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Paediatrics > Neurology > Flashcards

Neurology Flashcards

1
Q

What are some features of a development history?

A

Motor milestones - gross and fine motor.
Speech and language development
Play esp. symbolic play and social behaviour
Early cognitive development
Self-help skills
Vision and Hearing assessment.

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2
Q

What are some features of the neurological exam in children?

A

Appearance
Gait
Head size
Skin findings

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3
Q

What are some common neurological conditions in children?

A 
Migraine
Traumatic Brain Injury 
Tourette syndrome
Epilepsy
Brain Tumours
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4
Q

What are some different patterns of headache children present with?

A

Acute recurrent
Chronic progressive
Chronic non progressive
Isolated acute

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5
Q

What examination would you carry out for a child with headache?

A 
Growth parameters
BP
Sinuses
Teeth
Visual acuity
Fundoscopy
Visual fields - craniopharyngioma
Cranial bruit
Focal neurological signs
Cognitive and emotional status.
Headache type
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6
Q

What are some factors that point to childhood migraine?

A 
Associated abdo pain, nausea and vomiting
Focal symptoms before, during, after attack. 
Pallo
Aggravated by bright light/noise
Relation to fatigue/stress
Helped by sleep/dark room/ rest
Family history often positive. 
Hemicranial pain
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7
Q

What are some features that indicate tension headache?

A

Diffuse, symmetrical
Band like distribution
Present most of the time
Constant ache

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8
Q

What are some features that point to raised intracranial pressure?

A

Aggravated by activities that raise ICO e.g coughing, straining at stool, bending.
Woken from sleep with headache +/- vomiting.

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9
Q

What are some features that point to analgesia overuse headache?

A

Headache is back before allowed to use another dose.
Paracetamol and NSAID use
Particular problem with compound analgesics e.g. cocodamol.

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10
Q

What are the indications for neuroimaging in a child?

A

Features of cerebellar dysfunction.
Features of raised ICP
New focal neurological deficit e.g. new squint.
Seizure esp. focal
Personality change
Unexplained deterioration of school work.

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11
Q

What is the management for migraine in children?

A

Effective pain relief for acute attacks e.g triptans.

Preventative (at least 1 a week) - Pizotifen, Propranolol, Amitryptyline, Topiramate, Valproate.

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12
Q

What is the treatment of Tension type headache in children?

A

Aim at reassurance there is no sinister cause.
Simple analgesia for acute attacks.
Prevention - Amitryptyline.
Discourage analgesics in chronic TTH.

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13
Q

What is a convulsion?

A

Seizure where there is prominent motor activity.

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14
Q

What is an epileptic seizure?

A

Electrical phenomenon that causes a sudden attack.

Abnormal excessive hyper synchronous discharge from a group of cortical neurones.

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15
Q

What is epilepsy?

A

Tendency to recurrent, unprovoked epileptic seizures.

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16
Q

What are some examples of non epileptic seizures?

A 
Hypoxia-ischaemia
Hypoglycaemia
Infection 
Trauma
Reflex anoxic seizure (common in toddlers)
Syncope
Parasomnias e.g night terrors
Behavioural stereotypes
Psychogenic non epileptic seizures.
17
Q

What is a febrile convulsion?

A

A seizure occurring in infancy/childhood, usually between 3 months and 5 yrs, associated with fever but without evidence of intracranial infection or defined cause for the seizure.

18
Q

What are some different seizure types?

A

Jerk/shake - clonic, myoclonic, spasms
Stiff - usually a tonic seizure
Fall - atonic, tonic, myoclonic
Vacant attack - absence, complex partial seizure.

19
Q

What are some mechanisms of epileptic fit?

A

Chemically triggered by:

  • decreased inhibition gamma-amino butyric acid (GABA)
  • excessive excitation of glutamate and aspartate
  • excessive influx of sodium and calcium ions.

Chemical stimulation produces an electrical current.

Summation of multiple electrical potentials results in depolarisation of many neurons.

20
Q

What is the role of the EEG?

A

Useful in identifying seizure types. seizure syndrome and aetiology.

21
Q

How are seizures diagnosed?

A 
History
Video recording of event
ECG in convulsive seizures
Interrictal/ictal EEG
MRI
Genetics
Metabolic tests - esp if associated with developmental delay/regression.
22
Q

What is the management of epilepsies in children?

A

Start with 1 anti-epileptic drug once you know the diagnosis.
Slow upward titration until side effects manifest or considered insufficient.

23
Q

What are some drug treatments for epilepsy?

A

Sodium Valproate (not in girls) or Levetiracetam are 1st line for generalised.

Carbamazepine 1st line for focal.

Several new AED with more tolerability and fewer side effects e.g. Levetiracetam, lamotrigine, Perampanel.

Steroids, Immunoglobulins and ketogenic diet are other therapies.

24
Q

What is Vagus Nerve Stimulation VNS?

A

Therapy that sends a tiny electric shock to vagus nerve.

Inserted just below clavicle with hand-help magnet.

25
Q

When do fontanelles close?

A

At birth bone are not fused.
Posterior fontanelle closes 2-3 months after birth.
Anterior fontanelle closes between 1-3 years of age.

26
Q

What is mircocephaly?

A

Occipitofrontal circumference <2 standard deviations = mild.

occipitofrontal circumference <3 standard deviation = moderate/severe.

Usually indicates small brain called micranencephaly.

27
Q

What is macrocephaly?

A

Occipitofrontal circumference > 2 standard deviations.

Can have other physical abnormalities e.g facial features, hepatosplenomegaly, bony deformities.

28
Q

What are some examples of head shape problems?

A

Plagiocephaly - flat head
Brahycephaly - short head or flat at back
Scaphocephaly - boat shaped skull
Craniosynostosis.

29
Q

what makes you suspect a neuromuscular disorder in a child?

A 
Baby is floppy from birth
Slips from hands
Paucity of limb movements
Alert but less motor activity
Delayed motor milestones 
Able to walk but frequent falls.
30
Q

What is Duchenne’s Muscular dystrophy?

A

Xlinked P21, dystrophin gene.
1 in 3500 male infants
Delayed gross motor skills
Symmetrical proximal weakness - waddling gait, calf hypertrophy, Gower’s sign positive.
Elevated Creatinine Kinase Levels - >1000
Cardiomyopathy
Respiratory involvement in teens.

31
Q

What are the features of Neuropathy?

A 
Distal weakness
May have concomitant sensory symptoms and signs
Reflexes lost early
Fasciculations may be present
Contractures not present
No myocardial dysfunction
32
Q

What are the features of Myopathy?

A 
Usually proximal weakness
Usually pure motor
Reflexes preserved til late
Fasciculations not typical 
Contractures present
May have accompanying cardiac dysfunction with dystrophies.

Paediatrics (12 decks)

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