neurology Flashcards
important parts of development history
- motor milestones (gross and fine motor skills)
- speech and language development
- play especially symbolic and social
- self-help skills
- vision and hearing assessment
neuro examination in childhood
- opportunistic approach and observation skills
- appearance
- gait
- head size
- skin
- real world examination
clinical evaluation of child headache disorders
- isolated acute
- recurrent acute
- chronic progressive
- chronic non-progressive
history of typical headache episode
- any warning
- location
- severity
- duration
- frequency
headache examination
- growth parameters
- OFC
- BP
- sinuses
- teeth
- visual acuity
- fundoscopy
- visual fields
- cranial bruit
- focal neurological signs
- cognitive and emotional status
pointers to childhood migraine
- 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
clinical presentation migraine headache
- hemicranial pain
- throbbing/ pulsatile
- abdo pain/ N+V
- relieved by rest
- photophobia
- phonophobia
- visual, sensory, motor aura
- positive family history
clinical presentation tension headache
- diffuse, symmetrical
- band-like distribution
- present most of the time
- constant ache
pointers to analgesic overuse headache
- headache is back before allowed to use another dose
- paracetamol/ NSAIDs
pointers to raised ICP headache
- aggravated by activities that increase ICP e.g. coughing, straining at stool, bending
- woken from sleep with headache +/- vomitting
indications for neuroimaging
- features cerebellar dysfunction
- features raised ICP
- new focal neurological defecit
- seizures especially focal
- personality change
- unexplained deterioration of school work
preventative migraine management
at least 1/ week of:
- pizotifen
- propanolol
- amitryptyline
- topiramate
- sodium valproate
acute management migraine
- pain relief
- triptans
management TTH
- reassurance
- best is nothing
- amitryptiline
- acute attacks simple analgesia
syncope
faint
convulsion
seizure where there is prominent motor activity
epileptic seizure
abnormal excessive hyper synchronous discharge from a group of cortical neutrons
epilepsy
tendency to recurrent, unprovoked, spontaneous epileptic seizures
acute symptomatic seizures
due to acute insults e.g. hypoxia-ischaemia, hypoglycaemia, infection, trauma
febrile convulsion
any seizure occurring in infancy/ childhood, usually between 3 months -> 5 years, associated with fever but without evidence of intracranial infection or defined cause
movement associated with clonic, myoclonic seizures and spasm
jerk/ shake
movement associated with tonic clonic seizures
none, stiff
movement associated with atonic/ tonic/ myoclonic seizures
fall
what type of seizures associated with vacant attacks
absence, complex partial seizures
what are epileptic fits chemically triggered by
- decreased inhibition (GABA)
- excessive excitation (glutamate and aspirate)
- excessive influx of Na and Ca ions
what can be used to record epileptic seizures
electroencephalogram
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
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
why is EEG useful
- identifying seizure types
- seizure syndrome
- etiology
investigations epilepsy
- history
- video recording of event
- ECG in convulsive seizures
- interictal/ ictal EEG
- MRI brain
- genetics
- metabolic tests
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
first line drug for generalised epilepsy management
sodium valproate or levetiracetam
first line drug for focal epilepsies
carbamazepine
new AEDs with less side effects
- levatiracetam
- lamotrigine
- perampanel
other therapies for epilepsy (other than AEDs)
- immunoglobulins and ketogenic diet
assessing the child with the unusual head
- accurate measurement and interpretation
- head size problems (macrocephaly and microcephaly)
- refer early for specialist opinion
when does the posterior fontanelle close
2-3 months after birth
when does the anterior fontanelle close
1-3 years of age
micranencephaly
small brain
definition macrocephaly
OFC >2SD
definition mild microcephaly
OFC
definition moderate/ severe
OFC <3 SD
causes of macrocephaly
- familial
- hydrocephalus
- large brain
- ## hepatosplenomegaly
plagiocephaly
flat-head
brachycephaly
short head or flat at back
scaphocepahly
boat shaped skull
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
whats wrong duchenne muscular dystrophy
Xp21 dystrophin
presentation Duchenne muscular dystrophy
- delayed gross motor skills
- symmetrical proximal weakness
- elevated creatinine kinase levels
- cardiomyopathy
- resp involvement in teens
features of symmetrical proximal weakness
- waddling gait
- calf hypertrophy
- Gowers sign positive
neuromuscular conditions of muscles
- muscular dystrophies
- myopathies - congenital and inflammatory
- myotonic syndromes
neuromuscular conditions of neuromuscular junciton
- myasthenic syndromes
neuromuscular conditions of nerves
hereditary or acquired neuropathies
neuromuscular conditions of anterior horn cell
spinal muscular atrophy
presentation neuropathy
- distal weakness
- may have concomitant sensory symptoms and signs
- reflexes lost early
- fasciculations may be present
presentation myopathy
- proximal weakness
- usually purely motor
- reflexes preserved till late
- contractures present
- may have accompanying cardiac dysfunction with dystrophies
