Neurology - CP/Epilepsy Flashcards
(39 cards)
What are the causes of cerebral palsy?
80% in antenatal origin due to vascular occlusion/cortical migration disorders/structural maldevelopment of the brain during gestation.
10% due to hypoxic ischaemic injury during delivery
10% are postnatal origin (preterm infants esp vulnerable - IVH, encephalopathy etc)
What are the different types of cerebral palsy?
spastic cerebral palsy (90%)
dyskinetic cerebral palsy (6%)
ataxic (hypotonic) cerebral palsy (4%)
Describe spastic CP
limb tone is increased due to UMN damage
associated with brisk reflexes
presents early
What are the three categories of spastic CP?
Hemiplegia - unilateral involvement of the arm and leg involvement, may be due to neonatal stroke
Quadriplegia - all four limbs affected, often severely, poor head control and low central tone. Associated with seizures, microcephaly
Diplegia - affects legs > arms, likely to be preterm
What is dyskinetic CP?
Choreic movements
Athetosis - slow writing distal movements
Dystonia - twisting appearance
Extrapyramidal system affected, used to be due to rhesus disease of the newborn
What is ataxic CP?
Mostly genetic, may be acquired brain injury in cerebellum
- Trunk and limb hypotonia
- delayed motor development
- intention tremor
What is craniosynostosis?
early fusion of cranial sutures - may cause raised ICP
What are the features of CP?
- abnormal limb/trunk posture and tone, delayed motor milestones
- feeding difficulties
- abnormal gait
- asymmetric hand function before 1 year
- primitive reflexes persist
What is cerebral palsy?
Abnormality of movement and posture, limiting activities, due to non-progressive disturbances in developing brain
May see disturbance of cognition, communication, perception, sensation, seizure, musculoskeletal problems
Affects 2/1000 live births
How are children with CP treated?
Physiotherapy - to prevent muscle weakness and to prevent muscles getting stuck in a rigid position
Drugs - Diazepam (muscle relaxant but lots of SEs), botox injectionscan be used, finally baclofen intrathecal therapy can be used
Orthopaedic surgery - used to lengthen muscles which are causing problems
What is epilepsy?
- incidence 0.05%
- recurrent unprovoked seizures associated with abnormal, excessive or synchronous neuronal activity
- mostly idiopathic causes
What are generalised seizures?
- arise from both hemispheres
- loss of consciousness
- no warning
- symmetrical seizures
bilateral synchronous EEG discharge
What are the different types of generalized seizures?
absence myoclonic tonic tonic-clonic atonic
What is an absence seizure?
- transient loss of consciousness with an abrupt onset and termination
- flickering eyelids, altered muscle tone
- typical = petit mal
- hyperventilation may proceed seizure
What is a myoclonic seizure?
brief repetitive jerking limbs, neck or trunk
physiological appearance - hiccoughs or Stage II sleep
What is a tonic seizure?
generalised increase in tone
What is a tonic clonic seizure?
- rhythmic muscle group contraction after tonic phase
- may fall while rigid tonic, become cyanosed
- clonic = jerking of limbs
- cyanosis, irregular breathing, possible tongue biting and incontinence
- may last seconds to minutes
- followed by LoC or deep sleep
What is an atonic seizure?
- often combined with myoclonic jerk and transient loss of muscle tone
- sudden fall, or drop of head
What are focalised seizures?
- onset limited to one cerebral hemisphere
- relatively small group of dysfunctional neurones
- may see an aura dependent on origin
- may see change in consciousness
What happened during a frontal focal seizure?
motor phenomena e.g. Jacksonian march, clonus, atony
What happened during a temporal focal seizure?
auditory or sensory phenomena, autosomatisms, déjà vu
What happened during a occipital focal seizure?
positive or negative visual phenomena
What happened during a parietal focal seizure?
contralateral altered sensation (dysaethesia)
What investigations should be carried out when epilepsy is suspected?
EEG - unless seizure is captured, an EEG only supports diagnosis
MRI/CT - assess brain structure if there are neurological signs between seizures or if focal seizures
Other - functional scans (PET/SPECT scan), metabolic and genetic studies
