Paediatric Neurology 1 - Acute Flashcards
What is the mechanism of a reflex anoxic seizure?
When a child suffers a minor injury such as a bump, it triggers the vagal reflex, causing transient bradycardia and circulatory impairment. The child will go pale, limp and lose consciousness for a few seconds before recovering rapidly.
At what age are breath holding spells most common?
Infantile - any age from 6 months to about 18 months.
Breath holding spells will have a post-ictal phase, true or false?
False
This is one of the key points in distinguishing between a breath holding incident and an actual seizure
List some viral causes of meningitis:
Mumps Coxsackie Echovirus HSV Poliomyelitis
List the bacterial causes of meningitis:
Neisseria Meningitis (meningococcal)
Streptococcus Pneumoniae (pneumococcal)
Haemophilus influenza B (rare since vaccine)
Group B strep, Listeria and E coli (newborns)
What diagnostic test is done to confirm meningitis?
Lumbar puncture
What tends to precede a viral meningitis?
Viral infection such as gastroenteritis or pharyngitis
What are the classic symptoms of meningitis?
Drowsy child with headache, neck stiffness and fever.
Younger children will be irritable with high pitched cry.
May have suffered from febrile convulsions
Positive Kernig’s sign
Petechial purpuric non blanching rash
On a LP, what reading indicates worse prognosis?
Low glucose in the CSF
What other pathologies may lead to stiff neck?
Tonsillitis
Otitis media
Lymphadenitis
Subarachnoid bleed
What is the acute treatment of meningitis?
Unknown organism: Ceftriaxone IV
If pre-brain hernia signs treat with mannitol
ABCDE with fluid access
Give dexamethasone with first dose of antibiotic
What are some complications of meningitis?
Secondary abscesses Subdural effusion Hydrocephalus Ataxia Paralysis Deafness Epilepsy
Why do we give dexamethasone in patients with meningitis who do not have septic signs?
It reduces risk of deafness by decreasing the inflammation of the meninges themselves
What is the most common cause of encephalitis?
HSV
How is HSV encephalitis treated?
Aciclovir IV
In HSV encephalitis, what might the EEG / MRI show?
Temporal lobe involvement
What syndrome can occur if aspirin is used to treat a child suffering from a viral illness e.g. influenza, chicken pox etc, and what is it?
Reye’s syndrome
Non infectious encephalitis w/ personality change, lethargy and raised ICP. Can lead to hepatic failure
How is Reye’s syndrome managed?
Aggressive supportive therapy and ICP lowering methods
List some metabolic causes of paediatric coma’s:
Hypoglycaemia Diabetic ketoacidosis (Hyperglycaemia) Adrenal insufficiency Cerebral oedema Hyper/hypo natraemia Urea cycle disorders etc
What are some causes of a raised ICP in children?
Head injury Subdural bleeding Micro encephalitis Hypoxia DKA Reye's syndrome Tumours
List some signs and symptoms of a raised ICP:
Listless irritable Headache Diplopia Vomiting Tense fontanelles Decreased responsiveness Cushing's triad Papilloedema Hydrocephalus
What is Cushing’s triad?
This is a trio of raised BP, slow pulse and abnormal breathing patterns. It is a warning sign of imminent coning
What are the most common brain tumours in children?
Astrocytoma of brainstem (Gliomas in general) Medullablastomas Neuroblastomas Pinneal tumours Retinoblastoma Mid brain and third ventricle tumours
Why is sinusitis usually only a problem in older children?
Frontal sinuses do not develop until after 10 years old
When do febrile convulsions usually occur?
Ages 6 months to 5 yers old
What are the common sources of a febrile convulsion?
URTI
UTI
Meningitis
What % of children will suffer a febrile convulsion at some point?
3%
What congenital brain abnormalities may lead to global developmental delay?
Hydrocephalus
Microencephaly
