy
A
- Genetic
- Stroke
- ID/CP
- Head trauma
- Brain tumour
- Infection
- Other
12
Q
Febrile seizures
A
- Seizure when temperature above 38oC
- Recovery position, remove tight clothing around neck, look for signs of hypoxia and try to time seizure
- Call 999 if:
- Has a febrile seizure that lasts longer than 5 minutes
- The seizure involves only some parts of the body instead of the whole body
- Has trouble breathing or turns blue
- Isn’t responding normally
- Has another seizure within 24 hours
- Had to take an anti-seizure medicine to make the seizure stop
