Neurology Flashcards
what is involved in the neurological examination of a child?
observation of the child appearance gait head size skin findings
other neurological examination depending on age
what patterns of headache require further investigations?
isolated acute
chronic progressive
what are the different patterns of headaches?
isolated acute
acute recurrent
chronic progressive
chronic non-progressive
what questions would you ask in the history regarding a typical episode of their headache?
any warning? (aura) location? severity? duration? frequency?
what is involve in the clinical examination of a child with headache?
growth parameters, OFC blood pressure sinuses, teeth visual acuity fundoscopy visual fields cranial bruit focal neurological signs cognitive and emotional status
what is the most likely cause if a child presents with a headache and their growth is plautus?
craniopharyngioma
what is the difference in the distribution of a migraine vs tendon headache?
migraine - hemicranial pain
tendon - diffuse, symmetrical, band-like
describe features of a migraine.
hemicranial pain throbbing. pulsatile aggravated by light, noise relived by rest may go into dark, quiet room, lie down visual, sensory, olfactory aura positive family history abdominal pain ,nausea, vomiting
what features of a headache would indicate raised intracranial pressure?
aggravated by physical activity, lying down, coughing
woken up by sleep by headache +/- vomiting
when would you refer a child for neuroimaging with a headache?
features of cerebellar dysfunction
features of raised intracranial pressure
new focal neurological deficit e.g. squint
seizures
personality change
unexplained deterioration at work
what is the management of migraines?
immediate relief - triptans
preventative - propanolol, topiramate, amitryptilline
when would you give a child preventative medication for migraine?
> 1 per week
what is the management for a tension type headache in a child?
analgesia i.e. paracetamol
prevention i.e. amitryptilline
attention to psychological or emotional problems
aim to reassure that its nothing serious
what is an epileptic seizure?
an abnormal excessive hyper-synchronous discharge from a group of (cortical) neurones
what is an anoxic seizure and in what age group pis it most common?
commonly in toddlers
secondary seizure triggered by an environmental stimulus which stimulates the vagal nerve causing a brief stoppage of the heart
what is the most common age group for a febrile seizure?
3 months - 5 years
what is the commonest cause of an acute symptomatic seizure in childhood?
febrile seizure
what is the mechanism of an epileptic fit?
chemically triggered by;
- decreased inhibition
- excessive excitation
- excessive influx of Na and Ca ions
summation of multitude of electrical potentials result in depolarisation of many neurones which can lead to seizures
what is the use of an EEG?
helpful in confirming epilepsy after clinical diagnosis
useful in identifying seizure types, seizure syndrome, and etiology
what genetic condition can be the cause of epilepsy?
tuberous sclerosis
what is the management for focal and generalised epilepsy in children?
focal - 1st line Na valproate or levetiracetam (girls)
generalised - 1st line Carbamazepine
what non-drug treatments are there for epilepsy?
ketogenic diet surgery vagal nerve stimulation immunoglobulins steroids
when does the anterior and posterior fontanelles fuse?
posterior - 2-3 months
anterior - 18-24 months
what is mild and moderate/severe microcephaly?
mild OFC < 2SD
moderate/severe OFC > 2SD
what is craniosynostosis?
cranial stature fuse too early
doesn’t allow your head to grow
what is a cardinal presenting feature of a motor neurone problem?
muscle weakness
floppy
what features in a child would you suspect a motor neurone disorder?
floppy from both slips from the hands paucity of limb movements alert but less motor activity delayed motor milestones able tow all but frequent falls
what are features of duchesses muscular dystrophy?
waddling gait calf hypertrophy gower's sign positive elevated creatinine kinase (>10000) cardiomyopathy respiratory involvement in teens
what is the anatomical abnormality in spinal muscular atrophy?
anterior horn cell
would you find fasciculation in a neuropathy or myopathy?
neuropathy
are reflexes lost early in neuropathy or myopathy?
neuropathy
spared until late in myopathy
what is scaphocephaly?
boat shaped skull
what is brachycephaly ?
short head or flat at the back
what is plagiocephaly?
flat head
what is deformational plagiocephaly ?
deformation of the skull due to the position of the baby in utero - benign
