neurology

Question 1

common problems

Answer 1

migraine
traumatic brain injury
tourette syndrome
epilepsy
brain tumour

Question 2

headache

Answer 2

chronic progressive
chronic non progressive
growth is very important to access
not growing well- congenital brain tumour (craniopharyngioma)
common causes of secondary headache- sinuses

differentiate primary/secondary

Question 3

Pointers to child hood migraine

Answer 3

abdo pain, nausea, vomiting
focal symptoms/ signs, during after attack
Aura, aggravated by bright light and sound
family history positive
relation to fatigue / stress
Hemicranial pain
Throbbing/ pulsatile
Abdo pain, nausea, vomiting
Relieved by rest
Photophobia/ phonophobia
Visual, sensory, motor aura
Positive family history

Question 4

tension headache

Answer 4

symptomless, present all the time.

Question 5

Management

Answer 5

Acute attack: effective pian relief, triptans

Preventative (at least 1/week): Pizotifen, Propranolol, Amitryptyline, Topiramate, Valproate

more than one migraine a week
preventive treatment.

Question 6

syncope

Answer 6

Faint (a neuro-cardiogenic mechanism)

Question 7

Epileptic seizure

Answer 7

abnormal hypersynchronous discharge from a group of neurons mainly your cortex

Question 8

Febrile seizures

Answer 8

read more

An 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
Commonest cause of ‘acute symptomatic seizure’ in childhood

Question 9

seizure type

Answer 9

Fall: Atonic/ tonic/ myoclonic

Question 10

infantile spams

Answer 10

6months to 12 months

Question 11

tonic clonic seizures

Answer 11

eyes are open

difficulty breathing

Question 12

provoked seizure

Answer 12

environmental stimulus overstimulates vagus nerve

Question 13

diagnosis

Answer 13

History
Video recording of event
ECG in convulsive seizures
Interictal/ ictal EEG
MRI Brain: to determine etiology eg. Brain malformations/ brain damage
Genetics: idiopathic epilepsies are mostly familial; also single gene disorders eg. Tuberous sclerosis
Metabolic tests: esp if associated with developmental delay/ regression

Question 14

How fontanelles close

Answer 14

two gaps anterior and posterior fontanelle

posterior close in 3 months
anterior close 18 to 22 months

Question 15

Abnormal head shape

Answer 15

Plagiocephaly ‘flat-head’
Brachycephaly ‘short head or flat at back’- down syndrome
Scaphocephaly ‘boat shaped skull’
Craniosynostosis

Question 16

When to suspect a NM disorder

Answer 16

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

Complete head lag

Question 17

Muscular dystrophy

Answer 17

CK is raised