Neurology Flashcards
State some differentials for seizures in children
Syncope Breath holding spells Reflex anoxic seizures Daydreaming Tics Self-gratification Psychologically induced events
Compare breath holding spells and reflex anoxic seizures
Breath holding: emotional event leads to crying then holding breath on exhalation. They go limp, collapse and may have brief clonic jerks
Reflex anoxic seizures: fear or pain leads the child to stop breathing. They go pale and limp and can seize
A child presents to A&E seizing, what needs to be ruled out?
Hypoglycaemia Hypoxia Fever Meningitis Intracranial bleed Hypercalcaemia Toxins
Compare simple and complex febrile seizures
Simple:
- <15 minutes
- only one event per fever
- complete recovery within an hour
Complex:
- > 15 minutes
- may have focal features
- can reoccur within same fever
How should parents manage febrile seizures?
- cool blankets and fluids during a febrile illness
- if seizing then clear the area
- can give rectal diazepam
- call 999
- check for non-blanching rash
Describe myoclonic, tonic and clonic
Myoclonic: electric like shock movements
Tonic: sustained contraction
Clonic: rhythmic jerking
What does an EEG of absence seizures show?
3 - 4 Hz spike and wave
How would an occipital focal seizure present?
bright coloured flashing lights
How would a centroparietal focal seizure present?
- spreading sensorimotor phenomenon
- paraesthesia
How would a temporal focal seizure present?
- lip smacking
- plucking at clothes
- de ja vu
- post ictal dysphasia
How would a frontal focal seizure present?
- dystonic posture
- guttural noises
- Jacksonian march
- post ictal weakness
Wests syndrome/ infantile spaspsm:
a) age of onset
b) description of child
c) EEG
d) management
a) <1 year
b) flexion of limbs and trunk followed by arching of back and extended arms - lasts seconds but can get 50+ in a row. Developmental delay
c) hypsarrhythmia
d) Vigabatrin
Dravet syndrome/ severe myoclonic:
a) age of onset
b) description of child
a) <1 year
b) focal or general, affecting one side of body. Development delay after a couple of years
Lennox-Gastoux:
a) age of onset
b) description of child
c) EEG
d) management
a) < 4 years
b) complete variety of seizure types
c) slow spikes
d) ketogenic diet
Janz syndrome/ juvenile myoclonic:
a) age of onset
b) description of child
c) EEG
d) management
a) teenagers
b) myoclonic seizure on waking up +/- GTC and absence.
c) generalised spike and wave
d) valproate
What are the types of focal and diffuse primary head injury?
Focal: haematoma and contusion
Diffuse: DAI and concussion
Describe the CT appearance of an intraventricular haemorrhage
Hyperdense in the ventricles
State some indications for an immediate CT head in a child
- LOC > 5mins
- GCS < 14
- Focal neurological deficit
- seizures
- Signs of basal skull fracture
- amnesia
- 3 episodes of vomiting
- tense fontanelle
Aside from a typical migraine, how else might migraines present in children?
Hemiplegic
Basilar (aura + syncope with minimal headache)
Cyclical vomiting
Abdominal migraine
What is the stepwise management of migraines in children?
- NSAIDs and intranasal sumatriptan for acute attacks
- Propranolol for prophylaxis
- prochlorperazine
Define cerebral palsy and state some causes
Non-progressive, permanent disorder of movement and posture arising during development
- Hypoxia
- Teratogenic drugs
- Infections
What are some neonatal/ infantile signs that a child may have cerebral palsy?
- low apgar score
- floppy
- hand preference < 18 months
- delay in gross motor development
- toe walking
- persistent primitive reflexes
What are the 3 types of cerebral palsy and what part of the brain is affected in each?
spastic: corticospinal tracts
ataxic: cerebellum
dyskinetic: basal ganglia
Describe the features of spastic cerebral palsy
- upper limb in fixed flexion
- lower limb extended knee and plantar flexed foot leading to hemiplegic gait
- equinovarus foot
- increased tone with jerky movements
- slow, slurred speech
Describe the features of ataxic cerebral palsy
- wide based gait
- intention tremor
- movements with abnormal force and inaccuracy
Describe the features of dyskinetic cerebral palsy
- involuntary movements triggered by attempts at control ones
- can get chorea, dystonia and athesosis
State some conditions associated with cerebral palsy
- learning difficulties
- hearing and sight difficulties
- epilepsy
- constipation and urinary incontinence
- ADHD
How can spasticity in cerebral palsy be managed?
Baclofen
Botulinum injections
