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Paediatrics > neurology > Flashcards

neurology Flashcards

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

A

fall

24
Q

what type of seizures associated with vacant attacks

A

absence, complex partial seizures

25
Q

what are epileptic fits chemically triggered by

A
  • decreased inhibition (GABA)
  • excessive excitation (glutamate and aspirate)
  • excessive influx of Na and Ca ions
26
Q

what can be used to record epileptic seizures

A

electroencephalogram

27
Q

how are seizures triggered by chemical stimulation

A

chemical stimulation produces electric current.

summation of multiple electric; potentials results in depolarisation of many neutrons which can lead to seizures

28
Q

stepwise approach to diagnosis of epilepsy

A
  • 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
Q

why is EEG useful

A
  • identifying seizure types
  • seizure syndrome
  • etiology
30
Q

investigations epilepsy

A
  • history
  • video recording of event
  • ECG in convulsive seizures
  • interictal/ ictal EEG
  • MRI brain
  • genetics
  • metabolic tests
31
Q

management epilepsy in children

A
  • 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
Q

first line drug for generalised epilepsy management

A

sodium valproate or levetiracetam

33
Q

first line drug for focal epilepsies

A

carbamazepine

34
Q

new AEDs with less side effects

A
  • levatiracetam
  • lamotrigine
  • perampanel
35
Q

other therapies for epilepsy (other than AEDs)

A
  • immunoglobulins and ketogenic diet
36
Q

assessing the child with the unusual head

A
  • accurate measurement and interpretation
  • head size problems (macrocephaly and microcephaly)
  • refer early for specialist opinion
37
Q

when does the posterior fontanelle close

A

2-3 months after birth

38
Q

when does the anterior fontanelle close

A

1-3 years of age

39
Q

micranencephaly

A

small brain

40
Q

definition macrocephaly

A

OFC >2SD

41
Q

definition mild microcephaly

A

OFC

42
Q

definition moderate/ severe

A

OFC <3 SD

43
Q

causes of macrocephaly

A
  • familial
  • hydrocephalus
  • large brain
  • ## hepatosplenomegaly
44
Q

plagiocephaly

A

flat-head

45
Q

brachycephaly

A

short head or flat at back

46
Q

scaphocepahly

A

boat shaped skull

47
Q

when to suspect NM disorder

A
  • 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
Q

whats wrong duchenne muscular dystrophy

A

Xp21 dystrophin

49
Q

presentation Duchenne muscular dystrophy

A
  • delayed gross motor skills
  • symmetrical proximal weakness
  • elevated creatinine kinase levels
  • cardiomyopathy
  • resp involvement in teens
50
Q

features of symmetrical proximal weakness

A
  • waddling gait
  • calf hypertrophy
  • Gowers sign positive
51
Q

neuromuscular conditions of muscles

A
  • muscular dystrophies
  • myopathies - congenital and inflammatory
  • myotonic syndromes
52
Q

neuromuscular conditions of neuromuscular junciton

A
  • myasthenic syndromes
53
Q

neuromuscular conditions of nerves

A

hereditary or acquired neuropathies

54
Q

neuromuscular conditions of anterior horn cell

A

spinal muscular atrophy

55
Q

presentation neuropathy

A
  • distal weakness
  • may have concomitant sensory symptoms and signs
  • reflexes lost early
  • fasciculations may be present
56
Q

presentation myopathy

A
  • 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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