Neurology / Neurodevelopment Flashcards
Main excitatory neurotransmitter
Glutamate
Main inhibitor neurotransmitter
GABA
Which spinal tract travels in the dorsal column and where does it cross midline?
Fine touch, vibration, proprioception
Crosses at the medualla
What is sensed by the spinothalamic tract and where does it cross midline?
Pain and temp
Crosses immediately at SC –> thalamus
What spinal tract is in the ventral horn and where does it cross the midline?
Motor tract
Crosses at level of medulla
What is Brown-Sequard syndrome and how does it present?
Hemi-section of SC
- Ipsilateral loss of fine touch, proprioception and motor
- Contralateral pain and temperature
Features of Charot-Marie-Tooth Syndrome
- Dominant
- Progressive damage to peripheral nerves - demyelination
- Peripheral weakness
- Hammer toes
- High arch feet
- Legs like upside down champagne bottles
- Reduced sensation
- Reduced nerve condution
Features of Rett Syndrome
Mostly girls
Mutation MECP2 gene
- Microcephaly
- GI disorder
- Seizures
What do nerve conduction studies test for?
Axonal degeneration = reduced amplitude
Demyelination = reduced velocity
Pathophysiology and features of MS
Rare in childhood
AI –> demyelination –> lesions in white matter –> demyelinating plaques
Relapsing / remitting neurological Sx
Ix: LP - oligoclonal bands, raised IgG. Evoked potentials.
ADEM - Pathophysiology, presentation, Ix and Tx
Immune mediated response to infection / vaccination –> monophasic acute demyelination in brain (white matter) and SC
Presents - Abrupt, fever, headache, drowsiness, coma, seizures, paresis, CN palsies
Ix: MRI, CSF mildly increased lymphocytes / protein
Tx: Support hydration, IV methylpred
Pathophysiology of migraines
- Genetic component
- NO - vasodilation
- Cortical spreading depression
- Raised seratonin / dopamine
Pathophysiology acute migraine treatment
- Triptans = 5-HT agonists –> block neurotransmission and reduced neuropeptide release
- Dopamine antagonists eg prochlorperazine
Pathophysiology of migraine prophylaxis
- Pizotogen >5y = seratonin/ histamine antagonist
- Propranolol >2y = beta-1 receptor antagonist, reduced noradrenergic action, altered GABA firing
Features and management of idiopathic intracranial HTN
- More in overweight teen girls
- Presents: Headache, nausea, visual disturbance, papilloedema
- Normal brain imaging, raised LP opening pressure
- Tx: Therapeutic LP, acetazolamide (reduced CSF production) +/- furosemide. If not effective, CSF shunt
Presentation of raised ICP
- Headache - more mornings / cough/ micturition
- Vomiting esp morning
- Focal neurological Sx
- Cushing’s sign - low HR, high BP, irregular resps
- Fluctuating mental state
Management raised ICP
- Close monitoring Co2/ glucose/ electrolytes/ temp in normal range
- Elevate bed 30 degrees, increased jugular flow
- Analgesia / sedation - reduced O2 demand
- Seizure prophylaxis
- Bolus 3% NaCl / mannitol
- Fluid restriction
- Surgical decompression
Causes of ischaemic stroke in children
- Perinatal - MCA - thrombotic from placenta
- Cardiogenic - CHD, arrhythmia, cardiomyopathy, infective endocarditis
- Thromboembolic eg vasculitis
- Haem - sickle cell, coagulation disorder
AEDs for generalised tonic clonic seizures
1st line: Sodium valproate
2nd line: Lamotrigine, levetiracetam
AEDs for tonic / atonic seizures
1st Line: Sodium Valproate
2nd Line: Lamotrigine
AEDs for absence seizures
1st line: Ethosuximide, sodium valproate
2nd line: Lamotrigine
AEDs for myoclonic seizures
1st line: Sodium valproate
2nd line: Levetiracetam, topiramate
AEDs for Focal seizures
1st line: Carbamazepine, lamotrigine
AEDs for Infantile spasms
Vigabatrin or Prednisolone
Vgabatrin only if Tuberous Sclerosis
Presentation radial nerve palsy
C5-8, T1
Causes: humerus / radial fracture, “saturday night palsy”
Sensory: post. arm, radial distribution of dorsum hand
Motor: Weak elbow extension, absent triceps / supinator reflex, weak wrist / thumb / MCP extension
Presentation of median nerve palsy
C5-8, T1
Causes: Humerus fracture, carpal tunnel
Sensory: palmar thenar side
Motor - weak grip, weak forearm pronation. “Hand of benediction”
Presentation of ulnar nerve palsy
C8 / T1
Causes: Supra-condylar fracture, compression cubital tunnel
Sensory: Hypothenar eminence
Motor: Claw hand, weak flexion, intrinsic muscles
Presentation of Erb’s palsy
C5-8, T1. Brachial plexus injury
“Tip the waiter”
Causes: shoulder dystocia
Sensation - loss over seargent’s patch
Motor - limp, adducted, internally rotated shoulder, extended elbow, pronated wrist
Presentation of CNIII palsy
“Down and out”
Ptosis
Dilated pupil, absent pupillary reflex
Presentation of CNIV palsy
Double vision, improved by tilting head to opposite side –> difficulty reading booking / going down stairs
Prob with superior oblique
Presentation of CNVI palsy
Eye inwards
Prob with lateral rectus
Presentation of CN VII
Bell’s palsy
Weak muscles of facial expression
Bell’s= UMN –> forehead sparing
Horner syndrome = SNS via CN VII - Ptosis, miosis and anhidrosis
Presentation of myasthenia gravis
Weakness of skeletal muscles
Fatiguability on exertion
Bulbar muscle weakness and weakness head extension / flexion
ACh receptor antibody
Treatment of myasthenia gravis
Thymectomy
Immune modulating agents
