Neurology Flashcards
Patterns of headaches
- Isolated acute
- Recurrent acute
- Chronic progressive
- Chronic non-progressive
Questions to ask about recurrent or chronic headache history
- Any warning?
- Location
- Severity
- Duration
- Frequency
Examination carried out for headaches
- Growth parameters, OFC, BP
- Sinuses, teeth, visual acuity
- Fundoscopy
- Visual fields (craniopharyngioma)
- Cranial bruit
- Focal neurological signs
- Cognitive and emotional status
Pointers to childhood migraine
- 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
Migraine vs Tension headache
Site of pain
- Migraine
- Hemicranial pain
- Pulsatile / throbbing
- Tension headache
- Diffuse, symetrical
- Band-like distribution
Pointers to raised intracranial pressure
- Aggravated by activities that raise ICP eg. Coughing, straining at stool, bending
- Woken from sleep with headache +/- vomiting
Pointers to analgesic overuse headache
- Headache is back before allowed to use another dose
- Paracetamol/ NSAIDs
- Particular problem with compound analgesics eg. Cocodamol
Indications for neuroimaging
- 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
Management of migraine
- Acute attack: effective pain relief, triptans
- Preventative (at least 1/week): Pizotifen, Propranolol, Amitryptyline, Topiramate, Valproate
Management of tension type headache
- 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
Definition of epileptic seizure
An abnormal excessive hyper synchronous discharge from a group of (cortical) neurons.
Definition of epilepsy
A tendency to recurrent, unprovoked (spontaneous) epileptic seizures.
Non-epileptic seizures and other mimics in children
- 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
Febrile convulsion
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.
What type of seizure will cause a child to jerk or shake?
clonic, myoclonic, spasms
What type of seizure will cause a stiff child?
usually a tonic seizure
What type of seizure will cause a child to fall?
Atonic / tonic / myoclonic
What type of seizure will cause a vanant attack?
absence seizure, complex partial seizure
Role of EEG in epilepsy
- An interictal EEG has limited value in deciding wether the individual has epilepsy
- Useful in identifying seizure types, seizure syndrome and etiology
Management of Epilepsies in children
- 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.
Side effects of antiepileptic drugs
CNS related can be detrimental
- drowsiness
- effect on learning
- cognition and behavioural
Epilepsy Management : Drug treatment
First line for generalised epilepsies
Sodium Valproate (not in girls) or Levetiracetam
Epilepsy Management : Drug treatment
First line for focal epilepsies
Carbamazepine
Other epilepsy therapies (mostly for drug resistant epilepsies)
steroids, immunoglobulins and ketogenic diet
