Neurology + Development (2s + 3) Flashcards
What are children with special needs?
- if they have developmental problems and disabilities
- these can affect their:
- behaviour or ability to socialsie
- reading + writing, eg. dyslexia
- ability to understand things
- concentration levels, eg. ADHD
- physical ability
What is the child development service?
- secondary care service available for children w/ special needs till they are of school-leaving age
- child has regular assessment + management that aims to meet all functional needs
- it involves multidisciplinary teams consisting of paeditricians, physios, OTs, SALT, clin psychologist, dietician, special health visitors, social services
- many agencies are involved: health, social, educational, voluntary, parent support groups
- each child has key worker who makes sure they get access to correct care
- community or hospital based
- service records all of children they provide for Special Needs register
Several education acts ensure that all children have educational inputs appropriate to their requirements and that everyone can attend mainstream schools if at all possible.
How are learning difficulties classified in terms of IQ and how are the moderate/mild met in terms of education needs?
- mild → 70-90
- moderate → 50-70
- severe → 20-50
- profound → <20
Those w/ mild and some with moderate learning difficulties are able to attend mainstream school if supported by additional helpers. Each child w/ special needs has a special educational needs coordinator from the teaching staff allocated to them. They formulate individual care plans.
For those who require high levels of support, what is provided?
- Local Educations Authority may need to do a Statement of Special Education Needs which is reviewed annually
- those w/ profound, severe and some of those w/ moderate learning difficulties need to attend special schools
- it is also necessary for some of those with severe physical, sensory, communication or behavioural problems to attend them as well
What is squint (strabismus) and what are the different types?
- failure of the 2 eyes to maintain proper alignment and work together as a team
- if you have stabismus, 1 eye looks directly at the object you are viewing while the other eye is misaligned:
- inward (esotropia, “cross-eyed”)
- outward (exotropia, “wall eyes”)
- upward (hypertropia)
- downward (hypotropia)
Can be divided into concomitant (common) and paralytic (rare)
What are the causes of a squint?
Exact causes of a squint isn’t always known, some people are born with a squint and others develop one later in life. In children, a squint is often caused by the eye attempting to overcome a vision problem, such as:
- short-sightedness
- long-sightedness
- astigmatism
- rarer causes ⇒ infections (measles), Down’s, developmental delays, CP
How are squints picked up in children, in terms of investigations?
- cover test → for older children - child shown object which their eyes fixate on, a squint is present if when the fixating eye is covered with a piece of cardboard, the other eye has to move to fixate on the object
- Hirshberg test → light shone on eyes from arm’s length, light should be symmetrically reflected + centred in each eye - if not, then stabismus present
Amblyopia is more likely in children with squint. What is amblyopia?
- in strabismus there will be normal vision in the preferred eye
- but due to the discrepancy between 2 images projecting to the brain from 2 eyes, the brain may ignore it from the deviated eye
- amblyopia describes abnormal brain development due to lack of stimulation of the brain from visual system
- this abnormal brain development is completed at 7 years of age
- so if strabismus not corrected by then, there will be permanent loss of vision in deviated eye
- occlusion of the good eye with a patch for a period of time each day will encourage the use of the deviated eye
What is the management of squint?
- glasses → can help if cause is eye-sight related
- eye exercises
- surgery → involves moving the muscles that control eye movement so the eyes line up correctly, recommended if glasses aren’t fully effective on their own
- injections to eye muscles → weaken them, which can help eyes line up better
- eye patches → may help prevent amblyopia
What would be your differentials for seizures in children?
- febrile convulsion → most common cause in kids, present as a single episode w/out a prior hx of seizures, but can be recurrent
- non-epileptic seizures → psychological, hard to diagnose, appear externally as seizures, features: flapping limbs (not tonic or clonic), tightly shut eyes which resist forced opening + distractability out of episodes
- breath-holding spells → precipitated by anger/frustration
- long QT syndrome → triggered by pain/fear/exercise
- syncope
- paroxysmal movement disorders → tics, ataxias, dyskinesias
- G-O reflux
- epilepsy
- panic disorder
- self-gratification behaviour
- reflex anoxic seizures → ECG shows asystole
- infection → sepsis, cerebral abscess, subdural empyemas can all lead to seizures
- tumour → focal mass may present w/ focal signs or signs of inc ICP
- toxins → drugs
- metablic → electrolyte imbalances or hypoglycaemia
- head injury → trauma or NAI
How are seizures classified?
What are infantile spasms?
- typically begin in infants aged 4-8months
- consist of clusters of myoclonic spasms
- typically upon awakening or falling asleep
- presentations can be more subtle
- include slight eye flutter or head drop
What is absence epilepsy?
- aka petit mal epilepsy
- frequent (can be 100+ / day) episodes
- brief staring spells, fluttering of eyelids
- last only a few seconds (typically up to 15s)
- patients return immediately to baseline mental status
- primarily generalised in onset
- diagnosis can be assisted by classical EEG features + hyperventilation trial, which often provokes seizures
What investigations can be done for suspected seizures in children?
- EEG → may show abnormal rhythms specific to epilepsy syndrome
- blood glucose
- basic metabolic panel
- FBC
- ECG
- MRI brain
- lumbar puncture
Language delay is when there is delay in understanding or expressing speech and/or language. An ‘alarm bell’ is not making clear single words by 2 years of age.
What are the red flags for developmental language disorder?
What are the causes of language delay?
- normal variant or familial
- global developmental delay
- learning difficulties
- hearing impairment
- anatomical defect causing abnormal speech production
- autism
- environmental or social deprivation
What is the International Headache Society (IHS) criteria for paediatric migraine without aura?
Tension type headache is the second most common cause of headache in children. What are the clinical features?
- symmetrical/bilateral
- last from 30 mins to 7 days
- have a pressing or tightening quality
- unaffected by physical activity
- management → paracetamol or NSAIDs for acute
What are the clinical features of a muscular dystrophy?
Children first present w/
- delayed walking
- frequent falls
- developmental delay (eg. lang delay)
- weakness ⇒ waddling gait or Trendelenburg gait → both due to proximal muscle weakness
- muscle pseudohypertrophy (particularly in calves) is also seen, where muscle enlarges due to fat deposition rather than muscle
- muscle weakness in the back ⇒ kyphoscoliosis
- Gower’s sign typically starts as early as the age of 3 + develops by 5-6yrs of age, it refers to motion of using hands to climb over their body in order to stand
