Neurology Flashcards
What are some features of a development history?
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.
What are some features of the neurological exam in children?
Appearance
Gait
Head size
Skin findings
What are some common neurological conditions in children?
Migraine Traumatic Brain Injury Tourette syndrome Epilepsy Brain Tumours
What are some different patterns of headache children present with?
Acute recurrent
Chronic progressive
Chronic non progressive
Isolated acute
What examination would you carry out for a child with headache?
Growth parameters BP Sinuses Teeth Visual acuity Fundoscopy Visual fields - craniopharyngioma Cranial bruit Focal neurological signs Cognitive and emotional status. Headache type
What are some factors that point to childhood migraine?
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
What are some features that indicate tension headache?
Diffuse, symmetrical
Band like distribution
Present most of the time
Constant ache
What are some features that point to raised intracranial pressure?
Aggravated by activities that raise ICO e.g coughing, straining at stool, bending.
Woken from sleep with headache +/- vomiting.
What are some features that point to analgesia overuse headache?
Headache is back before allowed to use another dose.
Paracetamol and NSAID use
Particular problem with compound analgesics e.g. cocodamol.
What are the indications for neuroimaging in a child?
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.
What is the management for migraine in children?
Effective pain relief for acute attacks e.g triptans.
Preventative (at least 1 a week) - Pizotifen, Propranolol, Amitryptyline, Topiramate, Valproate.
What is the treatment of Tension type headache in children?
Aim at reassurance there is no sinister cause.
Simple analgesia for acute attacks.
Prevention - Amitryptyline.
Discourage analgesics in chronic TTH.
What is a convulsion?
Seizure where there is prominent motor activity.
What is an epileptic seizure?
Electrical phenomenon that causes a sudden attack.
Abnormal excessive hyper synchronous discharge from a group of cortical neurones.
What is epilepsy?
Tendency to recurrent, unprovoked epileptic seizures.
What are some examples of non epileptic seizures?
Hypoxia-ischaemia Hypoglycaemia Infection Trauma Reflex anoxic seizure (common in toddlers) Syncope Parasomnias e.g night terrors Behavioural stereotypes Psychogenic non epileptic seizures.
What is a febrile convulsion?
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.
What are some different seizure types?
Jerk/shake - clonic, myoclonic, spasms
Stiff - usually a tonic seizure
Fall - atonic, tonic, myoclonic
Vacant attack - absence, complex partial seizure.
What are some mechanisms of epileptic fit?
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.
What is the role of the EEG?
Useful in identifying seizure types. seizure syndrome and aetiology.
How are seizures diagnosed?
History Video recording of event ECG in convulsive seizures Interrictal/ictal EEG MRI Genetics Metabolic tests - esp if associated with developmental delay/regression.
What is the management of epilepsies in children?
Start with 1 anti-epileptic drug once you know the diagnosis.
Slow upward titration until side effects manifest or considered insufficient.
What are some drug treatments for epilepsy?
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.
What is Vagus Nerve Stimulation VNS?
Therapy that sends a tiny electric shock to vagus nerve.
Inserted just below clavicle with hand-help magnet.
When do fontanelles close?
At birth bone are not fused.
Posterior fontanelle closes 2-3 months after birth.
Anterior fontanelle closes between 1-3 years of age.
What is mircocephaly?
Occipitofrontal circumference <2 standard deviations = mild.
occipitofrontal circumference <3 standard deviation = moderate/severe.
Usually indicates small brain called micranencephaly.
What is macrocephaly?
Occipitofrontal circumference > 2 standard deviations.
Can have other physical abnormalities e.g facial features, hepatosplenomegaly, bony deformities.
What are some examples of head shape problems?
Plagiocephaly - flat head
Brahycephaly - short head or flat at back
Scaphocephaly - boat shaped skull
Craniosynostosis.
what makes you suspect a neuromuscular disorder in a child?
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.
What is Duchenne’s Muscular dystrophy?
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.
What are the features of Neuropathy?
Distal weakness May have concomitant sensory symptoms and signs Reflexes lost early Fasciculations may be present Contractures not present No myocardial dysfunction
What are the features of Myopathy?
Usually proximal weakness Usually pure motor Reflexes preserved til late Fasciculations not typical Contractures present May have accompanying cardiac dysfunction with dystrophies.
