Neurology Flashcards
what is the most common paediatric medical emergency
status epilepticus
for the collapsed/convulsing child, what should you think about
electrical shock ingestion trauma hypoglycaemia brady/tachy arrhythmia
what is status epilepticus
ongoing seizure for at least 5 min
management of collapsed/convulsing child in hospital
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
All fits are epilepsy, true or false
false!!
taking a history for a convulsing child
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
D.Dx of convulsions in neonates
benign myoclonus of infancy reflux normal baby movements neonatal seizures infantile spasms
D.Dx of convulsions in infants/toddlers/preschooler
reflex anoxic seizures breath holding attack syncope/cardiac gratification tics and stereotypies febrile convulsions symptomatic seizures epilepsy
features of febrile convulsions
6mth - 6yrs
in context of infection (Not CNS)
temp >38
simple vs complex
criteria for febrile seizure
>1mth old childhood seizure febrile illness no CNS infection no previous neonatal/unprovoked sezires doesnt meet criteria for other seizures
what are the subtypes of febrile seizure
simple
complex
febrile status epilepticus
describe simple febrile seizure
<15 min
generalised
no recurrence within 24 hours
no post ictal pathology
describe complex febrile seizure
> 15 min
focal
may have repetitive seizures
Todd’s paresis may be present
describe febrile status epilepticus
> 30 min
RF for recurrent febrile seizures
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
advice for parents regarding febrile seizures
protect child from harm
do not restrain child or put anything in their mouth
ABCDE and BLS
most children with febrile seizures dont develop epilepsy, true or false
true
D.Dx of convulsions in school age children
syncope
cardiac
features of syncope
vagal symptoms: tunnel vision / hearing feeling hot / needing a drink go deathly pale occur when standing / hot / cyclical / growth spurts
what should you ask about if you suspect cardiac cause of convulsions
FH of sudden death
occurring wile exercising, sitting or nocturnal
which epilepsies are specific to childhood
childhood absence epilepsy
benign epilepsy of childhood with centro-temporal spikes
juvenile myoclonic epilepsy (early adolesence)
investigations for convulsions
ECG video recording EEG (not diagnostic) MRI brain - if focal onset genetics
define epilepsy
- at least 2 unprovoked seizures occurring >24hr apart
- 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
- diagnosis of an epilepsy syndrome
what tool can you use to assess the unconscious child
AVPU
GCS
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
what are the reversible causes of an unconscious child
4H - hypoxia, hypoglycaemia, hypothermia, hypo/hypertension infection ingestion trauma metabolic conditions ^ICP stroke
what are the 3 time sensitive neurological emergencies
seizure/convulsion
unconscious child
acute paralysis
other acute neurological presentations
paralysis progressive weakness progressive ataxia dizziness loss of skills funny eye movements
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
how to tell if its a seizure
bilateral fixed dilated pupils unresponsive stiffening urinary incontinence tongue biting eye rolling
phenytoin side effects
venotoxic
phenobarbitone side effects
sedative
what are infantile spams
rare events but almost always indicate severe underlying neurological problem
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
what are infantile spasms
rare seizure disorder occurring in young children usually <1 year old
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
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
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
what cardiac cause of seizures/convulsions must you rule out
LQTS
also HOCM and aortic stenosis
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)
D.Dx of motor stereotypies
tic disorder / tourette syndrome compulsions paroxysmal dyskinesias seizures myoclonus dystonia
onset of tic disorers
begin 4-5 yr but dont present until 9-10 yr
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3992090/
useful article on tics
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…
what are compulsions
movements of ritualistic behaviours to reduce stress
on a background of inflexibility and intrusive thoughts
what are paroxysmal dyskinesias
encompass conditions where there is excess unwanted movement e.g. tics, chorea, dystonia, myoclonus, tremor
what is epilepsy
condition characterised by recurrent epileptic seizures
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
what are breath holding attacks
child is crying and breathes out but forgets to breathe in therefore turn blue
risk of recurrence of febrile seizure
25%
