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Year 4 Child Health > Neurology > Flashcards

Neurology Flashcards

1
Q

what is the most common paediatric medical emergency

A

status epilepticus

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2
Q

for the collapsed/convulsing child, what should you think about

A 
electrical shock 
ingestion 
trauma 
hypoglycaemia 
brady/tachy arrhythmia
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3
Q

what is status epilepticus

A

ongoing seizure for at least 5 min

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4
Q

management of collapsed/convulsing child in hospital

A

ABCDE(DEFG)
IV/IO lorazepam 0.1mg/kg
OR buccal midazolam 0.5mg/kg OR PR diazepam 0.5mg/kg
after 10 min, if still fitting give IV/IO lorazepam and call for senior help
phenytoin / phenobarbitone

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5
Q

All fits are epilepsy, true or false

A

false!!

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6
Q

taking a history for a convulsing child

A 
history of child 
what were they doing before the event 
how did the event start 
how did it progress, what did it look like, what did you hear 
how did it end 
has it happened again
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7
Q

D.Dx of convulsions in neonates

A 
benign myoclonus of infancy 
reflux 
normal baby movements 
neonatal seizures 
infantile spasms
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8
Q

D.Dx of convulsions in infants/toddlers/preschooler

A 
reflex anoxic seizures 
breath holding attack 
syncope/cardiac 
gratification 
tics and stereotypies 
febrile convulsions 
symptomatic seizures 
epilepsy
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9
Q

features of febrile convulsions

A

6mth - 6yrs
in context of infection (Not CNS)
temp >38
simple vs complex

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10
Q

criteria for febrile seizure

A 
>1mth old 
childhood seizure 
febrile illness 
no CNS infection 
no previous neonatal/unprovoked sezires 
doesnt meet criteria for other seizures
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11
Q

what are the subtypes of febrile seizure

A

simple
complex
febrile status epilepticus

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12
Q

describe simple febrile seizure

A

<15 min
generalised
no recurrence within 24 hours
no post ictal pathology

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13
Q

describe complex febrile seizure

A

> 15 min
focal
may have repetitive seizures
Todd’s paresis may be present

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14
Q

describe febrile status epilepticus

A

> 30 min

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15
Q

RF for recurrent febrile seizures

A

age of onset <18 mth
fever <39
FH in 1st degree relative
shorter duration of fever before seizure
multiple seizures during the same febrile period
day nursery attendence

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16
Q

advice for parents regarding febrile seizures

A

protect child from harm
do not restrain child or put anything in their mouth
ABCDE and BLS

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17
Q

most children with febrile seizures dont develop epilepsy, true or false

A

true

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18
Q

D.Dx of convulsions in school age children

A

syncope

cardiac

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19
Q

features of syncope

A 
vagal symptoms: 
tunnel vision / hearing 
feeling hot / needing a drink 
go deathly pale 
occur when standing / hot / cyclical / growth spurts
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20
Q

what should you ask about if you suspect cardiac cause of convulsions

A

FH of sudden death

occurring wile exercising, sitting or nocturnal

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21
Q

which epilepsies are specific to childhood

A

childhood absence epilepsy
benign epilepsy of childhood with centro-temporal spikes
juvenile myoclonic epilepsy (early adolesence)

22
Q

investigations for convulsions

A 
ECG 
video recording 
EEG (not diagnostic)
MRI brain - if focal onset 
genetics
23
Q

define epilepsy

A
  1. at least 2 unprovoked seizures occurring >24hr apart
  2. 1 unprovoked seizure and a probability of further seizures similar to the general recurrence risk after 2 unprovoked seizures occurring over the next 10 years
  3. diagnosis of an epilepsy syndrome
24
Q

what tool can you use to assess the unconscious child

25
what paediatric specific components should you look for in D+E of ABCDE
``` pupil size and reactivity and fundi posture neck stiffness fontanelle rash fever ```
26
what are the reversible causes of an unconscious child
``` 4H - hypoxia, hypoglycaemia, hypothermia, hypo/hypertension infection ingestion trauma metabolic conditions ^ICP stroke ```
27
what are the 3 time sensitive neurological emergencies
seizure/convulsion unconscious child acute paralysis
28
other acute neurological presentations
``` paralysis progressive weakness progressive ataxia dizziness loss of skills funny eye movements ```
29
indications for urgent brain imaging
``` altered conscious level --> CT focal seizures --> CT CN involvement or focal neruology --> CT raised ICP --> CT spinal cord injury / compression --> MRI ```
30
how to tell if its a seizure
``` bilateral fixed dilated pupils unresponsive stiffening urinary incontinence tongue biting eye rolling ```
31
phenytoin side effects
venotoxic
32
phenobarbitone side effects
sedative
33
what are infantile spams
rare events but almost always indicate severe underlying neurological problem
34
what is Sandifer syndrome
condition involving spasmodic torsional dystonia with arching (hyperextension) of the back and rigid opisthotonic posturing associated with symptomatic GORD, oesophagitis or hiatus hernia
35
what are infantile spasms
rare seizure disorder occurring in young children usually <1 year old
36
features of infantile spasms
subtle, hard to recognise sudden bending forward and stiffening of body, arms and legs extensor spams - arms and legs fly outwards episodes occur in clusters with each episode lasting 1-2 sec with a pause then further spasm little head drops
37
pathology behind infantile spasms
chaotic brainwave pattern causes loss of skills and brain damage longer it goes unrecognised, the greater the impact on future development
38
describe reflex anoxic seizures
not epileptic seizures | can be triggered by a bump to the head or getting a fright resulting in a momentary drop in oxygen to the brain
39
what cardiac cause of seizures/convulsions must you rule out
LQTS | also HOCM and aortic stenosis
40
examples of childhood motor stereotypies
``` hand flapping twisting body rocking head banging face or mouth stretching (must be impairing normal daily activity to be classed as this) ```
41
D.Dx of motor stereotypies
``` tic disorder / tourette syndrome compulsions paroxysmal dyskinesias seizures myoclonus dystonia ```
42
onset of tic disorers
begin 4-5 yr but dont present until 9-10 yr
43
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3992090/
useful article on tics
44
what is Tourette's syndrome
tics are multiple and a phonic tic is present at some point over a period of at least 1 year onset before 18yr, present on a daily basis and not related to PMH, DH...
45
what are compulsions
movements of ritualistic behaviours to reduce stress | on a background of inflexibility and intrusive thoughts
46
what are paroxysmal dyskinesias
encompass conditions where there is excess unwanted movement e.g. tics, chorea, dystonia, myoclonus, tremor
47
what is epilepsy
condition characterised by recurrent epileptic seizures
48
https://epi-care.eu/wp-content/uploads/2019/03/SIGN-81_Diagnosis-and-management-of-epilepsy-in-children-and-young-people_2005.pdf
useful SIGN guideline for epilepsy
49
what are breath holding attacks
child is crying and breathes out but forgets to breathe in therefore turn blue
50
risk of recurrence of febrile seizure
25%

Year 4 Child Health (22 decks)

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