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
What measurement is taken for head size?
Occipitofrontal circumference
Definition of microcephaly
- OFC <2 SD: mild
- OFC <3 SD: moderate/ severe
What to consider in microcephaly
- Prenatal or postnatal onset: is it crossing centiles downwards?
- Timing of onset may be a clue
- Multiple causes: antenatal, postnatal, genetic and environmental
Definition of macrocephaly
OFC > 2SD
Things to consider in macrocephaly
- Is it crossing centiles upwards?
- Sutures?
- Fontanelles?
- Familial?
- Hydrocephalus
- Large brain?
- Development normal?
- Other physical abnormalities – facial features, hepatosplenomegaly, bony deformities etc
When should a neuromuscular disorder be suspected?
- 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
Duchenne Muscular Dystrophy symptoms
- Delayed gross motor skills
- Symmetrical proximal weakness
- Elevated Creatinine Kinase levels
- >1000 in DMD
- Cardiomyopathy
- Respiratory involvement in teens
Neuropathy vs Myopathy
Site of weakness
Neuropathy - distal weakness
Myopathy - usually proximal
Neuropathy vs Myopathy
Sensory
Neuropathy - may have concomitant sensory symptoms and signs
Myopathy - usually pure motor
Neuropathy vs Myopathy
Reflexes
Neuropathy - reflexes lost early
Myopathy - reflexes preserved till late
Neuropathy vs Myopathy
Fasciculations
Neuropathy - fasciculations may be present
Myopathy - not typical
Neuropathy vs Myopathy
Contractures
Neuropathy - contractures not a feature
Myopathy - contractures present
Neuropathy vs Myopathy
Myocardial dysfunction
Neuropathy - not a typical feature
Myopathy - may have accompanying cardiac dysfunction with the dystrophies
