Neurology Flashcards
What are the signs of a migraine?
Hemi-cranial pain Throbbing Relieved by rest Photophobia Phonophobia Younger – abdominal pain, nausea, vomiting Older – aura (visual, sensory, motor)
How are migraines treated?
Acute attack – pain relief, triptans
Preventative if 1 or more per week – propranolol, pizotifen
What are the symptoms of tension-type headaches?
Symmetrical
Band-like distribution
Present most of the time
Constant ache
How are tension-type headaches treated?
Reassurance
Acute attacks – analgesia
Prevention – amitriptyline
What are the causes of epilepsy?
None Infection Hyponatraemia Toxins Trauma Tumour
What are the 2 main types of seizures?
Partial/focal - affects 1 hemisphere
Generalised - affects 2 hemispheres
How is epilepsy investigated?
History Video recording ECG in convulsive seizures EEG – if + clinical diagnosis MRI
How is epilepsy treated?
Partial/focal – carbamazepine Generalised – sodium valproate (not in girls) Lamotrigine Other – steroids, immunoglobulins Vagus nerve stimulation
What are the side effects of anti-epileptics?
Drowsiness
Can affect learning, cognition and behaviour
What are the signs of a febrile convulsion?
Rapid temperature rise
Simple – generalised tonic clonic, <15mins, only occur once in a single febrile illness
Complex – partial or focal seizures, >15mins, occur multiple times during the same febrile illness
What age group does febrile convulsions affect?
6 months - 5 years
What are the causes of febrile convulsions?
Fever caused by an underlying viral illness or bacterial infection
How are febrile convulsions treated?
Analgesia
How is duchenne muscular dystrophy inherited?
X-linked recessive
What gene is defective in duchenne muscular dystrophy?
Defective gene for dystrophin on the X chromosome
What are the signs of duchenne muscular dystrophy?
Symmetrical proximal weakness – waddling gait, calf hypertrophy, gower’s sign
Delayed gross motor signs
Cardiomyopathy
What is Gower’s sign?
In duchenne muscular dystrophy
Children with proximal muscle weakness use a specific technique to stand up from lying
How is duchenne muscular dystrophy treated?
No curative treatment Occupational therapy Physiotherapy Oral steroids Creatine supplement
What are signs of raised intracranial pressure?
Headache aggravated by coughing, staining at stool, bending etc
Woken from sleep with headache +/- vomiting
What are indications for neuroimaging with regards to headaches?
Features of cerebellar dysfunction Features of raised intracranial pressure New focal neurological deficit – eg new squint Seizures – especially focal Personality change Unexplained deterioration of schoolwork
What is a seizure fit?
Any sudden attack from whatever cause
What is syncope?
Faint - neuro-cardiogenic mechanism
What is a convulsion?
Seizure where there is prominent motor activity
What is an epileptic seizure?
An electrical phenomenon
What are other kinds of non-epileptic seizures?
Reflex anoxic seizure
Parasomnia
Psychogenic non-epileptic seizures
When should you measure a child’s head?
Every time you see them between birth and 3 years or any child with neurological symptoms Occipitofrontal circumference (OFC)
Microcephaly
Mild – OFC <2 SD
Moderate/severe – OFC <3 SD
Normally indicates small brain (microencephaly)
Has it always been a small head or is it not growing?
Causes – antenatal, postnatal, genetic and environmental
Macrocephaly
OCF >2 SD
Can only grow if the sutures are still open
Large brain? Development?
Other physical abnormalities – facial features, hepatosplenomegaly, bony deformities etc
Plagiocephaly
Flat head, squint
Ears at different levels
Brachycephaly
Short head or flat at the back
Down syndrome
Scaphocephaly
Boat shaped skull
Craniosynostosis
Cranial sutures close too early impairing bone growth
Needs to be corrected within 1 year
Deformational plagiocephaly
Reflects the in-utero position of the baby
When would you suspect a neuromuscular disorder in a child?
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
What is the pathology of cerebral palsy?
Disorder of movement and posture
Associated with a fixed insult to the developing brain
What are the causes of cerebral palsy?
Pre-natal, peri-natal, post-natal: Ischaemia Congenital infection Neonatal meningitis Prematurity Kernicterus
What are the symptoms of cerebral palsy?
Spastic – increased tone/reflexes, reduced power
Dystonic – involuntary movements
Ataxic – hypotonia, wide-based gait, nystagmus, intention tremor
What investigations would be done if cerebral palsy was suspected?
Creatinine kinase - increased
CT/MRI
How is cerebral palsy treated?
MDT
What are causes of neonatal seizures?
Hypoxic-ischaemia encephalopathy Infection – meningitis/encephalitis Intracranial haemorrhage/infarction Structural CNS lesions Metabolic disturbance – hypoglycaemia Metabolic disorders Neonatal withdrawal from maternal drugs or substance abuse Kernicterus
