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Yr4 - Paeds > Neurology > Flashcards

Neurology Flashcards

1
Q

Define of meningitis

A

Inflammation of arachnoid mater, pia mater and CSF
Viral
- enteroviruses
- HSV
- VZV
- HIV
Bacterial
- neonates - Streptococcus agalactiae, Haemophilus influenzae type B
- childhood - Neisseria meningitidis, strep pneumoniae

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2
Q

Pathophysiology of meningitis

A

Increased cytokines
Increased permeability of the blood-brain barrier
Cerebral vasculature vasodilation -> reduced perfusion pressure -> ischaemia
Cerebral oedema
Raised ICP

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3
Q

Risk factors for meningitis

A 
Maternal infection
Splenectomy
PROM
Not immunised
Low birthweight
CSF shunt
Prematurity
Immunocompromised
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4
Q

Clinical features of meningitis

A

Meningeal irritation
- neck stiffness, photophobia, Brudzinski sign, Kerning sign, seizures
Raised ICP + cerebral oedema
- altered consciousness, N+V, reduced GCS, bulging fontanelles, papilloedema
Cytokine release
- rigors, headache, fever
Meningococcal septicaemia
- hypovolaemia, non-blanching rash, reduced BP, increased HR, petechiae and purpura

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5
Q

Brudzinski sign

A

Child is supine

Passively flex their neck and they have reflex flexion of their hips

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6
Q

Kering sign

A

Patient supine
Passively flex hip and knee to 90
Passively straighten knee - produce pain along the spine

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7
Q

Ix for meningitis

A 
Blood cultures
FBC
CRP
Renal profile
Lumbar puncture - gold standard but contraindicated if features of raised ICP
- need plasma sample to compare too
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8
Q

Features of CSF in meningitis

A 
Bacterial
- turbid appearance
- neutrophils present
- high protein content
- low glucose content
Viral
- clear appearance
- lymphocytes present
- normal or slightly raised protein content
- normal or slightly low glucose content
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9
Q

Mx of meningitis

A

ABCDE appearance
Empirical abx IV
IV corticosteriods - if > 3 months of age

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10
Q

Complications of meningitis

A 
Ataxia
Abscess
DIC
Epilepsy
Paralysis
Deafness
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11
Q

Pathophysiology of febrile convulsions

A

Seizure that is associated with fever

- unrelated to other pathology

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12
Q

Epidemiology of febrile convulsions

A

Between 1 and 5 years of age 1 in 2o will suffer febrile convulsions

  • reoccur in 1/3 children
  • should not happen > 5 years old
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13
Q

Clinical features of febrile convulsions

A

Preceding febrile illness must be evident
Generalised tonic-clonic seizure - lasting about 5 mins
No features of meningitis, encephalitis or sepsis
Full recovery < 1 hour

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14
Q

Ix for febrile convulsions

A

Clinical diagnosis

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15
Q

Mx for febrile convulsions

A 
Manage fever
Managed at home
Do not restrain - fracture risk
Nothing in mouth
Recovery position after
Call 999 is last longer than 5 mins
Give rectal diazepam or oral midazolam if last longer than 5 mins
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16
Q

Define epilepsy

A

Enduring predisposition to generating unprovoked seizures

  • 2+ unprovoked seizures occurring > 24 hours apart
  • 1 unprovoked seizures and probability of further 2 seizures in next 10 years
  • diagnosis of epilepsy syndrome
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17
Q

Pathophysiology of epilepsy

A

Increased activation or decrease inhibition of neurones can lead to imbalance creating overall net excitation -> paroxysmal discharge
Brain region affected dictates symptoms associated with seizures

18
Q

Brain regions affected by epiepsy

A

Frontal lobe
- motor cortex - movement impairment
- frontal cortex - emotional/cognitive change
Temporal lobe
- auditory cortex - ringing or hissing/hearing music
- Wernicke’s area - dysphagia
- olfactory area - unusual taste or smell
- superior temporal gyrus - automatisms, lip smacking, chewing
Parietal
- sensory cortex - sensory disturbance
Occipital
- visual cortex - flashes, scotoma or blurring
Limbic
- amygdala, thalamus and hypothalamus - autonomic dysfunction

19
Q

Types of epilepsy

A 
Focal onset
- motor
- non-motor
Generalised onset - awareness always impaired
- motor
- non-motor (absence)
Unknown onset
- motor
- non-motor
20
Q

Risk factors for epilepsy

A 
Learning disability
1st degree relative affected
Idiopathic
Genetic syndromes - tuberous sclerosis
Metabolic disease
Mitochondrial disease
Intracranial infection
Post-traumatic
Electrolyte disturbance
21
Q

Diagnosis of epilepsy

A

Childhood absence
- 10% of childhood epilepsy
- frequent absence seizures with onset around 6 years
Juvenile myoclonic epilepsy
- 5%
- onset in adolescence
- characterised by myoclonic, tonic-clonic and absence seizures

22
Q

Definitions of seizures

A

Tonic - stiffness in limbs
Clonic - sustained rhythmical jerking of limbs
Tonic-clonic - initial stiffening followed by jerking
Atonic - sudden loss of muscle tone so child falls on floor
Myoclonic - brief muscle jerk
Automatisms - repetitive, purposeless actions

23
Q

Mx of epilepsy

A

Anti-epileptic drugs

  • focal seizures - carbamazepine or lamotrigine
  • generalised tonic-clonic seizures - sodium valproate or lamotrigine
  • absence - ethosuximide of sodium valproate
  • myoclonic - sodium valproate
  • tonic or atonic - sodium valproate
24
Q

Side effects of sodium valproate

A 
Ataxia
Liver failure
Pancreatitis
Reversible hair loss
Oedema
Appetite increased
Teratogenic
Thrombocytopenia
Enzyme (CYP450) inhibitor
25
Q

DDx to seizures

A 
Breath-holding spells
Tics
Self-gratification
Night terrors
Psychogenic non-epileptic seizures
26
Q

Causes of headaches

A

Primary
- tension-type
- migraine
- cluster
Secondary
- trauma - post-concussion, intracranial bleeds, fracture
- MSK - temporomandibular joint, cervical spine
- vascular - subarachnoid, parenchymal
- raised ICP - SOL, hydrocephalus
- meningeal irritation - meningitis, encephalitis
- sinuses - sinusitis

27
Q

Clinical features of tension headache

A

Bilateral or posterior
Tight
Unaffected by routine activity

28
Q

Clinical features of migraine

A 
Unilateral or bilateral
Pulsating
Severe
N+V
Photo/phonophobia
\+/- aura
29
Q

Clinical features of a cluster headache

A 
Unilateral
Around the eye
Stabbing/throbbing/burning
Severe
Ipsilateral
Epiphora
Nasal congestion
Sweating
30
Q

Clinical features of sinusitis

A 
Frontal 
Facial tenderness
Nasal congestion
Sore ear
Cough
Fever
31
Q

Clinical features of menignits

A 
Generalised
Unwell
Fever
Stiff neck
Rash
Focal neurology
32
Q

Clinical features of encephalitis

A 
Generalised
Fever
Altered mental status
\+/- seizures
\+/- reduced GCS
33
Q

Clinical features of SOL

A 
Localised or generalised
Slowly worsening
Worse in mornings
Worse with valsalva manoeuvre
Vomiting
Focal neurology
Altered personality
34
Q

Clinical features of haemomrrhage

A 
Sudden onset
Often follows trauma
Reduced GCS
Focal neurology
Seizures
35
Q

Clinical features of of TMJ

A

Unilateral or bilateral
Worse with jaw movement
Reduced mandibular movement

36
Q

Mx of headaches

A 
Headache diary
Treat secondary by underlying diagnosis
Treat primary headaches as
- tension-type - paracetamol or NSAIDs
- migraine 
      - acute - oral triptan + NSAID or paracetamol + anit-emetic
     - prophylaxis - topiramate or propranolol
- cluster 
     - acute - O2 + SC/IM triptan
     - prophylaxis - verapamil 1st line
37
Q

Define hydrocephalus

A

Rise in CSF volume within CNS -> raised ICP

38
Q

Pathophysiology of hydrocephalus

A

Non-communicating
- obstruction to flow of CSF
Communicating
- decreased drainage of CSF from subarachnoid space

39
Q

Causes of hydrocephalus

A 
Non-communicating
- SOL
- intraventricular haemorrhages
- stenosis of aqueduct
Communicating
- post-meningitis
- increased venous sinus pressure
40
Q

Clinical features of hydrocephalus

A 
Infants
- irritability
- poor feeding
- vomiting
- macrocephaly
- bulging fontanelle
- setting sun sign - eyes downward with upper lid retracted
- UMN signs - hypertonia and spasticity
Children
- headaches
- vomiting
- reduced GCS
- blurred/double vision
- difficulty walking
- UMN signs 
- papilloedema
- failure of upward gaze
- CN VI palsy
- Macewen sign - percussion of head results in cracked pot sound
41
Q

Ix for hydrocephalus

A

USS through fontanelles / CT for older children

42
Q

Mx of hydrocephalus

A

Hydrocephalus with raised ICP is surgical emergency

- surgical decompression via placement of ventricular shunt

Yr4 - Paeds (16 decks)

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