neurology Flashcards
what are the 4 types of primary headache?
- migraine
- tension headache
- cluster headache
- cough / exertional headache
presentation of tension headache?
- symmetrical
- gradual onset
- described as “tightness”, “band on head”
- no other symptoms in kids
do most migraines present with or without aura?
90% are without aura
presentation of migraine without aura?
- lasts 1-72h
- usually bilateral
- pulsing over temporal / frontal lobes
- GI disturbance
what are the 3 types of aura?
- visual
- sensory
- motor
give 2 examples of visual auras
- vision loss (total or partial)
- seeing zig zag lines
causes of secondary headache?
- head/neck trauma
- RICP
- infection
- substance misuse/withdrawal
- psychiatric disorder
which foods can trigger migraines?
- cheese
- chocolate
- coffee
what can migraines be associated with in girls?
- menstruation
- COCP
features of a headache from RICP/SOL?
- worse when lying down
- night-time waking
- morning vomiting
- change in mood/behaviour
potential presentation of RICP/SOL? there’s a LOT
- visual field defects
- squint
- facial nerve palsy
- abnormal gait
- torticollis
- growth failure
- papilloedema (late feature)
- cranial bruits
pain management for a primary headache?
- paracetamol and NSAID asap
- antiemetic (metoclopramide)
- sumatriptan (5-HT agonist)
prophylaxis of primary headaches?
- pizotifen (5-HT antagonist, causes weight gain and tiredness)
- propanolol (CI in asthma because BB)
- valproate (Na channel blocker)
what can epilepsy be secondary to?
- vascular occlusion in brain
- tumour
- congenital infection
- HIE
- intraventricular haemorrhage / ischaemia
non-epileptic causes of seizure?
- febrile
- metabolic deficiency (hypoglycaemia, hypocalcaemia, hyponatraemia)
- also HYPERnatraemia
- head trauma
- infection
- poison/toxins
define a febrile seizure
seizure accompanied by fever in absence of intracranial infection
what type of seizure is a febrile seizure?
generalised tonic-clonic
how many children with a febrile seizure will have another?
40%
what is the risk of going on to develop epilepsy after a simple febrile seizure?
- 1-2%
- same as every other kid
why is a septic screen so important in an infant with febrile seizures?
- the signs of meningitis are not as clear in them
- (usually the fever is from a viral illness)
management of a prolonged (>5 mins) febrile seizure?
- rectal diazepam
- OR buccal midazolam
causes of reflex anoxic siezures?
- minor head trauma
- cold food like ice cream
- fright
- fever
features of a reflex anoxic seizure?
- after the triggering event, child goes pale
- falls to floor
- generalised tonic-clonic seizure
- rapid recovery
physical signs of a migraine?
- unsteadiness
- light-headed sensation
what makes a breath-holding episode different from a reflex anoxic seizure?
- both in toddlers
- BHE brought on by anger vs pain in RAS
- BHE goes blue vs pale in RAS
presentation of absence seizures?
- transient LOC
- may be eyelid flickering
- could be preceded by hyperventilation
presentation of myoclonic seizures?
- repetitive limb jerking
- that’s how hiccups work!!
presentation of tonic seizures?
increased tone everywhere
presentation of tonic-clonic seizures?
- 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
presentation of atonic seizures?
- transient loss of muscle tone
- sudden fall to floor / drop of head
- often combined with myoclonic jerk
where is the lesion in a focal seizure with motor phenomena?
frontal lobe
where is the lesion in a focal seizure with smell/taste phenomena?
temporal lobe
where is the lesion in a focal seizure with visual phenomena?
occipital lobe (can be positive or negative phenomena)
where is the lesion in a focal seizure with contralateral altered sensation?
parietal lobe
which AED is contraindicated in absence or myoclonic seizures?
carbamazepine (makes these worse)
what do children prone to prolonged epileptic seizures carry with them?
buccal midazolam as a rescue therapy
when can AED therapy be stopped?
after 2 years of being seizure-free
adverse effects of valproate?
- weight gain
- hair loss
- teratogenic
- liver failure
adverse effects of carbamazepine?
- rash
- hyponatraemia
- ataxia
- interacts with COCP
which investigation is used to classify type of seizure in epilepsy?
inter-ictal EEG
when should an AED be prescribed?
- when seizures are intrusive
- when the type of epilepsy is known (think carbamazepine!)
presentation of cerebral palsy?
- hypotonia (floppy)
- delayed motor milestones
- muscle weakness
- unsteady / abnormal gait
- easily fatigued
- muscle cramps (from myopathy)
a) describe a positive Gower’s sign
b) is it ever normal?
c) where is this seen pathologically?
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
describe Charcot-Marie-Tooth disease presentation
- symmetrical
- slow progressing
- distal muscle wasting
- preschoolers will trip up in school from acute bilateral foot drop
- pes cavus
what causes Charcot-Marie-Tooth disease?
gene mutation CMTA1
investigation in Charot-Marie-Tooth? what is found?
nerve conduction studies show mixed neuropathy
name 3 peripheral neuropathies?
- Charcot-Marie-Tooth disease
- Guillain-Barre syndrome
- Bell palsy
a) what causes guillain-barre syndrome?
b) when does it present?
a) URTI or campylobacter gastroenteritis
b) any age, 2-3 weeks after the infection
presentation of guillain-barre syndrome? there’s a LOT
- 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
investigations for guillain-barre syndrome?
- MRI of spinal cord
- CSF has raised protein, normal WCC
management for guillain-barre syndrome?
- support respiration with ventilation
- otherwise it just recovers by itself
what is Bell palsy?
isolated LMN paresis of facial nerve
presentation of Bell palsy?
- unilateral facial weakness
- upper and lower face affected
management of Bell palsy?
- most cases recover by themselves
- corticosteroids help with facial oedema
main complication of Bell palsy?
conjunctivitis from not being able to shut your eye properly
age group affected in juvenile myasthenia gravis?
> 10 year olds
presentation of myasthenia gravis?
- ophthalmoplegia
- ptosis
- loss of facial expression
- difficulty chewing
- proximal weakness
- thymoma
how is myasthenia gravis diagnosed? there are 2 ways
- by watching an improvement over days after administering oral pyridostigmine
- finding anti-MuSK antibodies (rare)
management of myasthenia gravis?
- pyridostigmine (choline esterase inhibitor)
- prednisolone
- rituximab
- thymectomy if thymoma
what is the commonest muscular dystrophy?
Duchenne
pattern of inheritance of Duchenne muscular dystrophy?
X-linked recessive (only boys affected)
what is seen on bloods in Duchenne muscular dystrophy?
raised creatinine kinase (from muscle breakdown)
presentation of Duchenne muscular dystrophy?
- waddling gait
- language delay
- runs slower than peers
- climbs stairs slower
- positive Gowers sign
- pseudohypertrophy of calves (fatty tissue replacing muscle)
central causes of hypotonia?
- Down syndrome
- Prader-Willi syndrome
- hypothyroidism
- cerebral palsy
peripheral causes of hypotonia?
- spinal muscular atrophy
- spina bifida
- Guillain-Barre syndrome
- myasthenia gravis
- muscular dystrophy
- myotonic dystrophy
a) which brain bleed is commonest following trauma?
b) which artery is most likely to be affected?
a) extradural haemorrhage
b) middle meningeal artery
presentation of extradural haemorrhage?
- post-traumatic
- lucid interval
- then reduced consciousness
- dilated ipsilateral pupil
- paresis of contralateral limbs
- false localising CN6 palsy
investigation finding in extradural haemorrhage?
CT head shows lentiform shaped bleed
which brain bleed is most likely following NAI, e.g. violently shaking a baby
subdural haematoma
investigation finding in subdural haemorrhage?
CT head shows crescent shaped bleed
investigation finding in a subarachnoid haemorrhage?
CT head shows star shaped bleed
what is spina bifida?
failure of the vertebral column to close properly
early presentation of spina bifida?
- could be found antenatally
- incidental finding on X-ray
- skin lesion on lumbar region
later presentation of spina bifida?
- lower limb paresis + hypotonia
- dislocated hip from uneven muscle growth
- sensory loss
- bladder + bowel dysfunction
- scoliosis
- hydrocephalus
management of spina bifida?
- surgically fix it after birth
- physiotherapy for muscle bulk
- skin care to prevent ulcers
- long-term catheter
- regular toileting and laxatives
a) what are the 2 types of hydrocephalus?
b) what is the difference?
a) obstructive and communicating
b) obstructive stops CSF flow within the ventricular system, communicating stops CSF being reabsorbed
features of hydrocephalus in infant?
- bulging fontanelles
- rapidly growing head circumference
- “sun setting” sign is fixed downward gaze
management of hydrocephalus?
ventriculoperitoneal shunt
features of hydrocephalus in an older child?
RICP signs, same as adult
