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Paeds > Neurology > Flashcards

Neurology Flashcards

1
Q

A child presents complaining of headaches, what would you want to ask?

A
  • Recurrence?
  • More than 1 type?
  • Warning?
  • SOCRATES
  • Use of analgesia?
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2
Q

What would you examine on a kid with a headache?

A

Growth parameters (height, weight, OFC, BP)
Sinuses & teeth
Visual acuity, fields and fundoscopy- raised ICP
Listen for cranial bruit
Focal neurological signs- Craniopharyngioma
Cognitive/emotional status

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3
Q

Headaches in kids fall into 4 groups:

A
  • Migraines
  • TTHs
  • Raised ICP
  • Analgesic Overuse
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4
Q

How would you make the diagnosis of a migraine?

A

Hemicranial, throbbing & pulsatile headache

Relieved by rest
Often photo/phonophobic

Presence of an aura

Also useful to look for FH

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5
Q

How would you diagnose a tension type headache?

A

If a child sufferes from a constant diffuse, symmetrical (band-like distribution) headache

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6
Q

How would you treat a migraine?

A

Give them simple analgesics for acute attacks
Maybe Triptans if bad enough

If atleast 1/wk give preventative drugs:

  • Propranolol
  • Amitriptyline
  • Valproate
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7
Q

How do you manage a tension type headache?

A

Reassure the parent it’s nothing sinister

Attend to chronic underlying physical/psychological/emotional stressors

Discourage chronic use of analgesics

If necessary you can use simple analgesics acutely and amitriptyline preventatively

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8
Q

How would you spot a medication overuse headache

A

High use of PCM/NSAIDs (more problematic if with compound analgesics e.g. cocodamol)

Pain returns before they can have another dose

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9
Q

What would be red flags of a raised ICP headache?

A
  • Wakens them from sleep with headache and vomiting

- Aggravated by raising ICP e.g. coughing, toilet straining or bending over

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10
Q

Headaches are diagnosed clinically, when would you want to use imaging?

A

1) Cerebellar dysfunction e.g. ataxia
2) Raised ICP
3) New focal deficit e.g. new squint
4) Seizures
5) Personality change
6) Unexplained deterioration in schoolwork

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11
Q

What are the major causes of fits/falls/funny turns in kids?

A

1) Epilepsy
2) Acute Symptomatic seizures e.g. febrile convulsion
3) Reflex Anoxic Seizures
4) Syncope
5) Parasomnias e.g. night terrors
6) Psychogenic Seizures

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12
Q

What causes reflex anoxic seizures?

A

Trigger e.g. pain or fright –> Vagal overactivity –> bradycardia –> hypoxia & seizure

It’s not abnormal in toddlers

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13
Q

What is an Acute Symptomatic Seizure?

A

A response to an acute insult e.g. hypoglycaemia, infection or hypoxia

The most common form is a Febrile Convulsion (very common, ~1in20 kids). Seizure ass with fever but with no intracranial inf or defined cause

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14
Q

What can you use to diagnose epilepsy?

A

Mostly a clinical diagnosis!!!

  • History
  • Video recordings
  • ECG
  • Interictal/Ictal EEG
  • MRI (For malformations)
  • Genetics (Familial & single gene disorders e.g. Tuberous Sclerosis)
  • Metabolic tests if ass with developmental delay
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15
Q

What causes epilepsy in kids?

A

Mostly it’s idiopathic

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16
Q

Is childhood epilepsy generalised or focal?

A

Mostly generalised

17
Q

What factors are important when determining drug treatment for epilepsy?

A
  • Age
  • Gender
  • SEizure type
  • Epilepsy type
18
Q

What drugs do we use for childhood epilepsy?

A 
Generalised = Sodium Valproate
Focal = Carbamazepine

New better tolerated drugs e.g. Lamotrigine

19
Q

What are the major SEs of Anti-Epileptic Drugs (AEDs)?

A

CNS - Drowsiness, impacted learning, cognition & behaviour

Others include rashes & bone marrow problems

20
Q

Other than AEDs how can you treat epilepsy?

A

Some forms respond to Vagus Nerve Stimulation or Surgery

21
Q

What signs would raise concern of a neuromuscular disorder in a pre-walking child?

A
  • Floppy
  • Slips from hands
  • Paucity of limb movements
  • Alert but low motor activity
  • Delayed motor milestones
  • Myopathic facies
22
Q

What signs would suggest a neuromuscular disorder in a walking child?

A
  • Frequent falls
  • Awkward/clumsy positioning e.g. holding shoulders back, belly out, walking on toes
  • Gait e.g. waddling
  • Pes Cavus & hammer toes
23
Q

What is pes cavus and hammer toes indicative of?

A

Charcot Marie Tooth Disease

24
Q

How can you differentiate a neuropathy from a myopathy?

A

Myopathy:

  • Proximal weakness
  • Purely motor
  • Preserved reflexes
  • Contractures
  • ~Myocardial dysfunction

Neuropathies:

  • Distal weakness
  • ~sensory involvement
  • Loss of reflexes
  • ~Fasciculations
25
Q

List some of the major neuromuscular disorders in kids?

A

Muscular dystrophies e.g. Duchenne’s
Spinal Atrophy
Myasthenia Gravis

26
Q

How is Duchenne’s MD inherited?

A

X-linked –> female carriers and male suffers

Xp21 - the dystrophin gene

27
Q

How would you expect Duchenne’s MD to present?

A 
Delayed gross motor skills
Symmetrical proximal weakness
Waddling gait
Calf hypertrophy
Gower's Sign

~ Cardiomyopathy & Resp involvement in teens

28
Q

How do you confirm Duchenne’s?

A

Gower’s sign (required but not specific)

Raised CK (>1000)

29
Q

How do we treat Duchenne’s?

A

Steroids, thanks to this sufferers can stay on their feet etc much longer and live into early 30s

30
Q

What’s the most common cause of collapse in kids/adolescents?

A

Vasovagal Syncope

31
Q

What questions would you ask about a collapse/fit/fall to ascertain cause?

A
  • Any precipitant?
  • Any prodromal symptoms?
  • Timescale
  • Time to recover
  • Fh of epilepsy, syncope etc
  • H/o collapse
  • Fever/illness

3rd party:

  • Eye movement
  • Limb movement
  • Colour
  • Response/consciousness
32
Q

What can cause vasovagal syncope?

A
  • Missing meals (hypoglycaemia)
  • Dehydration
  • Stress
  • Posture change
  • Heat
  • Straining
  • Blood taking
  • Arrythmia e.g. Long QT
33
Q

What can you test in syncope?

A

Glc at the time
ECG for arrhythmia
BP for hypotension

34
Q

What advice would you give someone who suffers from syncope?

A
  • Reassure that it’s not something serious
  • Drink lots
  • Have proper meals
  • Take care on changing posture
  • Return if it recurs
  • Exercise legs (improves venous return)
35
Q

Head shape abnormalities

A
  • Microcephaly
  • Macrocephaly
  • Brachycephaly
  • Scaphocephaly
  • Craniosynotosis
  • Plagiocephaly
36
Q

what is brachycephaly

A

Flat at back of head

37
Q

What is scaphocephaly?

A

Boat shaped skull

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