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3A > Paediatric Neuro > Flashcards

Paediatric Neuro Flashcards

1
Q

What is cerebral palsy

A

A condition of permanent neurological problems resulting from damage to the brain around the time of brith

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2
Q

Are the symptoms of cerebral palsy progressive?

A

No however they may change over time with development

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3
Q

Causes of cerebral palsy

A

Birth asphyxia- hypoxic ischaemic encephalopathy
Maternal infections
Postnatal infections (e.g. meningitis, encephalitis)
Head injury

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4
Q

Types of cerebral palsy

A

Spastic
Dyskinetic
Ataxic
Mixed

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5
Q

Describe what spastic cerebral palsy is

A

Damage to the upper motor neurones leading to increased tone (spasticity) and brisk reflexes

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6
Q

What different types of spastic cerebral palsy are there?

A

Hemiplegia (unilateral involvement of arm and leg, usually the arm worse than leg)
Bilateral quadriplegia (all 4 limbs are affected, often severely)
Bilateral diplegia (all 4 limbs are affected however legs are much more severe than arms)

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7
Q

Explain dyskinetic cerebral palsy

A

Occurs due to damage of the basal ganglia and substantia nigra
Patients present with problems of muscle tone and movement - may include chorea, athetosis and dystonia
‘ slow writhing movements’

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8
Q

Explain ataxic cerebral palsy

A

Occurs due to damage to the cerebellum and often genetic.
Leads to uncoordinated movements

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9
Q

How may patient with cerebral palsy present?

A

Hemiplegic gait (due to increased muscle tone)
Delayed motor milestones
Feeding difficulties

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10
Q

Treatment approach of cerebral palsy

A

MDT
Physiotherapy
Muscle relaxants- baclofen

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11
Q

Describe the presentation of benign rolandic epilepsy

A

partial seizures at night- hemifacial paraesthesias, oropharyngeal and hypersalivation

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12
Q

when should an ambulance be called in patients with febrile convulsions

A

if lasting >5 misn

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13
Q

Treatment for spasticity in cerebral palsy

A

baclofen

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14
Q

What is a seizure

A

a paroxysmal abnormality of motor, sensory, autonomic and/or cognitive function due to transient brain dysfunction

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15
Q

Causes of epilepsy

A

genetic
structural
metabolic
cerebral malformation
cerebral tumours
cerebral tumours,

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16
Q

Causes of non-epileptic seizures

A

-cardiac syncope- e.g. prolonged QT
-neurally mediated syncope- e.g. reflex anoxic seizures
-expiratory apnoea syncope- breath holding spells
-hypovolaemic syncope- can occur in haemorrhagic, dehydration, anaphylaxis
-sudden rise in intracranial pressure (hydrocephalus, haemorrhage)
- sleep disorders
- functional/ medically unexplained/ dissociative seizures

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17
Q

How do focal frontal seizures present?

A

motor features such as posturing or peddling
Jaksonian march
motor arrest
post-ictal todds palsy
dysphagia or speech arrest

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18
Q

How do temporal lobe focal seizures present?

A

automatisms- lip smacking, chewing
dysphagia
deja vu
emotional disturbances (sudden terror)
hallucinations of smell, taste or sound

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19
Q

What is an absence seizure

A

transient loss of consciousness with abrupt onset and termination.
No accompanied motor phenomena except some eyelid flickering and minor alterations in muscle tone

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20
Q

What is a generalised seizures

A

electrical activity is discharged from both hemispheres of the brain
associated with a loss of consciousness

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21
Q

what is a focal seizure

A

seizures arise from one or part of a hemisphere
consciousness maintained

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22
Q

Treatment of tonic-clonic seizures

A

males- sodium valproate
females- lamotrigine or levetiracetam

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23
Q

treatment of absence seizures

A

1st line: ethosuximide
2nd line: sodium valproate (male), lamotrigine or levetiracetam (women)

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24
Q

what antiepileptic can exacerbate absence seizures

A

carbamazepine

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25
Q

first line treatment of focal seizures

A

lamotrigine or levetiracetam

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26
Q

second line treatment of focal seizures

A

carbamazepine

27
Q

What are infantile spasms

A

a type of epilespy syndrome which onsets 3-12 months
Seizures are characterised by violent flexor spass of the head trunk and limbs followed by extension of the arms (Salaam attack).
There will often be multiple bursts - 20-30

28
Q

What does the EEG of infantile spasms show

A

hypsarrhythmia

29
Q

How are infantile spasms treated

A

vigabatrin and/or corticosteroids

30
Q

underlying aetiology of infantile spasms

A

often underlying serious neurological cause
e.g. tuberous sclerosis, encephalitis

31
Q

What is Lennox-Gastaut syndrome?

A

a type of epilepsy syndrome that presents around 1 to 3 years
Can be an extension of infantile spasms
Seizures are mainly atonic, atypical absence seizures and tonic seizures in sleep.

32
Q

how does Lennox-Gastaut syndrome present on EEG

A

low generalised spike and wave

33
Q

What is childhood absence epilespy

A

a type of paediatric epilepsy syndrome that presents around 4-12 years.
Characterised by momentary unrresponsive stares with motor arrest which child cannot recall
May be induced by hyperventilaiton
treatment is ethosuximide
good prognosis

34
Q

What is benign rolandic epilepsy

A

an epilepsy syndrome that onsets at 4-10 years
Characterised by tonic clonic seizures in sleep and simple focal seizures with awareness of abnormal feeling in the tongue and distortion of the face

35
Q

How does juvenile myoclonic epilepsy present

A

myoclonic seizures, generalised tonic seizures and absence seizures.
Often right after waking- history suggests throwing drinks or spilling things in the morning

36
Q

How is epilepsy diagnosed?

A

detailed history- video if available
ECG- checks for arrhythmias
EEG
Brain imaging- CT or MRI. checks for structural abnormalities, not needed if characteristic epilepsy syndrome (e.g. absence seizures)
- metabolic investigations

37
Q

what might trigger breath holding spells

A

emotional pain or upset

38
Q

What is encephalitis

A

inflammation of the brain parenchyma- due to infectious or non-infectious cause

39
Q

What is the most common cause of encephalitis

A

HSV infection
in neonates HSV-2 acquired at birth is the most common cause
in children HSV-1 from cold sores is the most common cause

40
Q

What part of the brain does HSV most commonly affect?

A

the temporal lobe

41
Q

What are two examples of autoimmune encephalitis

A

NDMA-receptor-antibody - associated encephalitis
GABA-receptor- antibody encephalitis

42
Q

how does encephalitis present in children ?

A

altered consciousness
altered cognition
unusual behaviour
acute onset of neurological symptoms
acute onset of focal seizures
fever
peripheral signs of HSV- cold sores
HSV affecting the temporal lobe may cause aphasia

43
Q

How does encephalitis present in neonates

A

poor feeding, irritability, seizures, lethargy, temperature instability

44
Q

How is encephalitis in children diagnosed?

A

LP- viral PCR (not if raised ICP)
- CT scan if LP is contraindicated

45
Q

How is encephalitis treated

A

IV aciclovir if HSV or VZV
ganciclovir in cytomegalovirus

46
Q

what are the most common causes of meningitis in children under 3 months

A

Group B streptococcus
Listeria monocytogenes
E.coli

47
Q

what are the most common causes of meningitis in children 3 months to 6 years

A

Strep. pneumoniae
Neisseria meningitidis
Haemophilus influenzae

48
Q

What are the most common causes of meningitis in those over 6 years

A

neisseria meningitidis
strep. pneumoniae

49
Q

What are viral causes of meningitis

A

enteroviruses
HSV
HIV

50
Q

How does meningitis present

A

fever
headache
neck stiffness
purpuric non-blanching rash
drowsiness
nausea and vomiting
seizures

51
Q

how can meningitis present in babies

A

bulging fontanelles, reduced feeding, irritability, lethargy, unusual behaviour, high pitched weak cry

52
Q

When would you not perform a LP for the investigation of meningitis ?

A

focal neurological signs
papilledema
significant bulging fontanelle
disseminated intravascular coagulation
signs of cerebral herniation

53
Q

How does bacteria meningitis present on LP

A

polymorphs
cloudy CSF
low glucose
high protein

54
Q

how does viral meningitis present on LP

A

lymphocytes
clear CSF
glucose normal/ slightly low
normal or raised protein

55
Q

what is found in the CSF of TB meningitis

A

fibrin web

56
Q

What should be done if a CSF is contraindicated in meningitis

A

blood cultures
PCR

57
Q

What is given to treat menginitis in community

A

IM benzylpenicillin

58
Q

Treatment of meningitis in <3months

A

IV cefotaxime + IV amoxicillin/ampicillin

59
Q

Treatment of meningitis in over 3 months

A

IV cefotaxime/ ceftriaxone

60
Q

should you given steroids in the treatment of meningitis in someone under 3 months

A

no

61
Q

what are some indications to give dexamethasone in meningitis

A

CSF is frankly purulent
CSF WCC is > 100 per microlitre
CSF has protein concentration > 1g/l
CSF shows bacteria on gram stain

62
Q

Overview of treatment of meningitis

A
  • Broad spectrum anitbiotics (IV cefotaxime +/- IV amoxicillin)
  • consider dexamethasone in > 3months
  • fluids
  • notify public health england
63
Q

what is given to contacts of meningitis

A

ciprofloxacin

64
Q
A

3A (32 decks)

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