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paediatrics > neurology > Flashcards

neurology Flashcards

1
Q

what are the 4 types of primary headache?

A
  • migraine
  • tension headache
  • cluster headache
  • cough / exertional headache
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2
Q

presentation of tension headache?

A
  • symmetrical
  • gradual onset
  • described as “tightness”, “band on head”
  • no other symptoms in kids
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3
Q

do most migraines present with or without aura?

A

90% are without aura

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4
Q

presentation of migraine without aura?

A
  • lasts 1-72h
  • usually bilateral
  • pulsing over temporal / frontal lobes
  • GI disturbance
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5
Q

what are the 3 types of aura?

A
  • visual
  • sensory
  • motor
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6
Q

give 2 examples of visual auras

A
  • vision loss (total or partial)

- seeing zig zag lines

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7
Q

causes of secondary headache?

A
  • head/neck trauma
  • RICP
  • infection
  • substance misuse/withdrawal
  • psychiatric disorder
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8
Q

which foods can trigger migraines?

A
  • cheese
  • chocolate
  • coffee
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9
Q

what can migraines be associated with in girls?

A
  • menstruation

- COCP

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10
Q

features of a headache from RICP/SOL?

A
  • worse when lying down
  • night-time waking
  • morning vomiting
  • change in mood/behaviour
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11
Q

potential presentation of RICP/SOL? there’s a LOT

A
  • visual field defects
  • squint
  • facial nerve palsy
  • abnormal gait
  • torticollis
  • growth failure
  • papilloedema (late feature)
  • cranial bruits
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12
Q

pain management for a primary headache?

A
  • paracetamol and NSAID asap
  • antiemetic (metoclopramide)
  • sumatriptan (5-HT agonist)
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13
Q

prophylaxis of primary headaches?

A
  • pizotifen (5-HT antagonist, causes weight gain and tiredness)
  • propanolol (CI in asthma because BB)
  • valproate (Na channel blocker)
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14
Q

what can epilepsy be secondary to?

A
  • vascular occlusion in brain
  • tumour
  • congenital infection
  • HIE
  • intraventricular haemorrhage / ischaemia
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15
Q

non-epileptic causes of seizure?

A
  • febrile
  • metabolic deficiency (hypoglycaemia, hypocalcaemia, hyponatraemia)
  • also HYPERnatraemia
  • head trauma
  • infection
  • poison/toxins
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16
Q

define a febrile seizure

A

seizure accompanied by fever in absence of intracranial infection

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17
Q

what type of seizure is a febrile seizure?

A

generalised tonic-clonic

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18
Q

how many children with a febrile seizure will have another?

A

40%

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19
Q

what is the risk of going on to develop epilepsy after a simple febrile seizure?

A
  • 1-2%

- same as every other kid

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20
Q

why is a septic screen so important in an infant with febrile seizures?

A
  • the signs of meningitis are not as clear in them

- (usually the fever is from a viral illness)

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21
Q

management of a prolonged (>5 mins) febrile seizure?

A
  • rectal diazepam

- OR buccal midazolam

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22
Q

causes of reflex anoxic siezures?

A
  • minor head trauma
  • cold food like ice cream
  • fright
  • fever
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23
Q

features of a reflex anoxic seizure?

A
  • after the triggering event, child goes pale
  • falls to floor
  • generalised tonic-clonic seizure
  • rapid recovery
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24
Q

physical signs of a migraine?

A
  • unsteadiness

- light-headed sensation

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25
Q

what makes a breath-holding episode different from a reflex anoxic seizure?

A
  • both in toddlers
  • BHE brought on by anger vs pain in RAS
  • BHE goes blue vs pale in RAS
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26
Q

presentation of absence seizures?

A
  • transient LOC
  • may be eyelid flickering
  • could be preceded by hyperventilation
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27
Q

presentation of myoclonic seizures?

A
  • repetitive limb jerking

- that’s how hiccups work!!

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28
Q

presentation of tonic seizures?

A

increased tone everywhere

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29
Q

presentation of tonic-clonic seizures?

A
  • rhythmic contractions of muscle groups following a hypertonic phase
  • lasts secs-mins
  • irregular breathing
  • maybe cyanosis
  • tongue biting
  • urinary incontinence
  • LOC / deep sleep for hours afterwards
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30
Q

presentation of atonic seizures?

A
  • transient loss of muscle tone
  • sudden fall to floor / drop of head
  • often combined with myoclonic jerk
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31
Q

where is the lesion in a focal seizure with motor phenomena?

A

frontal lobe

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32
Q

where is the lesion in a focal seizure with smell/taste phenomena?

A

temporal lobe

33
Q

where is the lesion in a focal seizure with visual phenomena?

A

occipital lobe (can be positive or negative phenomena)

34
Q

where is the lesion in a focal seizure with contralateral altered sensation?

A

parietal lobe

35
Q

which AED is contraindicated in absence or myoclonic seizures?

A

carbamazepine (makes these worse)

36
Q

what do children prone to prolonged epileptic seizures carry with them?

A

buccal midazolam as a rescue therapy

37
Q

when can AED therapy be stopped?

A

after 2 years of being seizure-free

38
Q

adverse effects of valproate?

A
  • weight gain
  • hair loss
  • teratogenic
  • liver failure
39
Q

adverse effects of carbamazepine?

A
  • rash
  • hyponatraemia
  • ataxia
  • interacts with COCP
40
Q

which investigation is used to classify type of seizure in epilepsy?

A

inter-ictal EEG

41
Q

when should an AED be prescribed?

A
  • when seizures are intrusive

- when the type of epilepsy is known (think carbamazepine!)

42
Q

presentation of cerebral palsy?

A
  • hypotonia (floppy)
  • delayed motor milestones
  • muscle weakness
  • unsteady / abnormal gait
  • easily fatigued
  • muscle cramps (from myopathy)
43
Q

a) describe a positive Gower’s sign
b) is it ever normal?
c) where is this seen pathologically?

A

a) turning prone to start getting up, then holding onto knees to get upright
b) normal up to until the age of 3
c) cerebral palsy, DMD

44
Q

describe Charcot-Marie-Tooth disease presentation

A
  • symmetrical
  • slow progressing
  • distal muscle wasting
  • preschoolers will trip up in school from acute bilateral foot drop
  • pes cavus
45
Q

what causes Charcot-Marie-Tooth disease?

A

gene mutation CMTA1

46
Q

investigation in Charot-Marie-Tooth? what is found?

A

nerve conduction studies show mixed neuropathy

47
Q

name 3 peripheral neuropathies?

A
  • Charcot-Marie-Tooth disease
  • Guillain-Barre syndrome
  • Bell palsy
48
Q

a) what causes guillain-barre syndrome?

b) when does it present?

A

a) URTI or campylobacter gastroenteritis

b) any age, 2-3 weeks after the infection

49
Q

presentation of guillain-barre syndrome? there’s a LOT

A
  • ascending, progressive weakness
  • symmetrical
  • loss of tendon reflexes
  • loss of autonomic involvement
  • arrhythmias
  • difficulty chewing and swallowing (bulbar muscles)
  • bilateral face weakness
  • some sensory symptoms in distal limbs + trunk
50
Q

investigations for guillain-barre syndrome?

A
  • MRI of spinal cord

- CSF has raised protein, normal WCC

51
Q

management for guillain-barre syndrome?

A
  • support respiration with ventilation

- otherwise it just recovers by itself

52
Q

what is Bell palsy?

A

isolated LMN paresis of facial nerve

53
Q

presentation of Bell palsy?

A
  • unilateral facial weakness

- upper and lower face affected

54
Q

management of Bell palsy?

A
  • most cases recover by themselves

- corticosteroids help with facial oedema

55
Q

main complication of Bell palsy?

A

conjunctivitis from not being able to shut your eye properly

56
Q

age group affected in juvenile myasthenia gravis?

A

> 10 year olds

57
Q

presentation of myasthenia gravis?

A
  • ophthalmoplegia
  • ptosis
  • loss of facial expression
  • difficulty chewing
  • proximal weakness
  • thymoma
58
Q

how is myasthenia gravis diagnosed? there are 2 ways

A
  • by watching an improvement over days after administering oral pyridostigmine
  • finding anti-MuSK antibodies (rare)
59
Q

management of myasthenia gravis?

A
  • pyridostigmine (choline esterase inhibitor)
  • prednisolone
  • rituximab
  • thymectomy if thymoma
60
Q

what is the commonest muscular dystrophy?

A

Duchenne

61
Q

pattern of inheritance of Duchenne muscular dystrophy?

A

X-linked recessive (only boys affected)

62
Q

what is seen on bloods in Duchenne muscular dystrophy?

A

raised creatinine kinase (from muscle breakdown)

63
Q

presentation of Duchenne muscular dystrophy?

A
  • waddling gait
  • language delay
  • runs slower than peers
  • climbs stairs slower
  • positive Gowers sign
  • pseudohypertrophy of calves (fatty tissue replacing muscle)
64
Q

central causes of hypotonia?

A
  • Down syndrome
  • Prader-Willi syndrome
  • hypothyroidism
  • cerebral palsy
65
Q

peripheral causes of hypotonia?

A
  • spinal muscular atrophy
  • spina bifida
  • Guillain-Barre syndrome
  • myasthenia gravis
  • muscular dystrophy
  • myotonic dystrophy
66
Q

a) which brain bleed is commonest following trauma?

b) which artery is most likely to be affected?

A

a) extradural haemorrhage

b) middle meningeal artery

67
Q

presentation of extradural haemorrhage?

A
  • post-traumatic
  • lucid interval
  • then reduced consciousness
  • dilated ipsilateral pupil
  • paresis of contralateral limbs
  • false localising CN6 palsy
68
Q

investigation finding in extradural haemorrhage?

A

CT head shows lentiform shaped bleed

69
Q

which brain bleed is most likely following NAI, e.g. violently shaking a baby

A

subdural haematoma

70
Q

investigation finding in subdural haemorrhage?

A

CT head shows crescent shaped bleed

71
Q

investigation finding in a subarachnoid haemorrhage?

A

CT head shows star shaped bleed

72
Q

what is spina bifida?

A

failure of the vertebral column to close properly

73
Q

early presentation of spina bifida?

A
  • could be found antenatally
  • incidental finding on X-ray
  • skin lesion on lumbar region
74
Q

later presentation of spina bifida?

A
  • lower limb paresis + hypotonia
  • dislocated hip from uneven muscle growth
  • sensory loss
  • bladder + bowel dysfunction
  • scoliosis
  • hydrocephalus
75
Q

management of spina bifida?

A
  • surgically fix it after birth
  • physiotherapy for muscle bulk
  • skin care to prevent ulcers
  • long-term catheter
  • regular toileting and laxatives
76
Q

a) what are the 2 types of hydrocephalus?

b) what is the difference?

A

a) obstructive and communicating

b) obstructive stops CSF flow within the ventricular system, communicating stops CSF being reabsorbed

77
Q

features of hydrocephalus in infant?

A
  • bulging fontanelles
  • rapidly growing head circumference
  • “sun setting” sign is fixed downward gaze
78
Q

management of hydrocephalus?

A

ventriculoperitoneal shunt

79
Q

features of hydrocephalus in an older child?

A

RICP signs, same as adult

paediatrics (10 decks)

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