Paediatric Neurology

Question 1

What cause of injury should be considered in an infant presenting with sub dural haematoma and retinal haemorrhages?

Answer 1

Non accidental injury

Question 2

How is a tension headache usually described?

Answer 2

A symmetrical headache of gradual onset, like tightness/a band/pressure. Usually no other symptoms

Question 3

How is a migraine headache described?

Answer 3

Commonly bilateral, may be unilateral. Pulsatile over the frontal/temporal area.

Question 4

What can aggravate migraines in children?

Answer 4

Physical exercise

Question 5

How is migraine with aura different to migraine without aura?

Answer 5

Headache is preceded by unilateral visual (e.g hemianopia, scotoma), sensory or motor impairment (e.g hemiplegic migraine)

Question 6

What can be triggers for migraine?

Answer 6

Disturbance of biorhythms e.g late nights, stress, certain foods, caffeine. Menstruation and hormonal contraception

Question 7

What is an abdominal migraine?

Answer 7

Idiopathic, recurrent, episodic, midline abdominal pain lasting 1-72 hours. Associated vasomotor symptoms, nausea, and vomiting.
Well between episodes

Question 8

What are features of a headache which are suggestive of a space occupying lesion?

Answer 8

Worse on lying down, morning vomiting, night time waking from pain
Visual field defects, cranial nerve abnormalities, change in personality or academic ability, abnormal gait, toticollis

Question 9

What are some primary causes of headache?

Answer 9

Tension headaches, migraine, cluster headache..

Question 10

What are some secondary causes of headache?

Answer 10

Raised ICP, medication overuse, trauma, infection, sinusitis, problems with vision, CO poisoning

Question 11

What are triggers for tension headache in children?

Answer 11

Stress/fear/discomfort, skipping meals, dehydration, infection

Question 12

How do we manage tension headaches?

Answer 12

Reassurance, analgesia, reducing trigggers e.g (regular meals, hydration and reducing stress)

Question 13

What other symptoms are common with migraine aside from the headache?

Answer 13

Nausea and vomiting, abdominal pain, photophobia, phonophobia

Question 14

How do we manage migraine in children?

Answer 14

Rest, fluids, low stimulus environment, analgesia (paracetamol), sumatriptan, antiemetics (domperidone)

Question 15

What are options for migraine prophylaxis, when migraines are having a significant impact on the child’s life?

Answer 15

-propanolol
-pizotifen
-topiramate

Question 16

What are side effects/contraindications of the medications used for migraine prophylaxis?

Answer 16

Propanolol (avoid in asthma)
pizotifen (drowsiness)
Topiramate (teratogenic, avoid in females of child bearing age)

Question 17

When a child presents with headache, what infections would you check for signs of?

Answer 17

URTI, otitis media, tonsillitis, sinusitis (tender over affected sinus)

Question 18

Is most sinusitis bacterial?

Answer 18

No, most is viral and usually resolves in 2-3 weeks

Question 19

What are the different subsets of cerebral palsy?

Answer 19

Spastic
Dyskinetic
Ataxic
Mixed

Question 20

What is the most common subtype of cerebral palsy?

Answer 20

Spastic (70%)

Question 21

How does dyskinetic cerebral palsy typically present?

Answer 21

athetoid movements and oro-motor problems