Paed:Neuro Flashcards
What is a seizure?
A sudden disturbance of neurological function caused by an abnormal or excessive. neuronal discharge. Can be epileptic or non-epileptic.
What can cause epilepsy?
idiopathic secondary to cerebral dysgeneis, cerebral vascular occlusion, cerebral damage cerebral tumour neurodegenerative disorder neurocutaneous syndromes
What can cause a non-epileptic seizure?
Febrile seizures Metabolic: hypoglycaemia, hypocalcaemia, hypomagnesia, hypo/ernatraemia Head trauma Meningitis/encephalitis Poisons/toxins
What is a febrile seizure?
Seizure + fever, without intracranial infection due to bacterial meningitis or viral encephalitis.
How does a febrile seizure present?
Brief, generalised tonic-clonic seizures
Occurs in early viral infection when temperature is rising rapidly
Does NOT cause brain damage
*treat underlying infection
Explain paroxysmal disorders/funny turns
Breath-holding episodes: toddler precipitated by anger, holds breath, goes blue then limp and rapid recovery
Reflex anoxic seizures: toddler precipitated by pain, tops breathing, goes pale, brief seizure then rapid recovery
What is epilepsy?
Chronic neurological disorder characterised by recurrent unprovoked seizures consisting of transient signs associated with abnormal, excessive or synchronous neuronal activity in the brain.
What is a generalised seizure?
Discharge from both hemispheres (absence, myoclonic, tonic, tonic-clonic or atonic)
Focal
Seizures arise from one (or part of one) hemisphere
Clinical presentation of frontal focal seizure?
Motor cortex
Clonic movements including Jacksonian march
Asymmetrical tonic seizures
Atonic seizures from messiah frontal discharge
Clinical presentation of temporal focal seizure?
Most common
Auditory or sensory phenomena
Lip smakcing
De ja vu
Clinical presentation of occipital focal seizure?
Positive/negative visual phenomena
Clinical presentation of parietal focal seizure?
Contralateral altered sensation sensation (dysaesthesia)
Describe a generalised seizure
always LOC
no warning
symmetrical seizure
bilaterally synchronous seizure discharge on leg or varying asymmetry
Describe an absence seizure
Transient LOC with abrupt onset and termination, unaccompanied by motor phenomena except for some flickering of the eyelids and minor alteration in muscle tone.
Absences may be typical (petit Mal) or atypical
Often precipitated by hyperventilation
Describe a myoclonic seizure
Brief, often repetitive, jerking movements of the limbs, neck or trunk
Non-epileptic myoclonic movements are also seen physiologically in hiccoughs (myoclonus of the diaphragm( or on passing through stage II sleep (sleep myoclonus)
Describe a tonic seizure
Generalised increase in tone
Describe a tonic-clonic seziure
Rhythmical contraction of muscle groups following the tonic phase
Rigid tonic phase: children may fall to ground, stop breathing and become cyanose.
Followed by the clonic phase, with jerking of the limbs.
Irregular breathing, cyanosis persists + saliva may accumulate in the mouth.
May be biting of tongue and incontience of urine
Lasts seconds to minutes followed by unconsciouness or deep sleep for several hours
Describe an atonic seizure
Often combined with a myoclonic jerk, followed by a transient loss of muscle tone causing a sudden fall to the floor or drop of the head.
How is epilepsy diagnosed?
- Detailed history including eyewitness account
- EEG: 3Hz spike
- MRI + CT structural brain scan (identify tumour, vascular lesion and sclerosis)
- Functional scans: PET, SPECT to find areas of hyper metabolism in epileptogenic lesions.
- Metabolic Ix: na+ and glucose
How is epilepsy managed?
Buccal benzos?
Generalised seizures: valproate + lamotrigene
Focal seizures: carbamazepine, lamotrigene
Last resort: phenytoin
What is West syndrome?
4-6months Violent flexor spasms of head, trunk and limbs followed by extension of arms Often occurs on walking many times a day EEG: hypsarrhtmia Tx: vigabatrin or corticosteroids Often develop LD or epilepsy
What is Lennox-gastaut syndrome?
1-3 years
multiple seizure types but mostly drop attacks (Astatic seizures), tonic seizures and atypical absences
- complex neurological problems
Explain childhood absence epilepsy?
4-12 years
Stare momentarily and stop moving only for a few seconds
Child has no recall, can interfere with schooling.
Induced by hyperventilation (child asked to blow on windmill for 2-3mins in OP clinic)
EEG: 3Hz spike, bilaterally synchronous
What is benign epilepsy with centrotemporal spike? (BECTS)
4-10 years
Tonic-clonic seizures in sleep, or simple focal seizures with awareness of abnormal feelings in tongue and distortion of face
EEG: focal sharp wave
Doesn’t always need treatment
What is early-onset benign childhood occipital epilepsy? (panayiotopoulos type)
1-14years
Younger children: periods of unresponsiveness, eye deviation, vomiting and atonic features
Older children: headache and visual disturbance including disortion of images and hallucinations
EEG: occipital discharges
Remit in childhood
What is juvenile myoclonic epilepsy?
Adolesecne - adulthood
Myoclonic seizures, but generalised tonic-clinic seizures and absences ma occur usually shortly after waking.
Typical Hx: throwing drinks or cornflakes about in morning as myoclonus occurs at this time. Learning is unimpaired.
Genetic link identified. Remission unlikely.
What is cerebral palsy?
Abnormality of movement and posture causing activity limitation attributed to non-progressive disturbances that occurred in the developing fetal or infant brain.
Causes of CP?
80% antenatal: Vascular occlusion, cortical migration disorders, structural maldevelopment of the brain during gestation. Other antenatal: genetic syndromes, congenital infection
10% due to hypoxic-ischaemic injury during delivery
10% are postnatal orgin: meningitis, encephalitis, enchephalopathy, head trauma, symptomatic hypoglycaemia, hydrocephalus and hyperbilirubinaemia.
What can cause brain damage in pre term infants?
Periventricular leukomalacia secondary to ischaemia and/or severe intraventricular haemorrhage
Clinical presentation of CP?
Early features:
- Abnormal limb and or trunk posture and tone in infancy with delayed motor milestones, accompanied by slowing of head growth
- Difficulty feeding, oromotor incoordination, slow feeding, gagging, vomiting
- abnormal gait when walking
- asymmetric hand function before 12months
- persistent primitive reflexes
What are the clinical subtypes of CP?
1) Spastic CP 90%
1a) Hemiplegia
1b) Quadriplegia
1c) Diplegia
2) Dyskinetic CP 6%
3) Ataxic/hypotonic 4%
What is spastic cp?
Limb tone is persistently increased (spasticity) w/ associated brisk deep reflexes and extensor plantar reflexes. Clasp knife reflexes and initial hypotonia, especially of head and trunk.
What is hemiplegic spastic CP?
Unilateral invovlement of arm and leg, leg more than arm, face spared. happens 4-12months Fisting of affected harm flexed arm pronated form asymmetric reaching or hand function tiptoe walking (toe-heel gait) PMH normal
What is quadraplegic spastic CP?
All four limbs severely affected
Trunk has tendendcy to opisthonus (extensor posturing)
poor head control
low central control
ass w/ seizures, microcephaly, intellectual impairment
What is diplegic spastic CP?
All four limbs but legs much more than arms
Motor difficulties in arms apparent with functional use of hands
abnormal walking
ass w/ preterm birth due to periventricular brain damage
What is dyskinetic CP?
- Movements which are invvoluntary, uncontrolled and more evident with active movement and stress
- variable muscle tone
- dominate primitive reflex motor pattern
- Get chorea, athetosis and dystonia.
- Floppy, poor trunk control, delayed motor development in infancy due to damage in basal ganglia or extrapyramidal pathway
What are the causes of dyskinetic CP?
Kernicterus or hypoxic-ischaemic encephalopathy at term
What is chorea?
-Irregular sudden brief non repetitive movements
What is athetosis?
- Slow writhing movements occuring more distally eg. fanning fingers
W
What is dystonia?
Simultaneous contraction of agonist and antagnoist muscles of trunk and proximal muscles giving twisting appearance