Paediatric neurology Flashcards
Causes of headache in children
Fever
Upper resp or sinus infection
Primary headache - tension, migraine, cluster
Brain tumour
Red flag for brain tumour from headache
HA worse in the morning and HA that never completely
resolves
HA continuously getting worse over time
Headache treatment in children
Treat cause
Symptomatic treatment - hydration, anti-pyretics, paracetamol, NSAIDs
avoid triggers
When to refer child to paediatric neurology due to headache
Any secondary HA with a serious cause
HA not responding to aggressive primary care
management
Chronic daily HA
HA associated with significant psych issues
Woken at night by headache
Change in personality, behaviour or education
performance
Focal Neurology on exam:
field defect
cerebellar signs
fundoscopic signs of increased intracranial
pressure
Headache red flags
Headache
Fever
Stiff neck
Altered mental status
Seizures
Photophobia
Meningococcemia (rare)
Febrile convulsion tx
No treatment for seizure needed if sz has stopped
Regular treatment for seizures if still seizing - (O2, lorezepam, phenytoin)
Anti-pyretics
Reassure parents its common
Epilepsy Ix
Refer to paediatrics - investigations and management there
EEG
MRI
Genetic testing
Neuropsych testing
Blood tests for electrolyte or other serologic abnormalities
What is status epilepticus
a dangerous condition in which epileptic fits follow one another without recovery of consciousness between them.
Status epilepticus causes
fever (<6 y) 5% of children with febrile convolutions present in SE
meningitis
epilepsy
hypoxia
metabolic abnormalities
Brain tumour presentation
morning headache or headache that goes
away after vomiting
Frequent nausea and vomiting
Vision, hearing, and speech problems
Loss of balance or trouble walking
Unusual sleepiness
Personality changes
Seizures
Increased head size in infants
What is muscular dystrophy
group of inherited genetic conditions (x linked so only in boys) that gradually cause the muscles to weaken
3 main types of muscular dystrophy and differences between them
Duchenne - most common
Becker - less sever phenotype with later onset of symptoms
Limb girdle dystrophies - older children/teenagers, in wheelchair by adulthood
Muscular dystrophy investigations
Serum CK
Cardiac – ECG, Echo
Muscle biopsy & genetic testing for diagnosis
What is cerebral palsy
Chronic impairment of muscle tone, movement, strength and coordination
Static non-progressive ‘fixed’ disorder
Cerebral palsy symptoms and clinical findings
Sx - Spasticity, delayed motor milestones, ataxia (“scissor gait”), dysarthria, seizure disorder
Findings - hyperreflexia, limb length discrepancies, microencephaly, retinopathy
