Neurology and MSK Flashcards
What is Status Epilepticus?
When a person has had 2 seizures within 30 minutes, without returning back to normal
OR
A seizure longer than 5 minutes
What are the causes of Status Epilepticus?
Ischaemic Stroke/Intracranial Haemorrhage/Hypoxia
Meningitis/Encephalitis
Acute head trauma
New onset epilepsy
Drug intoxication
Drug withdrawal
Hypoglycaemia/other metabolic disorders
Electrolyte Imbalance
What is the initial management/investigation for Status Epilepticus?
A-E
Airway management
Breathing checks - oxygen therapy if needed
Circulation checks
D - don’t ever forget glucose (BM), look for blood loss, pupillary reflexes and accommodation reflex
E - abdo exam and skin exam
What is the 1st line medication for Status Epilepticus?
Benzodiazepines
Give three examples of benzodiazepines?
AND
How are they given?
Diazepam (Rectally)
Midazolam (Buccal)
Lorazepam
Which benzodiazepine should be given if the patient enter status epilepticus with IV access?
IV Lorazepam
What is the second line treatment option for someone still in Status Epilepticus?
Phenytoin or Phenobarbitone
What should you do if someone has been in Status Epilepticus for more than 45 mins and is not responding to other treatment?
Induce coma using gen anaesthesia
What is the serious risk associated with three doses of Benzodiazepines?
Respiratory depression
What is the clinical definition of a Simple Febrile Seizure?
Short generalized seizure than lasts < 15 mins
It won’t recur within 24 hours
Occuring during a febrile episode that is not linked to acute problem within the nervous system
In which age are Simple Febrile Seizures more likely to occur?
6 months to 5 years
What is the clinical definition of a Complex Febrile Seizure?
Focal, generalised or prolonged seizure lasting > 15 mins
Recurring more than once in 24 hours
Usually associated with post-ictal symptoms
What does post-ictal mean?
After a seizure
What is Todd’s Palsy?
Focal weakness in a part of or all of the body after a seizure. Todd’s palsy usually localised to left or right side of body, and usually subsides fully within 48h.
What is Febrile Status Epilepticus?
Complex Febrile Seizure that lasts >30 mins, or has shorter serial seizures, without consciousness regained in between seizures
Why is an EEG not recommended as a diagnostic tool for a child in a Febrile Seizure?
It can show epileptic activity in normal people, but can also be normal in many children with epilepsy.
Hence, it is not very sensitive
What is Epilepsy defined by?
> 2 unprovoked seizure occurring > 24 hours apart
Diagnosis of an epilepsy syndrome
1 unprovoked seizure and a probability of further seizures similar to general recurrence risk (at least 60%) after 2 unprovoked seizures
How do you Safety Net a parent with a child who has had Febrile Seizures?
Train them on first aid training and what not to do if the child has a seizure again
Looking out for status epilepticus - seizure longer than 5 mins or 30 mins
Call an ambulance if the child enters Status Epilepticus
What is Cerebral Palsy?
Disorder of movement & posture due to a non-progressive lesion of motor pathways in developing brain.
(non-progressive means it doesn’t get worse)
What are the three groups of causes of Cerebral Palsy
AND
Name 2 causes within each group
Antenatal - cerebral malformation and congenital infections (rubella, toxoplasmosis and CMV)
Intrapartum (during birth) - birth asphyxia and trauma
Postnatal - intraventricular haemorrhage and encephalitis/meningitis
What are the motor clinical features of Cerebral Palsy?
Abnormal muscle tone in early years
Delayed motor milestones (struggle. to sit, crawl, walk etc)
Abnormal gait
Feeding difficulty
What are the non-motor clincal features of cerebral Palsy?
Learning difficulties
Behavioural challenges
Epilepsy
Squints
Hearing difficulties
What does Hemiplegia mean?
unilateral arm & leg weakness/paralysis
What does Diplegia mean?
Symmetrical paralysis, e.g. both arms
What does Quadripelgia mean?
Paralysis of all 4 limbs
What is the most common type of Cerebral Palsy?
Spastic Cerebral Palsy (70-80%)
What is the cause of Spastic Cerebral Palsy?
Damage to the upper motor neurons in the pyramidal tract.
It can be bilateral
How is Cerebral Palsy managed?
MDT
Treatment of spasticity - oral diazepam, oral & intrathecal(into the spinal cord) baclofen, botulinum toxin type A
What is Duchenne Muscular Dystrophy?
X-linked recessive disease which results in progressive weakness of muscles from the age of 5 onwards. It is the progressive myofibre degeneration and the gradual replacement of muscle by fibrotic tissue.
What is the aetiology of Duchenne Muscular Dystrophy (DMD)?
Defect in the Dystrophin gene causing the whole protein it codes for to be damaged.
Who is more likely to be affected in DMD?
Males (because it is x-linked recessive)
When is the first clinical feature of DMD usually seen?
2-3 years old - awkward gait, causing them to be unable to run properly
At age 12, what is the most likely occurrence for males with DMD?
They are in a wheelchair
What are the diagnostic signs of DMD?
High creatinine kinase
Muscle biopsy shows stain positive for dystrophin
What is the management of DMD?
It is not curable so glucocorticoids to slow down symptom progression
Overnight CPAP (continuous positive airway pressure)
Physiotherapy & muscle conditioning can improve quality of life
How is a child’s bone age determined?
By doing an XR of their wrist. the carpals of children ossify at different ages. Checking their carpals will help determine the bone age.
What is Retts Syndrome?
A rare genetic neurological disorder that occurs almost exclusively in girls and leads to severe impairments
What is the disease that is caused by Neonatal Jaundice that goes unnoticed, which leads to brain damage?
Kernicterus
