Paediatric: Nervous system Flashcards
What is cerebral palsy and how is it caused?
Cerebral palsy is caused by a lesion during development due to a static injury
It is characterised by abnormal movement and posture and impairment in cognition, language, communication, perception, sensation also MSK abnormalities
What are the key features of cerebral palsy in children?
Abnormal movement and posture - 90% spastic, 6% dyskinetic, 4% ataxic
Difficulty feeding - poor oromotor coordination, gagging, vomiting, slow feeding
Abnormal gait (once and if walking begins)
Assymetric hand use < 12 months
Delayed motor milestones (1-18 months)
What is the primary cause of spastic cerebral palsy? what are its features? (tip there are two main types)
UMN lesion in pyramidal/cortiospinal tract
- Spasticity i.e. increased tone with dynamic catch (tone increases with velocity of movement)
- Increased plantar reflexes
Hemiplegia presents at 4-12 months
- U/L motor paresis/plegia, fisting, flexed arm, pronated forearm, asymmetric hand function, tip-toe walking,
Quadraplegia due to hypoxic injury
- scissoring of legs, microcephalic, opisothotonos, seizures, SEVERE intellectual imp.
What are the causes of Cerebral palsy?
80% ante-natal causes e.g. TORCH, vascular occlusion
10% hypoxic injury
10% post-natal - meningitis, encephalitis, hypoglycaemia
Explain the features of ataxic, dyskinetic and athetoid CP?
Ataxic - ataxic gait (wide based, unsteady trunk, poor coordination)
Dyskinetic - involuntary movements
Athetoid - writhing movements
What are the features of Febrile convulsion?
- Fever > 37.0
- Convlusions
- Myoclonic - shock like movement of one or multiple parts of body
- Clonic - rhythimic jerking
- Tonic - Stiff
When are febrile convulsions most common (age)?
6 months to 5 years
What is the management of febrile convulsions?
- Paracetamol - control temp and reduce secure risk
2. Rescue pack of rectal diazepam or buccal midzolam
What is the similarity and differences between generalised and focal seizures?
Both are due to hyperproliferation of neurones in the cerebrum
Generalised arises from both hemispheres and involves impairment of consciousness
Focal arises from one lobe of a single hemisphere and may or may not involve impairment of consciousness?
Tell me the 6 types of generalised seizure and their features
- Myoclonic - electric shock like movement of one limb or multiple parts of body
- Clonic - rhythmic jerking
- Tonic - sustained stiff contractions
- Tonic-clonic
- Atonic - myoclonic seizures followed by complete paralysis
- Absence - period of 5-15seconds of unresponsiveness
Explain the 4 types of focal seizures?
- Frontal - dystonic
- Occipital - flashing, multicoloured lights
- Temporal - acute gastric discomfort, memory disturbances, anxiety
- Parietal - heme-sensory disturbance
What is the definition of and acute management of status epileptics?
Seizure lasting > 5 mins
- ABCDE - start the clock
- Oxygen
- Midzaolam (buccal) or Diazepam (rectal) or Lorzepam (IV)
- Lorazepam IV
- Phenytoin
- RSI
What is the criteria of migraine without aura?
A. ≥ 5 attacks fulfilling B-D
B. Lasts 1-48hrs
C. ≥ 2 of: U/L or B/L; pulsating; aggravated by normal activity; mod-sev intensity
D. ≥ 1 of: Nausea + vomiting; photo/phonophobia
What is the criteria for migraine with aura?
A. Lasts 1-48hrs
B. ≥ 2 attacks fulfilling C
C. ≥ 3 of: ≥ 1 episode of reversible aura; aura developing gradually over ≥ 4 mins; aura < 60mins; headache follows aura < 60mins
What is the treatment for migraine?
- Paracetamol and domperidone
- Weight loss
- Propanolol (prophylaxis)
What are the feature of raised ICP in a child?
- Headache - worse with straining, coughing, lying flat, leaning forward
- Bulging fontanelle
- Abnormal eye: U/L dilatation, Papilloedema
- Abnormal exam: tip-toe walking, ataxic gait, past-pointing
- Nausea + vomiting
- Decreased LoC - GCS and AVPU
What is the management for a child with raised ICP?
- Urgent MRI/CT (identify if SOL)
- Diuretics (reduce CSF formation) - acetazolomide or furosemide
- Steroids
- Ventriculo-peritoneal shunt
What are the two types of breath holding attacks?
- Blue breath holding attacks
- triggered by intense sobbing or crying
- baby stops breathing on exhalation –> syncope –> turns blue - Reflex anoxic seizure
- triggered by anger or being scared
- baby tries to cry –> stops breathing on exhalation –> goes ghostly grey –> syncope –> limp and stiff –> eyes roll back
What is the management of breath holding attacks
nothing
What is setting sun eyes asign of?
Hydrocephalus
Other features are:
- Macrocephaly
- Distended head veins
- Bulging fontanelle and sutures
- signs of increased ICP
What is the most common cause of retinal haemorrhage in infants?
Inflicted head injury caused by excessive shaking
What are the types of plagiocephaly?
- Fully fused:
Synostosis –> I/L flat forehead, C/L prominent forehead, C/L protruding orbit, - Partial fused:
minor plagiocephaly - typically occurs when babies lie on head
What is a Tic? in whom is it most common?
A voluntary, unwanted movement that develops roughly around 6 years in males
What are the features of a Tic?
Repetitive, unwanted movements or sounds (repeat the same tic)
Typically around face + head - grunting (common), blinking,, frowning, throat clearing, head flicking
Worse when inactive, stressed or anxious
Best when concentrating or playing sport
A young 8 year old male, presents with myoclonic movements involving nods, blinks, twitching of mouth and verbal profanity. What is this?
Tourettes syndrome - clonic, tonic, dystonic, phonic tics usually - Jerks Blinks Sniffs Nods Spitting Stuttering verbal profanity etc.
What is the treatment of Tics?
- Behavioural management of child and parent
2. Medication: Risperidone or Clonidine
What are the features of retinoblastoma and when does it commonly occur?
Starbismus (cross eyes)
Loss of red light reflex
Visual disturbances
Presentation at 18 months
