Neurology Flashcards
what is cerebral palsy?
Disorder of developmental delay, due to a non-progressive fixed cerebral lesion in early childhood.
Causes of Cerebral palsy
Most are idiopathic
of those which have a cause..
80% antenatal : TORCH, abndomal brain development, stroke during labour
10% perinatal: Hypoxic ischeamic encephalopathy, Intrapartum trauma
10% postnatal - neonatal hypoglycaemia, hyperbilirubineamia, cerebral infarct, meconium aspiration, CNS infections.
Risk factors of cerebral palsys?
increased maternal and paternal age, multiple pregnancy, first child.
Classification of cerebral palsy
Gross motor function classification score (GMFCS)
1. Walk without limitation
2. Walk with limitation
3. Walk with equipment assistance, can utilize and control wheelchair. Some independence in standing transfers
4. Self mobility with powered motor assistance
Severe control limitations, required physical assistance ad transport mechanically.
Presentation of crerbal palsy
Signs of developmental delay, delayed motor milestones.
Difficulty feeding
abnormal posture, increased muscle tone
persistent primitive reflexes
recurrent chest infectsios, constipation, reflux.
abnormal walking - tip toe walking or circumduction gait.
What are the 3 main types of cerebral palsy and their features?
Spastic (80%)
- stiff and tight muscles
- will have hemiplegia, diplegia r quadriplegia (most common)
- will have circumduction gait if hemiplegic, will have scissoring gait of diplegic and tiptoe walking
Dyskienetic
- damage to basal ganglia
-withering involuntary movements, unusual posture.
- often normal intellectual development
Ataxic
- damage to cerebellum, shaky movements, poor balance.
- wide baised gait, unsteady trunk.
Conditions commonly associated with cerebral palsy
epilepsy, recurrent chest infections, deafness, learning disability, unsafe swallows, stunted growth.
Investigations and diagnosis for crerbral palsy
developmental assessment clinical diagnosis exclusion of other causes: bloods - FBC, U&Es, CK, TFTs, Vit D imaging: MRI spine, Bone scan, hearing test
RED flags for developmental delay
persistent primitive reflexes not walking by 18 months exclusive toe walking hand preference before 18 months not babbling by 12 months no understanding commands by 18 months fixed squint not fixing and following by 6 weeks lack of social smile at 6 months
Management of cerebral palsy
MDT involvement with occupational therapists, SALT, physiotherapists, dieticians, peads.
Aims - to promote independence.
splints and mobility aids
Spacisity aids
Treatments for Spacisity
Baclofen - lots of side effects (nightmares, dizziness, anxiety)
Botox - to block acetylcholine to the muscle to stop contractions.
orthopaedic involvement, dorsal risotomy
who gets febrile convulsions? how common are they?
3% of children, most common in children between the ages of 6 months and 6 years.
causes of febrile convulsions
fever, often due to viral infectiosn (URTI, OM or tonsillitis most commonly).
features of simple vs complex/atypical febrile convulsion
simple: tonic clonic, lasts less than 15 mins, only happens once within an illness
complex: lasts more than 15 mins, may recur within the same illness, can be focal (very concerning).
Epilepsy risk with febrile convulsions
Population risk is 1/100
Simple <15 mins - 1/50 risk of developing epilepsy
Complex >15 mins 1/20 risk of developing epilepsy
Presentation of febrile fit
Before: history of febrile illness, temp above 38.5, lymph node enlargement
During: LOC, generalised tonic clonic
After: no neurological signs, will have post ictal phase
Investigations for febrile convulsions
Find source of infection!
Sepsis screen: LP, blood culture, CXR, urine dip, bloods (FBC, U&Es, CRP, ESR)
Management of febrile convulsions
seizure management - A-E. time seizure, remove danger, put in the recovery position.
if fit continues for over 5 mins use buccal midazolam.
Find and treat source of infection
Management of pyrexia - paracetamol, hydration.
education for parents for febrile convulsions
1/3 risk of recurrence with future infections,
call an ambulance of the fit id lasting over 15 mins.
1-2% risk of epilepsy development.
red flags - of severe infection and when to seek help.
Red Flags for febrile convulsions sepsis
Colour - pale, mottled, No response to social skills Weak or high pitch continuous cry Signs of respiratory distress, grunting, tachypnoea, recessions, Non-blanching rash focal signs.
what is a rigor?
shaking associated with fevers, no post-ictal phase, can happen at any age, may be peripherally shut down.
presentation of breath holding attacks
episodic apnoea, precipitated by crying usually due to pain or anger. red face, limbs extended, may later become cyanosed and briefly LOC.
will have a RAPID full recovery. No post-ictal signs.
What age of children have breath holding attacks?
common in children under three, usually between 6-18 months. will resolve by school age.
investigations and management of breath holding attacks
Clinical diagnosis - no signs of fitting, full rapid recovery after attacks. families often asked to record events.
Reassurance to parents no medical management needed.
When attacks happen, parents ignore, may need to put in recovery position.
Risk factors for epilepsy
FH, SGA, HIE, febrile convulsions, head trauma, bleeds to brain.
Presentation of epileptic seizure
Before: Prodrome - changes in mood, sleep deprivation. can have localising features eg preceding aura or motor symptoms.
During: either generalised (tonic (stiff) , clonic (jerk), tonic clonic, absence, myoclonic) or partial seizure ( focal symptoms, preceding aura)
After: post ictal phase - headaches, confusion, dysphasia, amnesia
Investigations and diagnosis of epilepsy
diagnosis: ned 2 unprovoked seizure over 24 hours apart. History is key
investigations: look for causes.
Bloods: U&Es, bone profile - important to check calcium, potassium and sodium.
Imaging - need head MRI to rule out space occupying lesion.
ECG to identify any cardiac cause.
antiepileptic mediation used in tonic clinic seizures
Carbamazepine, valproate, lamotrigine
antiepileptics used in absence seizures
Lamotrigine, valproate, ethosuximide.
Management for epilepsy (not acute)
Antiepileptic medication - depends on seizure type.
Keep fit diary
precautions with swimming, no baths.
Inform school, may have slow progress, can have developmental delay.
