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neurology Flashcards

(56 cards)

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1
Q

important parts of development history

A
  • motor milestones (gross and fine motor skills)
  • speech and language development
  • play especially symbolic and social
  • self-help skills
  • vision and hearing assessment
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2
Q

neuro examination in childhood

A
  • opportunistic approach and observation skills
  • appearance
  • gait
  • head size
  • skin
  • real world examination
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3
Q

clinical evaluation of child headache disorders

A
  • isolated acute
  • recurrent acute
  • chronic progressive
  • chronic non-progressive
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4
Q

history of typical headache episode

A
  • any warning
  • location
  • severity
  • duration
  • frequency
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5
Q

headache examination

A
  • growth parameters
  • OFC
  • BP
  • sinuses
  • teeth
  • visual acuity
  • fundoscopy
  • visual fields
  • cranial bruit
  • focal neurological signs
  • cognitive and emotional status
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6
Q

pointers to childhood migraine

A
  • associated abdominal pain, N+V
  • focal symptoms/ signs before, during and after (visual disturbance/ parenthesis/ weakness)
  • pallor
  • aggravated by bright light/ noise
  • relation to fatigue/ stress
  • helped by sleep/ rest/ dark
  • FH often positive
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7
Q

clinical presentation migraine headache

A
  • hemicranial pain
  • throbbing/ pulsatile
  • abdo pain/ N+V
  • relieved by rest
  • photophobia
  • phonophobia
  • visual, sensory, motor aura
  • positive family history
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8
Q

clinical presentation tension headache

A
  • diffuse, symmetrical
  • band-like distribution
  • present most of the time
  • constant ache
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9
Q

pointers to analgesic overuse headache

A
  • headache is back before allowed to use another dose

- paracetamol/ NSAIDs

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10
Q

pointers to raised ICP headache

A
  • aggravated by activities that increase ICP e.g. coughing, straining at stool, bending
  • woken from sleep with headache +/- vomitting
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11
Q

indications for neuroimaging

A
  • features cerebellar dysfunction
  • features raised ICP
  • new focal neurological defecit
  • seizures especially focal
  • personality change
  • unexplained deterioration of school work
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12
Q

preventative migraine management

A

at least 1/ week of:

  • pizotifen
  • propanolol
  • amitryptyline
  • topiramate
  • sodium valproate
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13
Q

acute management migraine

A
  • pain relief

- triptans

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14
Q

management TTH

A
  • reassurance
  • best is nothing
  • amitryptiline
  • acute attacks simple analgesia
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15
Q

syncope

A

faint

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16
Q

convulsion

A

seizure where there is prominent motor activity

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17
Q

epileptic seizure

A

abnormal excessive hyper synchronous discharge from a group of cortical neutrons

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18
Q

epilepsy

A

tendency to recurrent, unprovoked, spontaneous epileptic seizures

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19
Q

acute symptomatic seizures

A

due to acute insults e.g. hypoxia-ischaemia, hypoglycaemia, infection, trauma

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20
Q

febrile convulsion

A

any seizure occurring in infancy/ childhood, usually between 3 months -> 5 years, associated with fever but without evidence of intracranial infection or defined cause

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21
Q

movement associated with clonic, myoclonic seizures and spasm

A

jerk/ shake

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22
Q

movement associated with tonic clonic seizures

A

none, stiff

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23
Q

movement associated with atonic/ tonic/ myoclonic seizures

24
Q

what type of seizures associated with vacant attacks

Study These Flashcards
A

absence, complex partial seizures

25
what are epileptic fits chemically triggered by
- decreased inhibition (GABA) - excessive excitation (glutamate and aspirate) - excessive influx of Na and Ca ions
26
what can be used to record epileptic seizures
electroencephalogram
27
how are seizures triggered by chemical stimulation
chemical stimulation produces electric current. | summation of multiple electric; potentials results in depolarisation of many neutrons which can lead to seizures
28
stepwise approach to diagnosis of epilepsy
- is the paroxysmal event epileptic in nature - is it epilepsy - what seizure types are occuring - what is the epilepsy syndrome - etiology - social and educational effects on child
29
why is EEG useful
- identifying seizure types - seizure syndrome - etiology
30
investigations epilepsy
- history - video recording of event - ECG in convulsive seizures - interictal/ ictal EEG - MRI brain - genetics - metabolic tests
31
management epilepsy in children
- anti-epileptic drugs should only be considered if diagnosis is clear, even if this means delay - role is to control seizures not cure epilepsy - start with 1 AED, slow upward titration until side effects manifest/ drug inefficient - age, gender and seizure type should be considered
32
first line drug for generalised epilepsy management
sodium valproate or levetiracetam
33
first line drug for focal epilepsies
carbamazepine
34
new AEDs with less side effects
- levatiracetam - lamotrigine - perampanel
35
other therapies for epilepsy (other than AEDs)
- immunoglobulins and ketogenic diet
36
assessing the child with the unusual head
- accurate measurement and interpretation - head size problems (macrocephaly and microcephaly) - refer early for specialist opinion
37
when does the posterior fontanelle close
2-3 months after birth
38
when does the anterior fontanelle close
1-3 years of age
39
micranencephaly
small brain
40
definition macrocephaly
OFC >2SD
41
definition mild microcephaly
OFC
42
definition moderate/ severe
OFC <3 SD
43
causes of macrocephaly
- familial - hydrocephalus - large brain - hepatosplenomegaly -
44
plagiocephaly
flat-head
45
brachycephaly
short head or flat at back
46
scaphocepahly
boat shaped skull
47
when to suspect NM disorder
- baby floppy from birth - slip from hands - paucity of limb movements - alert, but less motor activity - delayed motor milestones - able to walk but frequent falls
48
whats wrong duchenne muscular dystrophy
Xp21 dystrophin
49
presentation Duchenne muscular dystrophy
- delayed gross motor skills - symmetrical proximal weakness - elevated creatinine kinase levels - cardiomyopathy - resp involvement in teens
50
features of symmetrical proximal weakness
- waddling gait - calf hypertrophy - Gowers sign positive
51
neuromuscular conditions of muscles
- muscular dystrophies - myopathies - congenital and inflammatory - myotonic syndromes
52
neuromuscular conditions of neuromuscular junciton
- myasthenic syndromes
53
neuromuscular conditions of nerves
hereditary or acquired neuropathies
54
neuromuscular conditions of anterior horn cell
spinal muscular atrophy
55
presentation neuropathy
- distal weakness - may have concomitant sensory symptoms and signs - reflexes lost early - fasciculations may be present
56
presentation myopathy
- proximal weakness - usually purely motor - reflexes preserved till late - contractures present - may have accompanying cardiac dysfunction with dystrophies

Paediatrics (23 decks)

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