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Paediatrics > Neurology > Flashcards

Neurology Flashcards

1
Q

Patterns of headaches

A
  • Isolated acute
  • Recurrent acute
  • Chronic progressive
  • Chronic non-progressive
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2
Q

Questions to ask about recurrent or chronic headache history

A
  • Any warning?
  • Location
  • Severity
  • Duration
  • Frequency
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3
Q

Examination carried out for headaches

A
  • Growth parameters, OFC, BP
  • Sinuses, teeth, visual acuity
  • Fundoscopy
  • Visual fields (craniopharyngioma)
  • Cranial bruit
  • Focal neurological signs
  • Cognitive and emotional status
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4
Q

Pointers to childhood migraine

A
  • Associated abdominal pain, nausea, vomiting
  • Focal symptoms / signs before, during, after attack:
    • Visual disturbance, paresthesia, weakness
  • ‘Pallor’
  • Aggravated by bright light / noise
  • Relation to fatigue / stress
  • Helped by sleep / rest / dark, quiet room
  • Family history often positive
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5
Q

Migraine vs Tension headache

Site of pain

A
  • Migraine
    • Hemicranial pain
    • Pulsatile / throbbing
  • Tension headache
    • Diffuse, symetrical
    • Band-like distribution
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6
Q

Pointers to raised intracranial pressure

A
  • Aggravated by activities that raise ICP eg. Coughing, straining at stool, bending
  • Woken from sleep with headache +/- vomiting
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7
Q

Pointers to analgesic overuse headache

A
  • Headache is back before allowed to use another dose
  • Paracetamol/ NSAIDs
  • Particular problem with compound analgesics eg. Cocodamol
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8
Q

Indications for neuroimaging

A
  • Features of cerebellar dysfunction
  • Features of raised intracranial pressure
  • New focal neurological deficit eg. new squint
  • Seizures, esp focal
  • Personality change
  • Unexplained deterioration of school work
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9
Q

Management of migraine

A
  • Acute attack: effective pain relief, triptans
  • Preventative (at least 1/week): Pizotifen, Propranolol, Amitryptyline, Topiramate, Valproate
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10
Q

Management of tension type headache

A
  • Aim at reassurance: no sinister caus
  • Attention to underlying chronic physical, psychological or emotional problem
  • Acute attacks: simple analgesi
  • Prevention: Amitryptiline
  • Discourage analgesics in chronic TTH
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11
Q

Definition of epileptic seizure

A

An abnormal excessive hyper synchronous discharge from a group of (cortical) neurons.

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12
Q

Definition of epilepsy

A

A tendency to recurrent, unprovoked (spontaneous) epileptic seizures.

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13
Q

Non-epileptic seizures and other mimics in children

A
  • Acute symptomatic seizures: due to acute insults eg. Hypoxia-ischaemia, hypoglycemia, infection, trauma, febrile convulsion
  • Reflex anoxic seizure: common in toddlers
  • Syncope
  • Parasomnias eg. night terrors
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14
Q

Febrile convulsion

A

A seizure occurring in infancy/ childhood, usually between 3 months and 5 years of age, associated with fever but without evidence of intracranial infection or defined cause for the seizure.

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15
Q

What type of seizure will cause a child to jerk or shake?

A

clonic, myoclonic, spasms

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16
Q

What type of seizure will cause a stiff child?

A

usually a tonic seizure

17
Q

What type of seizure will cause a child to fall?

A

Atonic / tonic / myoclonic

18
Q

What type of seizure will cause a vanant attack?

A

absence seizure, complex partial seizure

19
Q

Role of EEG in epilepsy

A
  • An interictal EEG has limited value in deciding wether the individual has epilepsy
  • Useful in identifying seizure types, seizure syndrome and etiology
20
Q

Management of Epilepsies in children

A
  • Anti-epileptic drugs (AED) should only be considered if diagnosis is clear even if this means delaying treatment
  • Role of AED is to control seizures, not cure the epilepsy
  • Start with one AED: slow upward titration until side-effects manifest or drug is considered to be inefficient.
21
Q

Side effects of antiepileptic drugs

A

CNS related can be detrimental

  • drowsiness
  • effect on learning
  • cognition and behavioural
22
Q

Epilepsy Management : Drug treatment

First line for generalised epilepsies

A

Sodium Valproate (not in girls) or Levetiracetam

23
Q

Epilepsy Management : Drug treatment

First line for focal epilepsies

A

Carbamazepine

24
Q

Other epilepsy therapies (mostly for drug resistant epilepsies)

A

steroids, immunoglobulins and ketogenic diet

25
Q

What measurement is taken for head size?

A

Occipitofrontal circumference

26
Q

Definition of microcephaly

A
  • OFC <2 SD: mild
  • OFC <3 SD: moderate/ severe
27
Q

What to consider in microcephaly

A
  • Prenatal or postnatal onset: is it crossing centiles downwards?
  • Timing of onset may be a clue
  • Multiple causes: antenatal, postnatal, genetic and environmental
28
Q

Definition of macrocephaly

A

OFC > 2SD

29
Q

Things to consider in macrocephaly

A
  • Is it crossing centiles upwards?
  • Sutures?
  • Fontanelles?
  • Familial?
  • Hydrocephalus
  • Large brain?
  • Development normal?
  • Other physical abnormalities – facial features, hepatosplenomegaly, bony deformities etc
30
Q

When should a neuromuscular disorder be suspected?

A
  • Baby ‘floppy’ from birth
  • Slips from hands
  • Paucity of limb movements
  • Alert, but less motor activity
  • Delayed motor milestones
  • Able to walk but frequent falls
31
Q

Duchenne Muscular Dystrophy symptoms

A
  • Delayed gross motor skills
  • Symmetrical proximal weakness
  • Elevated Creatinine Kinase levels
    • >1000 in DMD
  • Cardiomyopathy
  • Respiratory involvement in teens
32
Q

Neuropathy vs Myopathy

Site of weakness

A

Neuropathy - distal weakness

Myopathy - usually proximal

33
Q

Neuropathy vs Myopathy

Sensory

A

Neuropathy - may have concomitant sensory symptoms and signs

Myopathy - usually pure motor

34
Q

Neuropathy vs Myopathy

Reflexes

A

Neuropathy - reflexes lost early

Myopathy - reflexes preserved till late

35
Q

Neuropathy vs Myopathy

Fasciculations

A

Neuropathy - fasciculations may be present

Myopathy - not typical

36
Q

Neuropathy vs Myopathy

Contractures

A

Neuropathy - contractures not a feature

Myopathy - contractures present

37
Q

Neuropathy vs Myopathy

Myocardial dysfunction

A

Neuropathy - not a typical feature

Myopathy - may have accompanying cardiac dysfunction with the dystrophies

Paediatrics (38 decks)

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